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Diaphragmatic hernia associated with strangulation of the small bowel in an Atacamena mummy.

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Diaphragmatic Hernia Associated with Strangulation of
the-Small Bowel in an Atacamena Mummy
Division ofdrcheologv, Universidad Del Norte, Antofagasta, Chile; Department of
Pathology, Medical College of Virginia, Healthsciences Division, Virginia
Commonwealth University, Richmond, Virginia 23298 and
University of Chile
KEY WORDS Diaphragmatic hernia
Atacamena mummy
Chile 2
This is the second case of a diaphragmatic herniafrom 200 autopsies of mummies of Atacamena Indians found in northern Chile. This case is
noted in an individual who died in the third century A.D. as a result of strangulation of two loops of the jejunum that entered the thoracic cavity. The herniation
was probably congenital in nature.
Diaphragmatic hernia is by definition the
transdiaphragmatic herniation or evisceration (in the absence of a sac) of some part of
the abdominal contents into the thoracic cavity. The opportunity for this to occur is related
with the development of the diaphragm which
is very complex.
Premature return of the intestine from the
body stalk may allow loops of the intestine to
enter the thorax through the pleuroperitoneal
canals thus preventing completion of the diaphragm posterior laterally. Since the left
canal closes later than the right and the liver
somewhat guards the right, the most likely
posterior, lateral, congenital site for a hernia
will be on the left. This is the most common
site in the newborn infant occurring about
1:2,500live births, and they are usually large
involving the herniation of a tremendous bulk
of abdominal viscera and are of the so-called
false variety without a sac (Askin, '75).
In a previous case report Gerszten et al.
('76) described a Chilean Colonial Indian
mummy from the Sixteenth Century with
esophageal hernia through which a large part
of the body of the stomach with the fundus
was found in the thoracic cavity. The present
case is in a female adult indian who died
around the Third Century AD. excavated from
the Caserones cemetery in the Tarapaca area
J. PHYS. ANTHROP. (1978)48: 17-20.
of northern Chile. The date of death was
determined archeologically and by carbon-14.
External and internal examination revealed no evidence of trauma, but when the
thoracic cavity was opened and carefully examined an opening was noted in the left posterior section of the diaphragm with what appeared to be two loops of the intestine protruding 15 cm or so into the thoracic cavity.
The lung on this side was completely collapsed
while the lung on the right side was partially
A careful dissection of the thoracic cavity
was undertaken to expose the hernia site,
shown in figure 1. The herniated loops of the
intestine (arrow) may be seen under the
raised left lung. The left lung and plural cavity are darker in color than the right, as a result of extravasated blood released after necrosis of the strangulated loops. Figure 2
shows a posterior view of the trunk with
scapulae, vertebral column, and pelvis removed. The white line is a rope marking the
level of the diaphragm. The two strangulated
jejunal loops can be seen in the thoracic cavity resting on a piece of white paper. The liver
' Supported by a grant from the National Geographic Society.
Correspondenceand reprint requests to:Dr. Marvin J. Allison, Department of Pathology, Medical College of Virginia, Box 22, Richmond, Virginia 23298.
Fig. 1 The body is supine in this view of the chest cavity. The left lung has been retracted to show the herniated loops of the intestine (arrow) in the posterior portion of the left thoracic cavity.
Fig. 2 This posterior view of the trunk with the scapulae, vertebral column and pelvic bones removed shows
t h e two strangulated loops of jejunum resting about 15 cm inside the thoracic cavity. A white rope has been
added t o show the level of the diaphragm. The liver and kidney may be seen on the right below the diaphragm.
The left kidney was removed to show the color of the normal intestines in the abdominal cavity.
is the area under the arrow, and just below
this may be noted the right kidney. The kidney on the left side has been removed to expose the normal intestine, so that difference
in color between normal intestine and the
strangulated loops in the thoracic cavity may
be noted. These loops appear to be part of the
Although in this present case it is impossible to completely eliminate a traumatic hernia, the lack of any signs of injury and this
posterior location would strongly suggest a
congenital defect at or near the foramen or
gap of Bochdalek (Bockus, '66).
This is the second case of a diaphragmatic
hernia from the examination of 200 mummies
taken out of cemeteries in the Tarapaca area
of northern Chile.
Askin, F. B. 1975 Thoracic Parietes, Pathology of Infancy and Childhood. Seconded. John W. Kissane, ed. Moshy,
St. Louis, pp. 554-570.
Bockus, H. L. 1966 Diaphragmatic Hernia, Esophageal
Hiatus Hernia and Eventuation of the Diaphragm.
Gastroenterology. Saunders, Philadelphia, pp. 232-261.
Gerszten, E., J. Munizaga, M. J. Allison and D. M. Klurfeld
1976 Diaphragmatic hernia of the stomach in a Peruvian
mummy. Bull. N.Y. Acad. Med., 52; 601-604.
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associates, atacamena, bowen, small, diaphragmatic, strangulation, mummy, hernia
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