Elderly woman presented with a 1-day history of abdominal pain, vomiting, and acute onset of respiratory distress. There was no history of trauma to the chest or abdomen. After initial resuscitation, a Chest x-ray was performed which showed bowel shadow under the right hemidiaphragm. She then underwent computed tomography (CT), which showed a defect in the right hemidiaphragm and segment of herniated small bowel loop with fecalization into the thoracic cavity. After initial resuscitation, she underwent laparotomy, reduction of bowel loops, and primary repair of the hernia defect. Postoperatively she remained well and was discharged on 4th post-operative day.
Congenital diaphragmatic hernia occurs in 1 out of every 4000-5000 live births. A majority of the patients will be diagnosed either antenatally or will present with respiratory distress in the neonatal period. Presentation in adults is extremely rare and mostly characterized by abdominal pain, vomiting, intestinal obstruction with some acute respiratory distress, at the background of insignificant past medical history. Surgical management is the mainstay of treatment in symptomatic cases.
CDH of Morgagni type can present uncommonly in adults with symptoms. A good history and clinical examination along with aid of chest x-ray and CT scan should establish the diagnosis. Early surgical intervention is key to prevent ischemia and later gangrene of intestinal content.
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