Congenital Diaphragmatic Hernia - Diagnosis After Intra-Thoracic Cholecystitis

Abstract

Congenital diaphragmatic hernia due to diaphragmatic agenesis is extremely rare. We report the case of a 53-year-old female patient with a congenital right diaphragmatic hernia due to a right hemidiaphragm agenesia diagnosed in the context of acute intrathoracic cholecystitis. She was admitted to the Emergency Department for diffuse abdominal pain, nausea and vomiting with 2 days of evolution. Thoracic and abdominal radiography showed hydro-aerial levels in the right hemithorax. The computed tomography showed a right diaphragmatic hernia with signs of incipient incarceration. The patient underwent surgery consisting of a right exploratory thoracotomy, reduction of the hernial contents, closure of the defect with a double-sided prosthesis anchored in a pericardial patch, and pericardial reconstruction with a polypropylene prosthesis, with a remarkable evolution. This case shows a rare late presentation of a congenital hemidiaphragm agenesia in adulthood, with a special focus on the indications and surgical techniques used for its correction.