Asymptomatic diaphragmatic hernia in an elderly patient: case report and review of conservative management.

backgroundDiaphragmatic dome hernia (DH) is a rare condition in adults, often congenital or traumatic, involving a diaphragmatic defect allowing abdominal contents to herniate into the thoracic cavity. Asymptomatic presentation in elderly patients is uncommon and poses diagnostic challenges. CASE PRESENTATION: A 73-year-old man with a history of exploratory laparotomy for typhoid intestinal perforation 11 years prior presented with a productive cough. Imaging revealed an incidental large left-sided diaphragmatic hernia (Bochdalech type) with herniation of the transverse colon into the thoracic cavity, causing ipsilateral lung collapse and mediastinal shift. No other comorbidities were noted. Due to the patient's age, absence of symptoms related to the hernia, and patient preference, conservative management with clinical and imaging follow-up was chosen. At six months, the patient remained asymptomatic.

conclusionsAsymptomatic DH in adults is rare and relies on imaging for diagnosis. Conservative management with vigilant monitoring is a viable option for stable, high-risks surgical candidates, guided by individualized risk assessment. This case highlights the importance of tailored decision-making in managing asymptomatic DH in elderly patients.