Congenital right diaphragmatic hernia in an adult

Abstract

Diaphragmatic hernia in the absence of trauma in adults is very rare. It occurs as a result of unilateral diaphragmatic agenesis. The diagnosis of this rare condition is typically made in early infancy. However, in asymptomatic patients, the diagnosis is often delayed for months and even years. We present a case of a 27-year-old female, who was referred 48-hours after Caesarean section with suspected pulmonary embolism. Computed tomography scan revealed herniation of the liver as well as bowel loops into the right hemi-thorax. Exploration through a right thoracotomy revealed right diaphragmatic agenesis. The contents were reduced into the abdomen, and the defect was repaired using a mesh. The patient had an uneventful postoperative recovery and was discharged home 10 days later. This case highlights the acute late presentation of right diaphragmatic eventration with abdominal visceral herniation in adulthood. The condition may be triggered by the increasing size of gravid uterus.

Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

“…Diaphragmatic agenesis occurs on the left side in 88-97% of the cases, while right-sided defects are less common due to the earlier closure of the right pleuro-peritoneal canal. Moreover, even if right-sided diaphragmatic defects are present, the liver prevents herniation through such defects [7]. Diagnostic workup made in early infancy generally reveals associated genetic malformations, particularly aneuploidy syndromes [7][8][10].…”

“…Moreover, even if right-sided diaphragmatic defects are present, the liver prevents herniation through such defects [7]. Diagnostic workup made in early infancy generally reveals associated genetic malformations, particularly aneuploidy syndromes [7][8][10]. Diagnosis of CDA in adults is based on a high index of clinical suspicion supported by imaging studies.…”

“…The herniated viscera were reduced into the abdomen, and the defect was closed using a mesh. The patient had a smooth postoperative recovery and left the hospital 10 days later [7]. Ali et al described the case of a women who presented with progressive SOB during the last trimester of her gestation with total agenesis of the right hemidiaphragm.…”

“…Bilateral AHD is very rare [5] and infants with this defect rarely survive to have surgical intervention [6]. Unilateral AHD is mostly left-sided while the right-sided cases are extremely rare [7]. Most patients with congenital AHD present very early in life [3] and only few patients have been reported to reach adulthood [8].…”

Agenesis of the Diaphragm: A Case Report and a Brief Literature Review

“…Al-Zayer F et al (2019) описали случай торакотомии, выполненной 27-летней женщине с подозрением на правостороннюю диафрагмальную грыжу. При ревизии была обнаружена АГД, в связи с чем пациентке выполнена аллопластика диафрагмы синтетической сеткой [25]. Taha abdominal wall.…”