Late Onset Diaphragmatic Hernia: A Forgotten Etiology of Recurrent Vomiting in the Adolescent Population

Abstract

Diaphragmatic hernia is a rare disorder in adolescents with oftentimes delayed diagnosis due to late-onset and non-specific clinical manifestations. In this report, we present a case of diaphragmatic hernia in an 18-year-old male, where initial diagnosis was complicated by confounding factors of type 1 diabetes mellitus and cannabinoid hyperemesis syndrome. This case highlights the importance of having a high index of suspicion for diaphragmatic hernia in patients with nonspecific gastrointestinal symptoms to ensure timely recognition and surgical intervention.

Keywords:

• diaphragmatic hernia
• Bochdalek hernia
• Morgagni hernia
• type 1 diabetes mellitus
• cannabinoid hyperemesis syndrome
• vomiting
• gastrointestinal symptoms

Abbreviations

DH, diaphragmatic hernia; CDH, congenital diaphragmatic hernia; CXR, chest X-ray; T1DM, type 1 diabetes mellitus; MVA, motor vehicle accident; CHS, cannabinoid hyperemesis syndrome; AXR, abdominal X-ray.

Ethics Statement

The case report was reviewed and approved for exemption by the New York-Presbyterian Brooklyn Methodist Hospital Institutional Review Committee. A written informed consent was obtained from the patient to have the case details and any accompanying images published. Documentation is available upon request. The study follows the guidelines outlined in the Declaration of Helsinki.

Author Contributions

All authors:

Made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas.

Have drafted or written, or substantially revised or critically reviewed the article.

Have agreed on the journal to which the article will be submitted.

Reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage.

Agree to take responsibility and be accountable for the contents of the article.

Disclosure

Dr Sebron Harrison reports personal fees from AstraZeneca’s ADAURA Virtual Advisory Board, outside the submitted work. Authors declare no other conflict of interest.