A Case of Strangulated Intestinal Obstruction due to an Idiopathic Right Diaphragmatic Hernia

Abstract

We report a case of strangulated intestinal obstruction due to an idiopathic right diaphragmatic hernia in an adult whose hernia orifice was observed at the central tendon. An 89-year-old male presented to our emergency clinic because of abdominal pain and vomiting. There was no history of abdominal trauma. He had abdominal distention and slight tenderness in the epigastric region. Chest X-ray and computed tomography (CT) revealed prolapse of the small intestine and mesentery in the right thoracic cavity. Contrast CT revealed poor enhancement of the prolapsed organs. We diagnosed right diaphragmatic hernia with a strangulated intestinal obstruction. Emergency laparotomy confirmed an incarcerated ileum, with prolapse into the right thoracic cavity, just ventral to the right hepatic lobe. We reduced the herniated ileum and found a 3-cm hernia orifice at the right central tendon. The hernia orifice was sutured primarily and about 35 cm of necrotic ileum was resected. The patient was discharged on the 29th postoperative day. Subsequent hernia recurrence has not been observed.