Left-Sided Diaphragmatic Hernia Following Pediatric Liver Transplantation: First Reported Case From the Middle East

Acquired diaphragmatic hernia (DH) is an uncommon but clinically important complication after pediatric liver transplantation (LT), most often affecting the right hemidiaphragm. Left-sided defects are exceptionally rare in children, with only isolated cases reported. To the best of our knowledge, this is the first documented pediatric case of left-sided DH after LT from an Arab Middle Eastern country. A 16-year-old female with autoimmune hepatitis type 2 (AIH-2) on long-term immunosuppression presented two years post-transplant with acute epigastric and left upper quadrant pain that progressed to chest discomfort and dyspnea. Initial radiography suggested possible eventration, while subsequent advanced imaging revealed a left diaphragmatic defect with herniation of the gastric fundus. Surgical exploration confirmed gastric and omental herniation with ischemic changes, requiring conversion from thoracoscopy to open repair and primary closure. The patient recovered well without recurrence. This case underscores the diagnostic difficulty of post-transplant DH, particularly when delayed and left-sided, and highlights the importance of maintaining a high index of suspicion in LT recipients with unexplained abdominal or respiratory symptoms. Its atypical laterality, gastric involvement, and regional novelty broaden current understanding of this rare complication and emphasize the need for timely imaging and intervention.