# Small bowel obstruction due to internal herniation through a right side diaphragmatic defect; an unusual case report

## TL;DR

A rare case of small bowel obstruction caused by a right-side diaphragmatic hernia is reported in a 55-year-old man with severe abdominal symptoms.

## Contribution

This case highlights the importance of considering right-side diaphragmatic hernia in the differential diagnosis of bowel obstruction.

## Key findings

- Right-side diaphragmatic hernia is a rare but serious cause of bowel obstruction in adults.
- Early diagnosis and treatment are crucial to prevent complications like strangulation or perforation.

## Abstract

Right-side diaphragmatic hernia is a very rare cause of bowel obstruction and strangulation in adults, which is usually a congenital disorder.

A- 55-year-old male presented to the emergency department of our hospital complaining of abdominal pain, nausea, vomiting, abdominal distension, fever, and constipation for 4 days. On physical examination, the patient was fibril, toxic, tachycardic, and hypotensive. The patient had a distended abdomen with exaggerated bowel sounds, abdominal tenderness, guarding, and rigidity mostly in the right upper quadrant. There were some degrees of tempanicity on percussion. The digital rectal examination was normal with no evidence of impacted stool.

Patients with a diaphragmatic hernia frequently present with manifestations of internal herniation, incarceration, obstruction, ischemia from strangulation, or perforation. The patient may present with respiratory symptoms such as dyspnea, absence of breath sounds in the thorax, or abdominal symptoms such as abdominal pain and bowel dilatation.

Diaphragmatic hernia, which is a rare case, should be included in the differential diagnosis of small bowel obstruction to preclude complications.

•Right side diaphragmatic hernia is a very rare cause of bowel obstruction.•It is usually a congenital disorder.•Early diagnosis and treatment may preclude the complications.

Right side diaphragmatic hernia is a very rare cause of bowel obstruction.

It is usually a congenital disorder.

Early diagnosis and treatment may preclude the complications.