Bilateral diaphragmatic agenesis in an adult complicated by a paraduodenal hernia.

Diaphragmatic agenesis is an extremely rare clinical entity and has only been reported five previous times in the English literature. We report a patient with bilateral diaphragmatic agenesis complicated by a paraduodenal hernia. Diaphragmatic agenesis is rarely diagnosed preoperatively. Most diagnoses will likely be made during exploration for suspected bowel obstruction or other gastrointestinal emergency. When they are found repair seems warranted if contamination from associated procedures such as bowel resection is minimal. Repair of diaphragmatic agenesis can be approached much like the creation of a neodiaphragm after diaphragmatic resection. The diagnosis of paraduodenal hernia can usually be confirmed radiologically. Many cases of paraduodenal hernias have been reported and repair is uniformly recommended.