Spontaneous Left-Sided Diaphragmatic Hernia Masquerading as Chronic Dyspepsia in a 60-Year-Old Woman: A Case Report

We report a spontaneous left diaphragmatic hernia in an older woman that was mistaken first for dyspepsia and then for diaphragmatic eventration.A 60-year-old woman presented with a three-day history of worsening postprandial vomiting on top of two years of recurrent epigastric pain radiating to the left back, early satiety, and significant weight loss (7 kg over two months).She had been diagnosed with dyspepsia and, during an earlier admission, with left diaphragmatic eventration on non-contrast computed tomography (CT).On examination, breath sounds were decreased, and percussion was dull over the left fourth intercostal space, where bowel sounds (borborygmi) were also audible, suggesting bowel in the chest.Contrast-enhanced thoracic CT then showed a diaphragmatic hernia with part of the stomach protruding into the left hemithorax.She underwent a combined laparoscopic-thoracotomy repair.Surgery found a true defect in the central part of the left hemidiaphragm containing stomach and omentum with grade IV adhesions, which excluded eventration.Recovery was complicated by mild grade I subcutaneous emphysema, managed conservatively, and she was discharged on postoperative day 5.The dense adhesions called for a combined transabdominal-transthoracic approach, and prompt recognition with individualized multidisciplinary planning contributed to a favorable outcome.Diaphragmatic hernia should be considered in older patients with recurrent, atypical gastrointestinal or respiratory symptoms, particularly when earlier imaging points to eventration.