An unusual case of diaphragmatic hernia

Abstract

A 27-year-old man was admitted to the medical casualty with severe left sided chest pain and repeated vomiting. On admission, he was acutely ill and restless. Radial pulse was of low volume and fast at100/min while blood pressure was 80/60 mmHg. The trachea had shifted to the right side and air entry to the left chest was markedly reduced. The opacity seen in the chest radiograph was initially considered to be a large left sided pleural effusion. A chest drain was inserted into the left pleural cavity, but there was only a little improvement of the patient's clinical picture (Figure 1). The patient was reviewed and the diagnosis of obstructed left diaphragmatic hernia was made. Abdominal radiographs were not of much help.

Pneumoperitoneum due to a missed diaphragmatic hernia

“…The incidence of diaphragmatic hernia is more on the left side because the right hemidiaphragm being comparatively stronger than the left and the interposition of the liver in the right side preventing right-sided hernias The presentation of a diaphragmatic hernia can vary, from an asymptomatic hernia to a full-blown acute abdomen. Interestingly, respiratory complaints are commoner than the abdominal complaints [7]. Massive hematemesis and splenic vein thrombosis being the other modes of presentation of herniated gastric fundus [6].…”

“…Diaphragmatic hernias should be operated in order to avoid pulmonary and abdominal complications. Most hernias could be reduced abdominally but rarely thoracotomy is necessary [7]. However, when there is a history of trauma recently before the presentation, laparotomy would be adequate.…”