Posterolateral diaphragmatic hernia with small-bowel incarceration in an adult

Bochdalek hernia (BH), a closing defect of the peripheral posterior aspect of the diaphragm, is the most common of the congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and varied presentation, these hernias can pose a diagnostic challenge. A right-sided BH in a 40-year-old woman who presented with respiratory distress associated with abdominal pain and symptoms of small-bowel obstruction is reported. Midline laparotomy revealed necrotic small bowel and faecothorax of the pleural cavity. Diaphragmatic hernias should be included in the differential diagnosis of patients with acute or chronic gastrointestinal, or less frequently respiratory, symptoms.