Non-traumatic left-sided diaphragmatic hernia causing volvulus in an adult

Diaphragmatic hernias can be classified into congenital and acquired types. Most cases of congenital diaphragmatic hernia present early in life with respiratory distress while acquired diaphragmatic hernia usually presents following a history of trauma. Adult presentation of congenital diaphragmatic hernia is a rare finding and can remain asymptomatic for years until the herniated abdominal contents cause significant respiratory or gastrointestinal complications. This is a case report of a 55-year-old male patient presented to the emergency department with acute left-sided chest pain associated with dyspnea and abdominal distension. Chest roentgenogram showed gastric air bubble in the chest cavity. After initial resuscitation, CT thorax, abdomen, and pelvis was done which showed large diaphragmatic hernia with a wide central defect in the diaphragm with entire stomach and distal pancreas along with fat and omentum have been herniated into the thorax with organo-axial rotation of the stomach denoting volvulus and some degree of obstruction. Resultant marked distension of the stomach with air-fluid levels noted. Diagnosis of congenital diaphragmatic hernia can be challenging. Physical examination including auscultation of bowel sounds in the chest offers a diagnostic clue but the mainstay of diagnosis by chest imaging including chest roentgenogram and CT scan of the thorax and abdomen.