A rare cause of mechanical bowel obstruction in a young adult.

for decompression colonoscopy having been admitted 2 days previously for bow− el obstruction. Upon admission, the patient had slight abdominal distension. Analgesic and laxative treatments were initiated but proved ineffective, and conventional radiography showed increasing disten− sion of the cecum. Colonoscopy was per− formed up to the left colonic flexure (l" Fig. 1 a), and radiographic contrast agent did not reach the transversum (l" Fig. 1 b). Abdominal computed to− mography confirmed a mechanical ileus with herniation of the left colon flexure. Laparotomy was performed, and a 3 cm wide hiatus was found in the dorsolateral part of the diaphragm. The hernia was re− posed, the diaphragm sutured, and part of the great omentum resected because of ischemia. The patient recovered without complications and was discharged 7 days postoperatively. The prevalence of congenital diaphrag− matic hernias is reported to be 4.8/10000 births [1± 3]. If symptoms of congenital diaphragmatic herniation manifest later, in children or adults, gastrointestinal problems such as nausea, vomiting, ab− dominal pain, or bowel obstruction are most common [3]. In some reports of late−presenting hernias, bowel stricture was misdiagnosed as pneumothorax, ba− sal pneumonia, or empyema [4,5]. Diag− nosis is most often established with com− puted tomography. The most common congenital hernia (prevalence 6%), occurs in the posterolat− eral parts of the left diaphragm, and is known as Bochdalek’s hernia [5]. Retro− sternal hernia occurring on the right side, known as Morgagni’s hernia, or ret− rosternal left−sided hernia, known as Lar− rey’s hernia, is less common (l" Fig. 2). We believe that the most likely cause of our patient’s problem was a rare, late manifestation of a congenital diaphrag− matic hernia of none of the above−de− scribed types. Regardless of classification, symptomatic diaphragmatic hernia is a rare cause of mechanical bowel obstruc− tion in young adults. If colonoscopy is performed, concurrent radiographic in− vestigations can be helpful.