Small bowel ischaemia resulting from delayed presentation of an incarcerated right-sided diaphragmatic hernia

A 51 year old man presented with a short history of severe upper abdominal pain and vomiting. An initial chest radiograph demonstrated gas in the right subphrenic space and a subsequent CT scan demonstrated a hernia through the mid-part of the right hemi-diaphragm, containing small bowel and omentum. A detailed history revealed that there had been trauma to the right side of the chest approximately 12 years previously. An emergency laparoscopy revealed a right sided diaphragmatic hernia containing non-viable small bowel and omentum. After converting to a small midline laparotomy, a small bowel resection and primary anastomosis was performed. The patient was discharged from hospital 12 days later. In any patient presenting with symptoms of upper abdominal pain, with a prior history of trauma, the diagnosis of diaphragmatic hernia should therefore be considered.