Clinically, CDH in adults is asymptomatic in 30 to 50% of cases, being generally overweight women (28).
However, they can also occur in thin people as in the following case.
A 74-year-old woman was admitted to the hospital to complete the study of a three-month history of intermittent food vomiting that appeared between 30 minutes and 24 hours after ingestion and weight loss (10 kg).
No history of abdominal trauma.
Physical examination revealed only a slight decrease in vesicular murmur in the right hemithorax.
Dysphonia without odynophagia and dysmotility-type dyspepsia symptoms.
A plain chest X-ray showed occupation of the right lung field due to a mass located in the anterior inferior mediastinum of opacities, well-defined air-fluid levels in the anteroposterior plane, suggestive of anterolateral content.
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MRI shows a mass, compatible with the right thorax and a large defect in the anterior part of the diaphragm, which settles the anterolateral part of the thorax, in a hernial sac, antrum.
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The patient underwent laparoscopic surgery under general anesthesia.
A hernia orifice of 5 x 10 cm was observed, performing reduction of hernia content and resection of the hernia sac.
The defect is closed by placing a polypropylene mesh and silicone from the abdominal side, anchoring the mesh with stitches.
The evolution was satisfactory.
