Congenital diaphragmatic hernia presenting in adult life: a study of two cases

Abstract

Congenital Diaphragmatic hernia (CDH) usually presents in the newborn and rarely present as undetected cases in adult life. Defects in the diaphragm can cause abdominal organs to herniate into the thoracic cavity resulting in respiratory distress or strangulation of abdominal organs. Reported here are 3 cases of congenital CDH presenting in adult life. A 59-year-old male presenting with epigastric pain, bilious vomiting and constipation demonstrated an air-fluid level in the anterior mediastinum on chest radiograph. Surgery revealed an anterior Morgagni defect with a loop of terminal ileum herniated and strangulated into the pericardial sac. A15-year-old girl presenting with abdominal pain and pyrexia for 2 days, on CT chest and abdomen revealed right lobe of liver and transverse colon in the right hemithorax with the pericardium pushed to the opposite side. Surgery revealed a large right sided Bochdelaks type hernia. A strangulated gangrenous transverse colon was removed from within the thoracic cavity. In these cases the body had adapted by maintaining total lung volume by compensatory hyperplasia of the contralateral lung allowing the patients to survive with no symptoms for a long duration of time. Even though rare, the possibility of CDH presenting as acute abdomen is important to remember.