Right-sided Congenital Diaphragmatic Hernia with Herniation of the Liver into the Thoracic Cavity: A Case Report

Background Right-sided congenital diaphragmatic hernias (CDHs) with liver herniation into the thoracic cavity are rare clinical entities that may remain asymptomatic for extended periods. However, the systemic effects during observation are poorly documented. This case highlights that hernias appearing clinically stable may nevertheless lead to progressive physiological deterioration, ultimately necessitating urgent intervention. Case presentation: A 52-year-old male farmer presented with an incidentally discovered liver lesion during evaluation for drug allergy at a local hospital. Initial laboratory evaluation revealed normal hemoglobin (144 g/L) but elevated inflammatory markers (hsCRP 9.80 mg/L) and coagulation abnormalities (D-Dimer 4.01 µg/ml, FDP 9.60 µg/ml). Over a five-week observation period, the patient developed significant anemia, with hemoglobin decreasing to 93 g/L (a drop of 51 g/L), accompanied by worsening hypercoagulability (D-dimer 5.04 µg/ml, FDP 15.38 µg/ml). Progressive exertional dyspnea was noted. Computed tomography revealed a 7–8 cm defect in the right posterolateral diaphragm with extensive herniation of liver tissue into the thoracic cavity, initially misdiagnosed as a hepatic mass. Given the progressive laboratory deterioration, urgent surgical intervention was undertaken. The patient underwent laparoscopic diaphragmatic hernia repair with partial hepatectomy. About 9×5×4 cm segment of chronically herniated liver tissue was resected, and the diaphragmatic defect was repaired with continuous barbed sutures. The procedure lasted 4 hours and 10 minutes with minimal blood loss. Pathology confirmed fatty liver with incidental old schistosome egg deposition. Post-operatively, coagulation parameters normalized (D-Dimer 0.19 µg/ml, FDP 2.50 µg/ml) and the patient recovered uneventfully, being discharged on postoperative day 8. Conclusions Right-sided congenital diaphragmatic hernias with hepatic herniation into the thoracic cavity may lead to progressive systemic deterioration, including marked anemia and hypercoagulability, even in patients with minimal symptoms. Serial laboratory assessments are critical for detecting these changes and for guiding the optimal timing of surgical intervention.A successful outcome was achieved through laparoscopic partial liver resection and diaphragmatic hernia repair, thereby completely resolving the systemic abnormal symptoms.