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Small bowel obstruction due to internal herniation through a right side diaphragmatic defect; an unusual case report
1Department of Emergency Surgery & Trauma, Kabul University of Medical Sciences, Kabul, Afghanistan.
Insights
Right-sided diaphragmatic hernias are rare but can cause serious bowel obstruction and strangulation in adults. Early diagnosis is crucial to prevent complications like perforation.
Area of Science:
- Gastroenterology
- Surgical Case Reports
Background:
- Right-sided diaphragmatic hernia is an uncommon congenital anomaly.
- It can lead to life-threatening bowel obstruction and strangulation in adults.
Observation:
- A 55-year-old male presented with acute abdominal pain, distension, fever, and constipation.
- Physical examination revealed signs of peritonitis and bowel obstruction, predominantly in the right upper quadrant.
Findings:
- The patient's presentation was consistent with internal herniation and strangulation secondary to a right-sided diaphragmatic hernia.
- Diaphragmatic hernias can manifest with both abdominal and respiratory symptoms.
Implications:
- Diaphragmatic hernia should be considered in the differential diagnosis of small bowel obstruction, especially in adults.
- Prompt recognition and surgical intervention are essential to manage complications such as ischemia and perforation.
Introduction:
Right-side diaphragmatic hernia is a very rare cause of bowel obstruction and strangulation in adults, which is usually a congenital disorder.
Case Presentation:
A- 55-year-old male presented to the emergency department of our hospital complaining of abdominal pain, nausea, vomiting, abdominal distension, fever, and constipation for 4 days. On physical examination, the patient was fibril, toxic, tachycardic, and hypotensive. The patient had a distended abdomen with exaggerated bowel sounds, abdominal tenderness, guarding, and rigidity mostly in the right upper quadrant. There were some degrees of tempanicity on percussion. The digital rectal examination was normal with no evidence of impacted stool.
Discussion:
Patients with a diaphragmatic hernia frequently present with manifestations of internal herniation, incarceration, obstruction, ischemia from strangulation, or perforation. The patient may present with respiratory symptoms such as dyspnea, absence of breath sounds in the thorax, or abdominal symptoms such as abdominal pain and bowel dilatation.
Conclusion:
Diaphragmatic hernia, which is a rare case, should be included in the differential diagnosis of small bowel obstruction to preclude complications.
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