Asian Journal of Case Reports in Surgery

Background: Late-presenting congenital diaphragmatic hernia (CDH) is a rare condition in adolescents, often manifesting with non-specific gastrointestinal symptoms that mask the underlying diagnosis. The simultaneous occurrence of gastric volvulus, pancreatitis due to herniation, and intrathoracic ectopic kidney in a single patient represents an exceptionally rare constellation of findings.

Case Presentation: A 15-year-old male presented with a three-day history of acute-onset abdominal pain and recurrent non-bilious vomiting following an episode of heavy lifting. All the routine investigations were normal except for the elevated serum amylase (625 U/L) and lipase (723 U/L), suggestive of pancreatitis. Contrast-enhanced computed tomography revealed a large left-sided defect (96 mm) with herniation of the stomach, jejunal loops, splenic flexure/descending colon, spleen, pancreas and an intrathoracic ectopic kidney, along with marked gastric distension indicating volvulus. A laparoscopic approach was attempted but converted to open laparotomy due to the bulk of herniated contents. The herniated viscera were reduced into the abdominal cavity. Primary diaphragmatic repair was achieved using interrupted non-absorbable sutures without prosthetic mesh. Postoperative recovery was uneventful with normal renal and pancreatic markers. The patient was discharged on postoperative day five.

Conclusion: This case highlights the importance of maintaining a high suspicion for CDH in adolescents presenting with unexplained gastrointestinal obstruction. The concurrent findings of gastric volvulus, pancreatitis due to herniation, and intrathoracic ectopic kidney reflect the wide spectrum of visceral involvement possible in late-presenting CDH. Cross-sectional imaging plays an important role in diagnosis, and appropriate surgical intervention leads to favourable outcomes.