Incidental finding of a congenital diaphragmatic hernia in a middle-aged female: a rare case report and review of the literature

Introduction and importance: Congenital diaphragmatic hernia (CDH) is a rare condition in adults, often presenting with nonspecific respiratory symptoms and is easily misdiagnosed. CDH results from pleuroperitoneal canal closure failure during gestation, with Bochdalek hernias comprising the majority and Morgagni hernias (MHs) being rare. This case underscores the importance of considering CDH in adults with respiratory symptoms, especially following trauma. Case presentation: A 50-year-old woman presented with a 4-month history of intermittent dyspnea worsened by physical exertion, abdominal pain, distention, and constipation. She had a history of a road traffic accident 6 months ago. On physical examination, breath sounds were diminished over the right lung base. Imaging revealed a right-sided diaphragmatic hernia with bowel loops herniated into the thoracic cavity, causing lung compression. Surgical intervention via thoracotomy confirmed a diaphragmatic defect of 15 × 10 cm and hypoplasia of the right lung lobes. Herniated contents were reduced, and the diaphragmatic defect was repaired with mesh. Postoperatively, the patient showed significant symptom relief and was doing well at follow-up. Clinical discussion: Adult-onset CDH poses a diagnostic challenge and may lead to life-threatening complications. Right-sided MHs are rare. Imaging, especially CT, plays a key role in diagnosis. Prompt surgical intervention provides excellent outcomes and prevents life-threatening complications such as strangulation or cardiorespiratory compromise. Conclusion: A high index of suspicion should be maintained by clinicians for CDH in adults having unclear respiratory or abdominal symptoms, especially after trauma. Early identification and surgical intervention can prevent complications and lead to favorable outcomes.