To Wait or Not: A Case Series on Complicated Diaphragmatic Hernias in Adults

Aims: To describe the diagnosis, evaluation and management of cases of complicated diaphragmatic hernias in adults.

Study Design: Observational descriptive study.

Place and Duration of Study: Department of Surgery (Unit IV), SMS Medical College and Hospital, Jaipur (India), between February 2022 and August 2022.

Methodology: We identified all adult patients diagnosed with diaphragmatic hernia who underwent surgical treatment, during a period of 6 months in a single tertiary care centre. Data on patient demographics, clinical course, surgical characteristics, mortality and morbidity were collected.

Results: A total of 6 patients were identified (4 males; average age: 46.6 years). 3 patients were diagnosed with left Bochdalek hernia (BH), 1 with right BH, 1 with Morgagni-Larry hernia and 1 with traumatic diaphragmatic hernia (TDH). The most common presenting symptoms were abdominal pain and vomiting (50%). 2 patients were operated laparoscopically and 4 via laparotomy. The most commonly herniated organs were stomach and colon. Postoperative length of stay was 8.25 days on average. 2 deaths occurred in the post-operative period, and no recurrences were reported upon long-term follow-up.

Conclusion: Diaphragmatic hernias in adults present a substantial diagnostic and therapeutic challenge. Minimally invasive approach is associated with quicker recovery, and laparotomy may be reserved for emergencies. Higher degree of clinical suspicion is required to detect and confirm the diagnosis and must be followed by immediate surgical intervention without any “waiting period”.