Abstract
Diaphragmatic hernias are rare and mostly congenital, rarely spontaneous. Perforation and other complications of diaphragmatic hernias are even rarer and associated with significant morbidity and mortality. We report a patient presenting to the emergency department with features of empyema requiring intercostal drainage. However, on clinical worsening, radiological imaging showed features of diaphragmatic hernia and a subsequent thoracostomy revealed a herniated gastric perforation. Such cases are very rare and need a high index of suspicion for the diagnosis and early appropriate surgical management. Otherwise, it is associated with very high rates of mortality.
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