An Obstructed Diaphragmatic Hernia In Adulthood; a Case of Uncertain Origin

Abstract

 Background: Diaphragmatic hernia in adults is uncommon and often results from trauma; however, it may occasionally present without a clear etiology, raising the possibility of a missed congenital defect or sequelae of trivial remote trauma. Diagnosis is often delayed due to vague clinical and radiological findings, leading to significant morbidity. Case Presentation: We report the case of a 45-year-old male who presented with abdominal pain and obstipation for four days. Clinical examination revealed absent bowel sounds and reduced air entry in the left lower chest. Imaging demonstrated a left-sided diaphragmatic hernia with herniation of the splenic flexure and omentum, causing large bowel obstruction. The patient underwent emergency exploratory laparotomy, which revealed a 2 × 2 cm diaphragmatic defect with herniated bowel and omentum. The non-viable omentum was resected, viable bowel reposited, and the defect repaired with polypropylene sutures. The postoperative recovery was uneventful, and the patient was discharged on day nine. Conclusion: This case highlights the diagnostic challenges of diaphragmatic hernia presenting in adulthood without prior trauma. A high index of suspicion and timely surgical intervention are crucial to avoid complications. An abdominal approach can provide effective management, even in settings without thoracic surgical expertise.