Adult presentation of agenesis of the hemidiaphragm

A 66-year-old woman presented with a 3-day history of classical features of large bowel obstruction. At emergency laparotomy, the transverse colon and splenic flexure were located in the left hemithorax. The entire left hemidiaphragm was absent, and there were no diaphragmatic remnants visible. This is the oldest reported case of an absent hemidiaphragm. Previous cases of "agenesis" of the hemidiaphragm in adults either reported diaphragmatic remnants intraoperatively or failed to rule them out radiologically when managed conservatively. We would suggest that this is the first reported case of an adult presenting with true agenesis of the hemidiaphragm.