Surgical Management of Congenital Transdiaphragmatic Hernia with Abdominal Wall Involvement in an Adult: A Case Report

BACKGROUND: Congenital Transdiaphragmatic Hernia (CTDH) in adults is rare, often presenting with abdominal wall hernias, which complicates diagnosis and treatment. This case report discusses a 56-year-old male with intermittent upper abdominal discomfort, pleural effusion, and respiratory distress. CT scans identified a transdiaphragmatic intercostal hernia with pleural complications. Emergency intervention revealed necrotic omentum and high pleural fluid volume, highlighting the diagnostic complexity and need for prompt management in CTDH patients. AIM: To determine the diagnostic and therapeutic approach for CTDH in adults with abdominal wall hernia and pleural complications. METHODS: A case study was conducted in a hospital setting on a 56-year-old male presenting with symptoms of abdominal discomfort and respiratory distress. Contrast-enhanced CT imaging identified CTDH and abdominal wall hernia, with pleural effusion and atelectasis. The patient underwent emergency laparotomy, drainage of 2500 ml pleural fluid, hernia sac repair, and pleural drainage. Recovery was assessed with follow-up imaging to monitor resolution of pleural and pulmonary conditions. RESULTS: Emergency laparotomy revealed an incarcerated, necrotic omentum within the hernia sac, which was surgically removed. Approximately 2500 ml of dark pleural fluid was drained, and pleural drainage was performed. Post-surgery, the patient experienced significant recovery with full restoration of lung function and no postoperative complications. Follow-up imaging confirmed resolution of pleural effusion and atelectasis, demonstrating successful surgical intervention and recovery. CONCLUSION: Early diagnosis and individualized surgery are critical in managing adult CTDH, reducing risk of organ strangulation and respiratory failure.