Diaphragmatic hernia associated with strangulation of the small bowel in an Atacamena mummy.код для вставкиСкачать
Diaphragmatic Hernia Associated with Strangulation of the-Small Bowel in an Atacamena Mummy JUAN MUNIZAGA, MARVIN J. ALLISON AND EUGENIO ASPILLAGA 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 ABSTRACT 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 AM. 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 inflated. 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. 17 18 J. MUNIZAGA, M. J. ALLISON AND E. ASPILLAGA 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. DIAPHRAGMATIC HERNIA IN A MUMMY 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 jejunum. 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). 19 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. LITERATURE CITED 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.