Abstract Background Congenital diaphragmatic hernias (CDH) occur due to a defect in the diaphragm causing herniation of the abdominal contents into the thoracic cavity. The vast majority are diagnosed prenatally and very few adult presentations have been reported in the literature. Case A 30-year-old fit and healthy female was diagnosed with CDH after repeated presentations with gastrointestinal symptoms, such as bloating and abdominal pain. The symptoms started in her teenage years and were always attributed to irritable bowel syndrome. Due to their persistence, the patient underwent imaging which showed a left posterolateral (Bochdalek) hernia involving segments of both small and large bowel. The patient underwent an elective diagnostic laparoscopy and hernia repair. Initially adhesiolysis was carried out to allow the contents of the hernia to be reduced. The defect was repaired via interrupted non-absorbable sutures reinforced by a composite mesh. A chest drain was inserted to prevent a pneumothorax and to allow any potential pleural effusions to drain. The patient recovered well post-operatively and was discharged three days after. Discussion The most likely aetiology for adult-presenting CDHs is a diaphragmatic defect occurring in utero which leads to herniation of abdominal contents later in life. Despite its rarity, this diagnosis should be taken into consideration for patients with persistent vague gastrointestinal symptoms. Early surgical intervention is recommended and includes a wide range of approaches (minimally invasive vs open, abdominal vs thoracic operation) depending on location and size of the defect as well as the surgeon’s preference.
Brachimi et al. (Fri,) studied this question.