Pneumoperitoneum due to a missed diaphragmatic hernia

Diaphragmatic hernia is a condition where the abdominal contents can protrude into the thorax. Despite their rarity, hernia-related complications can have fatal results if treated late. In literature, the hernial contents of the stomach, spleen, pancreatic tail, small intestine, and colon are frequently mentioned.We describe a case of a 33-year-old patient who had a diaphragmatic hernia that was undetected. The patient complained of severe epigastric pain and abdominal pain, which was later determined to be an ischemic gastric perforation. Then total gastrectomy and esophago-jejunostomy along with repair of the diaphragmatic defect was performed.This case illustrates the necessity of having a high degree of suspicion and early discovery of a diaphragmatic hernia for improved patient outcome.