Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2021.366
Autopsy and Case Reports
Autopsy Case Report and Review

Fatal adult-onset diaphragmatic hernia in the context of the COVID-19 pandemic

Ajith Antony; Sheryl Suares; André Victor Fernandes

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Abstract

Late-presenting or “Adult-Onset” Diaphragmatic Hernia is uncommon, especially in individuals with no history of trauma. The non-traumatic diaphragmatic hernia may be a Congenital Diaphragmatic Hernia [CDH] lately manifested as a sequela to an iatrogenic intervention or prolonged infections. We aim to explore the genetic correlations in “adult-onset” CDH, with an insight into the indirect contribution of the COVID-19 pandemic towards the fatal outcome.In this report, we present a case of an adult female who died from the complications of an undiagnosed adult-onset diaphragmatic hernia, deemed completely preventable, if not for the global COVID-19 pandemic. There was no prior history of physical trauma or medical history of any relevance.Early diagnosis and rapid surgical intervention remain the keystone management for successfully treating individuals affected by this entity. The decedent in question presented with symptoms demanding hospital stay for investigations that would have aided in timely diagnosis and prevented death. However, the excessive fear of COVID-19 prevented the patient from undergoing hospitalization and follow-up, delaying the diagnosis and leading to death.

Keywords

Hernias, Diaphragmatic, Congenital, COVID-19, Genetics, case report

References

1 Mai CT, Isenburg JL, Canfield MA, et al. National population-based estimates for major birth defects, 2010-2014. Birth Defects Res. 2019;111(18):1420-35. http://dx.doi.org/10.1002/bdr2.1589. PMid:31580536.

2 Dott MM, Wong L-YC, Rasmussen SA. Population-based study of congenital diaphragmatic hernia: risk factors and survival in metropolitan Atlanta, 1968–1999. Birth Defects Res A Clin Mol Teratol. 2003;67(4):261-7. http://dx.doi.org/10.1002/bdra.10039. PMid:12854661.

3 Yang GPC, Tang CN, Siu WT, Ha JPY, Tai YP, Li MK. Diaphragmatic hernia: an uncommon cause of dyspepsia. JSLS. 2005;9(3):352-5. PMid:16121887.

4 DeAlwis K, Mitsunaga EM. Sudden death due to nontraumatic diaphragmatic hernia in an adult. Am J Forensic Med Pathol. 2009;30(4):366-8. http://dx.doi.org/10.1097/PAF.0b013e318187e013. PMid:19901820.

5 Ekanayake E, Fernando S, Durairajah P, Jayasundara J. Incarcerated Bochdalek hernia causing bowel obstruction in an adult male patient. Ann R Coll Surg Engl. 2017;99(6):e159-61. http://dx.doi.org/10.1308/rcsann.2017.0065. PMid:28660829.

6 Goh BKP, Wong ASY, Tay K-H, Hoe MNY. Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. CJEM. 2004;6(4):277-80. http://dx.doi.org/10.1017/S148180350000926X. PMid:17382006.

7 Bairagi A, Moodley SR, Hardcastle TC, Muckart DJ. Blunt rupture of the right hemidiaphragm with herniation of the right colon and right lobe of the liver. J Emerg Trauma Shock. 2010;3(1):70-2. http://dx.doi.org/10.4103/0974-2700.58659. PMid:20165725.

8 Janardhanan J, Tarvadi PV, Manipady S, Shetty M, Somashekar C. Traumatic displacement of stomach – A case report. J Forensic Leg Med. 2014;21:53-5. http://dx.doi.org/10.1016/j.jflm.2013.10.007. PMid:24365690.

9 Salaçin S, Alper B, Çekin N, Gülmen MK. Bochdalek hernia in adulthood: a review and an autopsy case report. J Forensic Sci. 1994;39(4):1112-6. http://dx.doi.org/10.1520/JFS13692J. PMid:8064271.

10 Dworschak GC, Engels H, Becker J, et al. De Novo Duplication of 11p15 Associated With Congenital Diaphragmatic Hernia. Front Pediatr. 2018;6:116. http://dx.doi.org/10.3389/fped.2018.00116. PMid:29922638.

11 Wenstrom KD, Weiner CP, Hanson JW. A five-year statewide experience with congenital diaphragmatic hernia. Am J Obstet Gynecol. 1991;165(4 Pt 1):838-42. http://dx.doi.org/10.1016/0002-9378(91)90425-Q. PMid:1951540.

12 Langham J Jr, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia: epidemiology and outcome. Clin Perinatol. 1996;23(4):671-88. http://dx.doi.org/10.1016/S0095-5108(18)30201-X. PMid:8982563.

13 Aboud MJ, Al-Shamsy MM. Fryns syndrome a presentation of two siblings with congenital diaphragmatic hernia. Pediatr Surg Int. 2011;27:567-71. http://dx.doi.org/10.1007/S00383-010-2831-Y.

14 Wynn J, Yu L, Chung WK. Genetic causes of congenital diaphragmatic hernia. Semin Fetal Neonatal Med. 2014;19(6):324-30. http://dx.doi.org/10.1016/j.siny.2014.09.003. PMid:25447988.

15 Longoni M, Pober BR, High FA. Congenital diaphragmatic hernia overview. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Mirzaa GM, Amemiya A, editors. GeneReviews®. Seattle (WA): University of Washington; 2022. PMID: 20301533.

16 Holder AM, Klaassens M, Tibboel D, de Klein A, Lee B, Scott DA. Genetic factors in congenital diaphragmatic Hernia. Am J Hum Genet. 2007;80(5):825-45. http://dx.doi.org/10.1086/513442. PMid:17436238.

17 Kantarci S, Casavant D, Prada C, et al. Findings from aCGH in patients with congenital diaphragmatic hernia [CDH]: a possible locus for Fryns Syndrome. Am J Med Genet A. 2006;140(1):17-23. http://dx.doi.org/10.1002/ajmg.a.31025. PMid:16333846.

18 Vora N, Bianchi DW. Genetic considerations in the prenatal diagnosis of overgrowth syndromes. Prenat Diagn. 2009;29(10):923-9. http://dx.doi.org/10.1002/pd.2319. PMid:19609940.

19 Yu L, Bennett JT, Wynn J, et al. Whole exome sequencing identifies de novo mutations in GATA6 associated with congenital diaphragmatic hernia. J Med Genet. 2014;51(3):197-202. http://dx.doi.org/10.1136/jmedgenet-2013-101989. PMid:24385578.

20 Yu L, Wynn J, Cheung YH, et al. Variants in GATA4 are a rare cause of familial and sporadic congenital diaphragmatic hernia. Hum Genet. 2012;132(3):285-92. http://dx.doi.org/10.1007/S00439-012-1249-0.

21 Haroun HSW. Congenital diaphragmatic hernias: a review article. Anatomy Physiol Biochem Int J. 2018;4(2):555635. http://dx.doi.org/10.19080/APBIJ.2018.04.555635.

22 Shin MS, Mulligan SA, Baxley WA, Ho K-J. Bochdalek hernia of diaphragm in the adult: diagnosis by computed tomography. Chest. 1987;92(6):1098-101. http://dx.doi.org/10.1378/chest.92.6.1098. PMid:3677819.

23 Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology. 1985;156(2):449-52. http://dx.doi.org/10.1148/radiology.156.2.4011909. PMid:4011909.

24 Anderson WAD, Damjanov I, Linder J. Anderson’s pathology. 10th ed. USA: Mosby; 1996.

25 Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am. 1998;8(2):371-9. PMid:9619310.

26 Iiai T, Ohmori K, Ohtaki M, et al. [Adult bochdalek hernia after playing at a tug of war]. Kyobu Geka. 1997;50(11):968-70. Japanese.

27 Choi J-Y, Yang S-S, Lee J-H, et al. Maternal bochdalek hernia during pregnancy: a systematic review of case reports. Diagnostics (Basel). 2021;11(7):1261. http://dx.doi.org/10.3390/diagnostics11071261. PMid:34359342.

28 Browning DJ. Letter: maternal death and diaphragmatic hernia. Med J Aust. 1973;2(6):297. http://dx.doi.org/10.5694/j.1326-5377.1973.tb128850.x. PMid:4744117.

29 Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of Incidental Bochdalek’s Hernia in a Large Adult Population. AJR Am J Roentgenol. 2001;177(2):363-6. http://dx.doi.org/10.2214/ajr.177.2.1770363. PMid:11461863.

30 Yamaguchi M, Kuwano H, Hashizume M, Sugio K, Sugimachi K, Hyoudou Y. Thoracoscopic treatment of Bochdalek hernia in the adult: report of a case. Ann Thorac Cardiovasc Surg. 2002;8(2):106-8. PMID: 12027798.

31 Navaratnarajah A, Barry V, Charif R. Bochdalek hernias associated with intrathoracic kidney: a case report and systematic review of outcomes including renal function. Clin Nephrol. 2020;8(1):1-11. http://dx.doi.org/10.5414/cncs109962.

32 Banac S, Ahel V, Rozmanić V, Gazdik M, Saina G, Mavrinac B. Congenital diaphragmatic hernia in older children. Acta Med Croatica. 2004;58(3):225-8. PMid:15503687.

33 Kato H, Aoki Y, Ohtaki J, et al. Sudden death in an adult due to nontraumatic diaphragmatic hernia. Am J Forensic Med Pathol. 2017;38(4):353-5. http://dx.doi.org/10.1097/PAF.0000000000000342. PMid:28901960.

34 Hafner K. Fear of Covid-19 leads other patients to decline critical treatment. The New York Times; 2020 [cited 2021 Aug 9]. Available from: https://www.nytimes.com/2020/05/25/health/coronavirus-cancer-heart-treatment.html

35 Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. N Engl J Med. 2020;383(7):691-3. http://dx.doi.org/10.1056/NEJMc2015630. PMid:32427432.

36 Jokic-Begic N, Lauri Korajlija A, Mikac U. Cyberchondria in the age of COVID-19. PLoS One. 2020;15(12):e0243704. http://dx.doi.org/10.1371/journal.pone.0243704. PMid:33332400.

37 Ghosh A, Nundy S, Mallick TK. How India is dealing with COVID-19 pandemic. Sens Int. 2020;1:100021. http://dx.doi.org/10.1016/j.sintl.2020.100021. PMid:34766039.

38 Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020;51:102083. http://dx.doi.org/10.1016/j.ajp.2020.102083. PMid:32283510.

39 Varshney M, Parel JT, Raizada N, Sarin SK. Initial psychological impact of COVID-19 and its correlates in Indian Community: an online [FEEL-COVID] survey. PLoS One. 2020;15(5):e0233874. http://dx.doi.org/10.1371/journal.pone.0233874. PMid:32470088.
 


Submitted date:
01/14/2022

Accepted date:
02/15/2022

Publication date:
03/21/2022

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