Acute presentation of congenital diaphragmatic hernia requiring damage control laparotomy in an adult patient

Abstract

Congenital diaphragmatic hernias constitute an infrequent but potentially serious presentation of bowel obstruction in the adult patient. Herein, we present a rare case of an adult patient with strangulation of colon within a Morgagni's hernia where timely recognition and intervention were life-saving. An 18-year-old female presented with an acute abdomen, respiratory failure, and shock secondary to a strangulated, previously undiagnosed Morgagni hernia requiring emergency laparotomy, reduction of hernia contents and resection of non-viable colon. The patient underwent repair of the hernia with restoration of bowel continuity and reconstruction of her abdominal wall in sequential fashion. Although congenital diaphragmatic hernias have been previously described in the adult population, there are few if any reports of such pathology presenting in such an acute, life-threatening fashion. This case highlights the importance of a high index of suspicion, early recognition, and timely surgical intervention for this rare, potentially fatal condition.

Figure 1:

Coronal view of herniated colon on computed tomography scan obtained at the referring facility prior to transfer.

Figure 2:

Anterior–posterior chest x-ray obtained after intubation demonstrating bowel loops and a coiled nasogastric tube within the stomach, above the diaphragm and a coiled nasogastric tube above the diaphragm.