A 35 year old female, presented with right sided chest pain, associated mild abdominal pain, and partial obstructive symptoms for several years. There was no significant past personal or family history). There was no history of trauma. Clinical examination revealed that she was mildly dehydrated, tachycardic (heart rate 110 beats per minute), afebrile, normotensive, and had mild abdominal tenderness. Investigation revealed a raised white cell count of 12.35x 10gl (reference range 4-10xgL). A chest radiograph revealed radio-opacity of right basal area (Figure 1) an abdominal erect radiograph was unremarkable. The patient was admitted with a presumed diagnosis of intra-abdominal tuberculosis, the medical officer was asked to do right thoracocentesis, which yielded a small amount of blood. While the patient was awaiting a chest and abdominal computed tomography (CT), she developed a mechanical intestinal obstruction. An emergency exploratory laparotomy was performed through a midline incision. We found a right sided Bochdalek's hernia containing transvers colon, right colon, along with the appendix and terminal ilium. The worrisome finding was that of a closed-loop intestinal obstruction. Incidentally, there were three accessory liver lobes, likely constituting the right lobe of the liver. The diaphragm had to be divided slightly to enable reduction of the incarcerated contents. These contents appeared compromised, but viable. Of particular interest, there was no hernia sac. The right lower lobe of the lung appeared hypoplastic. After reduction of the hernia contents, the diaphragmatic defect was repaired in a tension-free fashion. A limited resection and primary repair of the compromised redundant transvers colon was carried out. After careful consideration, we decided to carry out an incidental appendectomy. A right-sided chest tube was placed under direct vision, before closure of the diaphragmatic defect. The patient was transferred in to intensive care unit (ICU). She made an uneventful recovery and was discharged home. She was discharged home in excellent condition, and remains well at nine month follow-up (Figure 1).