Strangulated necrotic gastric fundus due to diaphragmatic hernia presenting with hydropneumothorax 5 years after left hepatic lobectomy: a case report and literature review.

INTRODUCTION: Diaphragmatic hernia (DH) is characterized by the protrusion of abdominal organs into the thoracic cavity through a diaphragmatic defect. Acquired DH typically results from trauma, prior surgery, or increased intra-abdominal pressure. Diagnosing DH complicated by hydropneumothorax is challenging due to atypical initial symptoms, often leading to misdiagnosis as primary pulmonary conditions.

CASE DESCRIPTION: A 60-year-old male presented to the emergency department with persistent respiratory distress, dyspnea, and an occasional cough. He had a surgical history of left hepatic lobe hemangioma resection five years prior. Emergency chest computed tomography (CT) revealed left-sided hydropneumothorax and herniation of the gastric fundus into the thoracic cavity. Emergency surgery confirmed necrotic gastric fundus caused by incarcerated diaphragmatic hernia. The patient underwent successful surgical repair and partial gastrectomy, leading to a full recovery.

CONCLUSIONS: Acquired DH in adults can be insidious, with non-specific symptoms that mimic common respiratory or cardiovascular diseases. A critical and life-threatening complication is strangulated DH leading to gastric necrosis. Clinicians must maintain a high index of suspicion for DH in patients with unexplained chest tightness and shortness of breath who have a history of regional surgery, even years after the initial procedure.