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Manipal Journal of Medical Sciences

Abstract

Background:
Diaphragmatic hernia (DH) in adults, although uncommon, presents a significant clinical challenge due to its variable symptoms and potential for life-threatening complications. The condition can be either traumatic or congenital, and in some cases, it may be found incidentally during imaging for unrelated conditions. This case series aims to highlight the diverse clinical presentations, diagnostic challenges, surgical management strategies, and postoperative outcomes associated with diaphragmatic hernias in adults.

Methods:
We present four cases of diaphragmatic hernias diagnosed in adult patients, including both traumatic and incidental findings. Case 1 involves a 26-year-old male with a traumatic diaphragmatic hernia following a road traffic accident. Case 2 describes a 78-year-old female with a right-sided diaphragmatic hernia diagnosed during evaluation for abdominal complaints. Case 3 presents a 28-year-old male with significant organ herniation following a traumatic event. Case 4 highlights a 62-year-old male with an asymptomatic, incidentally discovered left diaphragmatic hernia during imaging for peripheral arterial occlusive disease.

Results:
All symptomatic patients underwent surgical intervention, with primary diaphragmatic repair and mesh reinforcement performed in the majority of cases. The diagnostic modalities utilized included chest X-ray and CECT thorax and abdomen, with CT being the most effective in identifying the size, location, and contents of the hernia. Postoperative complications included pleural effusion, atelectasis, and pneumonia, which were managed with conservative respiratory support.

Conclusion:
Diaphragmatic hernias in adults present with diverse symptoms, ranging from life-threatening complications to incidental findings. Early diagnosis and timely surgical intervention are essential to prevent severe complications such as strangulation and organ dysfunction. While laparoscopic repair is increasingly favored in uncomplicated cases, open surgery remains necessary in more complex hernias. Asymptomatic diaphragmatic hernias may be managed conservatively, with careful monitoring for symptom development. This case series underscores the importance of individualized management strategies and the role of imaging in diagnosing this challenging condition.

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