PMC4843099_01
CT scan of chest abdomen pelvis showing herniation of transverse colon, splenic flexure, proximal small bowel and left lobe of the liver into the left chest resulting in mediastinal shift to the right (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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An urgent CT scan revealed extensive herniation of abdominal content through a large hiatal defect immediately to the left of the midline, with a consequent complete collapse of the left lower pulmonary lobe and displacement of cardio-mediastinum (see Fig. 1).
Intraoperative images showing hiatal defect (black arrow).
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Emergency laparotomy was performed with reduction of the diaphragmatic hernia and primary closure of the hiatal defect with interrupted number 1 Nylon (see Fig. 2).
PMC4843099_02
CT C/A/P showing herniation of dilated small bowel loops into the left hemithorax (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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This was confirmed by CT C/A/P showing small bowel obstruction secondary to DH with multiple dilated small bowel loops in the left hemithorax (see Fig. 3).
PMC4843099_03
CT C/A/P showing herniation of small and large bowel, compression of left lung and mediastinal shift (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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An urgent CT C/A/P showed a giant left-sided DH containing both small and large bowel, causing almost complete compression of the left lung and mediastinal shift to the right (see Fig. 4).