Diafragmatic hernia which was emerged from Bochdalek’s foramen is very rare in adult. It is outcome in infants and early childhood with dispnea. Seconder diafragmatic hernia is revealed with traumatic perforation. We have reported an adult patient with intrathoracic incarceration and perforation of the stomach spontaneously on the left side of the diaphragmatic defect resulting in empyema. Although similar cases were reported before, it is very rare that a herniation through Bochdalek foramen, without any preceding trauma, leaded to spontaneous perforation of stomach and empyema. A 56 years old male patient was admitted to emergency unit with an acute epigastric pain and hematemesis. A diagnosis of pleural effusion on the left side was made and thoracostomy tube was inserted. But the complaints of the patient continued and no expansion of the lung was achieved. The left thoracotomy showed the incarceration and perforation of the gastric fundus herniated posterolaterally through Bochdalek foramen in the diaphragma. The stomach and the diaphragma were successfully repaired. If there is pleural effusion on the left hemithorax suffering from epigastric pain and hematemesis, diaphragmatic hernia and gastric perforation must be considered in differential diagnosis.

Keywords : Diaphragmatic hernia, intrathoracic gastric perforation