Abstract
Introduction:
Diaphragmatic hernia is a defect in the diaphragm that is usually congenital and presents in childhood. Adult diaphragmatic hernias are almost always acquired, secondary to a lower chest or upper abdominal trauma. The left side is commonly (87%) involved. Right-sided involvement without a prior trauma is extremely rare, and only about 20 such cases have been reported. Presentation can be early or delayed and may range from asymptomatic cases to complications like obstruction and strangulation.
Materials and Method:
A 45-year-old lady presented to us with vague pain and discomfort in her right upper abdomen and lower thorax for 2 years, without any associated breathing difficulty. Chest X-ray revealed collapse of the right lower lung zone with a non-appreciable right hemidiaphragm. Ultrasound and CECT examinations revealed a right-sided posterolateral diaphragmatic hernia with herniation of the liver, gallbladder, omentum, and transverse colon into the right thoracic cavity. The patient underwent laparoscopic repair of the hernia, with reduction of the hernial contents back into the abdominal cavity. The diaphragmatic defect was repaired with sutures and reinforced with mesh placement. A thoracic drain was placed.
Results:
On surgery, the defect was found in the right posterolateral diaphragm. The hernia was found to contain liver, gallbladder, omentum, and transverse colon in the right lower thoracic cavity. No definite hernial sac was identified. The procedure was non-incidental, and the patient made a complete post-surgical recovery.
Conclusion:
We report an unusual case of adult right diaphragmatic hernia without any past trauma or surgery. Presentation of hernias ranges from the asymptomatic stage to vague symptoms, obstruction, and strangulation. Even in uncomplicated cases such as ours, surgery is indicated as early as possible to prevent future complications. It is essential for surgeons to be aware of this unusual condition and the surgical technique so as to facilitate prompt diagnosis and treatment and improve patient outcomes.
Patient Consent:
Patient written, informed, and valid consent was obtained and has been archived.
Place of work:
Dept. of General Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi.
Conflict of Interest:
The authors declare that there is no conflict of interest.
Author Disclosure Statement:
Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Runtime of video:
7 mins 34 seconds.
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