Massive right-sided diaphragmatic hernia with intrathoracic liver

Right-sided diaphragmatic hernias are rare and often present late due to delayed diagnosis. We report a female in her mid-20s who presented with progressive dyspnoea on exertion and a remote history of blunt trauma in childhood. Imaging revealed a massive right-sided diaphragmatic hernia with herniation of the entire right lobe of the liver, hepatic flexure of the colon and stomach into the right hemithorax. A thoraco-laparoscopic approach was initially planned; however, complete intrathoracic herniation of the liver and severe diaphragmatic atrophy precluded laparoscopic reduction. The patient was successfully managed through a limited thoracoabdominal incision with mesh-based reconstruction of the entire diaphragm. She had an uneventful postoperative recovery with complete re-expansion of the right lung and resolution of symptoms.