A sudden death of a prisoner: A rare case of adult presentation of Bochdalec hernia

Mostly diaphragmatic hernias are due to congenital or secondary to a traumatic rupture of the diaphragm. From this the incidence of congenital diaphragmatic hernias varies from 1: 2000 to 1: 5000 live births. Bochdalec hernia which is the commonest type, accounts for 75-85% of it. This condition is diagnosed antenatally or neonatally, only 5% are presented after neonatal period. We report a rare case of asymptomatic congenital Bochdalec hernia in an adult male prisoner who had died in the prison cell. A 26 year old male was brought dead to a tertiary care hospital where the prison officers stated that the deceased had a sudden attack of respiratory distress and collapsed. Post mortem examination revealed a left sided diaphragmatic hernia with collapsed left lung, mediastinal shift to the right and gangrenous small bowel in the chest cavity. Cause of death was ascertained as acute respiratory distress due to mediastinal shift due to strangulated diaphragmatic hernia. Congenital diaphragmatic hernia in an adult is a diagnostic challenge. The diagnosis should be considered in patients presenting with acute chest or abdominal pain or with chronic vague inconsistent cardio respiratory and abdominal symptoms.

DOI: http://dx.doi.org/10.4038/mljsl.v1i1.7276

Medico-Legal Journal of Sri Lanka 2011; 1(1), Jan-April : 49-51