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Initial chest x-ray showed air fluid level in left thoracic cavity.
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Figure 1: Initial chest x-ray showed air fluid level in left thoracic cavity.

Mentions: A 27-year-old female presented with a 4-day history of epigastric discomfort, which was associated with repeated vomiting. Physical examination and laboratory investigations were unremarkable. The initial chest radiograph on admission showed a large air-fluid level in the left thoracic cavity (Figure 1). A chest radiograph performed 2 years earlier was normal. She did not recall any event of significant trauma before admission.

Diaphragmatic Hernia: An Uncommon Cause of Dyspepsia

Yang GP, Tang CN, Siu WT, Ha JP, Tai YP, Li MK - JSLS (2005 Jul-Sep)

Bottom Line: Blunt thoracic and abdominal trauma associated with a 5% to 7% incidence of diaphragmatic injury, and in 3% to 15% for those with penetrating injury.Traditionally, diaphragmatic hernia is repaired by laparotomy or thoracotomy, or both.Operative approach and technique of diaphragmatic defect closure is elucidated.

Affiliation: Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China. wtsiu@netvigator.com

ABSTRACT
Adult onset diaphragmatic hernia is a rare condition with variable clinical manifestations. The majority of adult-onset diaphragmatic hernia is associated with trauma. Blunt thoracic and abdominal trauma associated with a 5% to 7% incidence of diaphragmatic injury, and in 3% to 15% for those with penetrating injury. These injuries may be left unrecognized when they occur but often are uncovered months later during work up for related symptoms. Prompt diagnosis and surgical repair is recommended by most authorities. Traditionally, diaphragmatic hernia is repaired by laparotomy or thoracotomy, or both. Herein, we report a case of adult onset diaphragmatic hernia presented with dyspepsia that was successfully repaired via laparoscopy. Operative approach and technique of diaphragmatic defect closure is elucidated.

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