Posttraumatic diaphragmatic hernia and death - Etiologic factor or putrefactive artifact?

Late-presenting diaphragmatic hernias, whether congenital or acquired, may remain clinically undetected until mediastinal shift with cardiorespiratory compromise or intestinal or gastric infarction with perforation occur. A r ight-sided diaphragmatic hernia with herniation of small intestine into the adjacent pleural cavity is described in a 72-year-old man who was found de ad at home in a putrefactive state. Subsequently, a history of a motor vehi cle accident 8 years previously was obtained. Although postmortem herniatio n due to extensive putrefactive change may have occurred, producing gaseous distention and migration of the intestine, tight twisting of the herniated intestine several times around a pleural fibrous adhesion suggested that t he herniation could have been an antemortem event. Unfortunately, marked ti ssue autolysis prevented assessment of possible ischemic changes in the her niated intestine. Although diaphragmatic hernia may be a contributing facto r to death at all ages, it may not be possible to exclude it as an artifact of putrefaction in a predisposed individual.