An Acquired Diaphragmatic Hernia Masquerading as Lumbar Hernia: a Case Report

Abstract

Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory or gastrointestinal symptoms. This case report discusses a middle-aged male presenting to us with a radiological diagnosis of lumbar hernia turning out to have diaphragmatic hernia intraoperatively. A 58-year-old gentleman presented to us, 6 months back, with a slowly progressing painless lump in the left lumbar region. The ultrasonography was suggestive of lipoma. The lump was excised under general anaesthesia, and intraoperatively it was a giant lipoma of size around 12 × 10 cm2 in subcutaneous plane. Two months later, he developed swelling at the same site where he had been subjected to ambulatory excision of a lipoma. The swelling was insidious in onset and gradually progressing over the period of next 4 months, and he again visited to us. Examination revealed an ill-defined fullness in the left lumbar region with suspicious positive cough impulse. Computed tomography scan of abdomen reported it to be a large incisional hernia in the left lumbar region (in view of history of lipoma surgery in the past). The chest X-ray revealed slight blunting of left costophrenic angle, and baseline blood investigation were normal. He was electively posted and proceeded for diagnostic laparoscopy. He had a rent in left hemidiaphragm anterolaterally, and only a part of omentum was adhered to its edge. The defect was laparoscopically suture repaired with polypropylene and strengthened with a polypropylene mesh with ProTack fixation. The postoperative recovery was uneventful. This paper describes a unique presentation of spontaneous diaphragmatic hernia mimicking a lumbar hernia. To our knowledge, no similar case has been reported and published.