21 year old girl presented with severe epigastric pain and gastric outlet obstruction. Chest Xray showed bowel in the chest. This episode settled but there was a subsequent episode of haematemesis. Past history revealed multiple episodes of vomiting and abdominal pain since childhood. She had also developed hypersplenism secondary to portal hypertension. This was due to the congested spleen within the chest cavity. The spleen was unreduceable laparoscopically so a laparotomy was performed to open the defect, reduce the hernia and patch the diaphragm.

Bochdalek Hernia