Fatal gastric perforation in a 4-year-old child with a late-presenting congenital diaphragmatic hernia

A previously well 4-year-old male presented with a 2-day history of listlessness, anorexia, left upper quadrant pain, and vomiting followed by sudden cardiorespiratory arrest and death. At autopsy a 50-mm diameter congenital defect in the posterolateral part of the left diaphragm was discovered associated with herniation of the stomach, spleen, greater omentum, and portions of the transverse colon and pancreas into the chest cavity. Perforation of the anterior wall of the stomach had filled the pleural cavity with gastric contents. This case demonstrates that not all late presenting congenital diaphragmatic hernias have a benign clinical outcome, and emphasizes the need for an increased awareness of this rate but potentially curable entity.Offprint requests to: R. W. Byard