A Congenital Right Sided Diaphragmatic Hernia Presented in Pregnancy: Rare Case Report

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Abstract Background: Diaphragmatic hernias are infrequent and remain undiagnosed till the symptoms arise. One third of these patients are asymptomatic. Its diagnosis is only established on the emergence of gastrointestinal, respiratory or cardiovascular complications. Surgical intervention is needed if complications arise. These Diaphragmatic hernias usually involve the left side of diaphragm either through a congenital defect or from a trauma over abdomen or chest as the right side has a type of protective gear which is the Liver lying below the diaphragm. The occurrence of right sided diaphragmatic hernia is rarest of rare. Patients may present with shortness of breath, obstruction, strangulation, gangrene and perforation of gut. The mortality is very high. Symptomatic diaphragmatic hernia in pregnant females is a matter of greater concern. Case Report: A 21-yr-old female, primigravida, primipara, with 22 weeks gestation, complained of severe abdominal pain and intractable vomiting since the last 7 days and for this acute intestinal obstruction was admitted to the emergency department. At the local Primary Health Center her symptoms were partially relieved by symptomatic management, but due to recurrence of symptoms she was referred to our rural hospital.Her chest radiograph revealed a right sided diaphragmatic hernia with large and small intestine as its content. She had no abdominal or respiratory complaints in past. Initially the patient’s general condition improved by nasogastric aspiration but then she developed tachycardia, tachypnoea, nausea and vomiting despite nasogastric aspiration, so emergency exploration was done. Exploratory laparotomy along with right thoracotomy was performed. As the gut was gangrenous, resection anastomosis was done along with diaphragmatic hernia repair.Conclusion: Diaphragmatic hernia in adults and pregnancy is a very rare entity. The right sided diaphragmatic hernia is rarest of rare that too in pregnancy.What makes this case even extraordinary is, it being the first case in studied literature showing specific right sided presentation during pregnancy, as the rest are left sided. Even though the risk of morbidity and mortality is high, once complications arise, but early intervention improves the outcome.

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