A 60-year-old woman suffering from worsening postprandial vomiting and severe weight loss was initially diagnosed with chronic dyspepsia and diaphragmatic eventration, only for clinicians to discover a spontaneous left-sided diaphragmatic hernia upon hearing bowel sounds in her chest, Cureus reported.
The case details a rare presentation where abdominal viscera shift into the thoracic cavity through a diaphragmatic defect without any history of trauma. Chronic upper gastrointestinal symptoms frequently mask such structural defects, delaying necessary surgical interventions.
- Diaphragmatic Hernia: A condition where abdominal organs push upward into the chest cavity through a tear or weak spot in the diaphragm, the main breathing muscle.
- Diaphragmatic Eventration: An abnormal elevation of a thinned-out, intact diaphragm without an actual tear, which can easily mimic a true hernia on initial imaging.
- Borborygmi: Audible bowel sounds heard in unusual places—such as the chest—indicating that the intestines or stomach have migrated past the diaphragm.
For two years, the patient experienced recurrent epigastric pain radiating to her left back, early satiety, and a weight loss of 7 kilograms over a two-month span, Cureus reported. Medical evaluations during earlier hospital visits attributed her symptoms to chronic dyspepsia. Before her June 2026 admission, she had never undergone an upper gastrointestinal endoscopy or chest imaging.
During an admission prior to her final presentation, a non-contrast abdominal CT performed on June 19, 2026, suggested left diaphragmatic eventration. However, persistent symptoms prompted a contrast-enhanced thoracic CT on June 26, 2026, which revealed that a portion of her stomach had herniated into the left hemithorax.
When the patient returned to the emergency department with severe vomiting, physical examination provided the definitive diagnostic clue. Physicians noted decreased breath sounds and a dull percussion note over the left fourth intercostal space. Distinct borborygmi were audible in the same region, signaling the presence of abdominal contents inside the chest.
Laboratory findings showed declining renal function, with an estimated glomerular filtration rate dropping to 59.9 mL/min/1.73 m² on admission, alongside elevated liver enzymes. A combined laparoscopic-thoracotomy approach successfully repaired the defect. Surgeons discovered a true central tear containing the stomach and omentum with grade IV adhesions, ruling out eventration entirely.
| Diagnostic Parameter | Initial Finding | Confirmed Post-Admission Finding |
|---|---|---|
| Primary Diagnosis | Dyspepsia and Diaphragmatic Eventration | Spontaneous Left-Sided Diaphragmatic Hernia |
| Imaging Modality | Non-contrast abdominal CT (June 19) | Contrast-enhanced thoracic CT (June 26) |
| Surgical Approach | Outpatient surgical follow-up | Combined Laparoscopic-Thoracotomy Repair |
Patients presenting with recurrent, unexplained gastrointestinal symptoms like persistent vomiting, early satiety, or atypical chest pain—particularly when initial scans suggest eventration—require comprehensive thoracic imaging. Surgical repair stands as the definitive intervention to prevent organ incarceration, volvulus, or strangulation. Individuals should seek immediate emergency evaluation if they experience sudden, severe chest pain, worsening shortness of breath, or uncontrollable vomiting.
The patient’s postoperative recovery involved minor subcutaneous emphysema managed conservatively. She was successfully discharged on postoperative day five following multidisciplinary planning and intervention.
- Cureus: Spontaneous Left-Sided Diaphragmatic Hernia Masquerading as Chronic Dyspepsia in a 60-Year-Old Woman: A Case Report.
- National Center for Biotechnology Information (PMC): Spontaneous Acquired Diaphragmatic Hernia in an Elderly Patient.
- National Center for Biotechnology Information (PMC): Delayed Diagnosis of Left-Sided Diaphragmatic Hernia.
