title: Intrathoracic intestinal diverticulum in a late presenting congenital bilateral diaphragmatic hernia: a case report.
abstract: BACKGROUND
  Hernias comprise 3% of all defects of the diaphragm. Bilateral hernias are extremely rare and usually occur in children. Here we present a case report of a bilateral Morgagni-Larrey diaphragmatic hernia with an intrathoracic intestinal diverticulum and late presentation. To the best of our knowledge this is the first report of this type.
  
  
  METHODS
  A 37-year-old Hispanic man was admitted to our emergency department with a 4-day history of obstipation, abdominal pain, distension, nausea, and vomiting. During the initial evaluation, chest and abdominal X-rays were performed, which revealed intestinal displacement into his right and left hemithorax. During laparotomy, a Morgagni-Larrey hernia with a sac was found. His small bowel with a large diverticulum, transverse colon, descending colon, and epiploic fat were herniated into his thorax. Tissues were returned to his abdominal cavity and the hernia defects were corrected with running non-absorbable sutures. He had no postoperative complications.
  
  
  CONCLUSIONS
  Bilateral congenital diaphragmatic hernias remain extremely rare. However, they should be considered in adult patients with intestinal obstruction even when respiratory symptoms are absent. This is the first description of a patient with a prolapsed intestinal diverticulum and bilateral diaphragmatic hernias.
authors.forename: Ruth
authors.initials: R
authors.lastname: Gómez-Rosales
authors.affiliation: Department of Surgery, Hospital Civil de Guadalajara Fray Antonio Alcalde, Calle Hospital 278, Guadalajara, CP 44280, Mexico. santiagopetersen@gmail.com.
authors.forename: Santiago
authors.initials: S
authors.lastname: Petersen-Morfín
authors.forename: Miguel
authors.initials: M
authors.lastname: Haro-García
authors.forename: Alejandra
authors.initials: A
authors.lastname: Ortiz-González
authors.forename: Alejandro
authors.initials: A
authors.lastname: Porras-Ruiz
authors.forename: Roberto
authors.initials: R
authors.lastname: González-Chávez