Incarcerated diaphragmatic hernia as a cause of acute abdomen

Diaphragmatic hernias are usually congenital, and they usually occur in the neonatal group. They do occur in the adult population, albeit very rarely. We present a case of an adult male patient with complications as a result of a congenital diaphragmatic hernia. The patient presented with atypical abdominal pain and respiratory distress. Radiological investigations confirmed a left hydropneumothorax as well as large bowel obstruction secondary to herniation of the omentum and transverse colon through a congenital defect in the left hemi-diaphragm. He had a laparotomy, which confirmed the radiological findings and a perforated transverse colon. He went onto have an extended right hemicolectomy and end-ileostomy; his left hemithorax was lavaged and a thoracostomy tube was inserted. He recovered well, except that he developed an empyema postoperatively for which he required a thoracotomy and decortication. He made good recovery following this and was discharged home nine days following his initial laparotomy.