Description

A 27-year-old man was admitted to the emergency room because of a violent epigastric pain that started a few hours earlier during intense physical exercise. The same symptomatology had also occurred 3 days earlier, while engaging in sports, but disappeared spontaneously. Despite the severe, painful clinical picture, the abdomen was treatable by palpation. Laboratory exams recorded abnormal leucocyte count 12 × 10⁹/L , amylase level 667 U/L and lipase level 1602 U/L.

A chest and abdominal X-ray showed diaphragmatic herniation of the bowel’s loops in the left thorax with both the cardiac shadow and mediastinum dislocated to the right. Once the patient was informed of the results, he reported being already diagnosed with diaphragmatic hernia during childhood, although no other investigations were performed back then. He had a history neither of trauma nor of other causes of pancreatitis. A CT scan revealed the herniation of the stomach, spleen, bowel’s loops …