Abstract
CASE HISTORY: A 13 year old, obese girl weighing 76 Kg, with a height of 170 cm, who was asymptomatic till a week back, presented to the emergency department with a history of worsening abdominal pain, distension of abdomen, vomiting, and constipation on and off since 6 days. She had no significant past paediatric /medical /surgical or family history. She was admitted at a private hospital for these complaints for past two days and was referred to us. At presentation, she was dehydrated with BP of 100/68 mm hg, pulse rate of 94/min and Respiratory Rate of 24/min. Her abdomen was distended with diffuse tenderness, but no guarding or rigidity. Abdominal X-ray showed multiple air fluid levels, with dilated bowel loop in right upper quadrant, X-ray chest showed space occupying density supradiaphragmatic near the right border of heart. Lab investigations revealed anaemia, leucocytosis, and hypokalemia with hypochloraemia. CT scan revealed-3.6x2.9 cm (ML x AP) sized defect in the anterior diaphragmatic aspect in midline below the xiphisternum through which a approx 9 cm long loop of transverse colon and mesocolon was herniating in to the anterior mediastinum, causing widening of retrosternal space and compression effect and displacement of heart towards the left with atelectasis of Right Middle Lobe
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