Surreal illustration of a diaphragmatic hernia.

The Silent Killer: Understanding Nontraumatic Diaphragmatic Hernias

Theo Raines in Health & Wellness August 2025 • 4 min read.

"Could that nagging chest pain be something more? Discover the hidden dangers of diaphragmatic hernias and when to seek help."

Imagine a scenario where a common complaint like epigastric discomfort turns into a life-threatening emergency. This is precisely what happened in a recent case involving a 43-year-old man with a nontraumatic diaphragmatic hernia, a rare condition where abdominal organs push into the chest cavity through a defect in the diaphragm. While diaphragmatic hernias are often associated with traumatic injuries, this case highlights the critical need to recognize and understand nontraumatic instances, which can present subtly and lead to sudden death.

Diaphragmatic hernias can be broadly classified into two categories: traumatic and congenital. Traumatic hernias result from injuries to the chest or abdomen, while congenital hernias are due to defects present at birth. Bochdalek hernias, the most common type of congenital hernia, occur in the posterolateral region of the diaphragm. Although typically diagnosed in infancy or childhood, these hernias can sometimes go unnoticed until adulthood.

In adults, congenital diaphragmatic hernias are exceedingly rare, with only around 100 symptomatic cases reported in medical literature. What makes these cases particularly challenging is their varied presentation. Unlike infants who often exhibit respiratory distress and cyanosis, adults may experience a range of symptoms, including breathing difficulties, abdominal or chest pain, and even signs of intestinal obstruction. Delayed diagnosis can have dire consequences, making awareness and vigilance essential.

The Case of the Silent Hernia

Surreal illustration of a diaphragmatic hernia.

In a recent case, a 43-year-old man with a history of epigastric discomfort and recent respiratory symptoms was found dead at home. He had sought treatment for his discomfort but did not receive further examination. A postmortem CT scan revealed a startling discovery: his stomach had herniated into the left pleural cavity, compressing his left lung and causing a significant shift in the mediastinum, the space between the lungs that houses the heart and major blood vessels.

An autopsy confirmed the CT scan findings, revealing that the man’s stomach, spleen, a portion of his colon, and omentum had herniated through a 9 x 5-cm defect in the posterolateral part of his left diaphragm. The stomach was severely distended, containing a large volume of fluid and food residue. Notably, there were no signs of ischemia, or lack of blood supply, in the herniated organs. The cause of death was ultimately attributed to respiratory failure resulting from the abdominal viscera compressing the lung. Key findings from the autopsy included:

A large diaphragmatic defect in the left posterolateral area.
Herniation of abdominal organs into the left pleural cavity.
Compression of the left lung and mediastinal shift.
Marked distention of the stomach with fluid and food residue.

This case underscores the insidious nature of nontraumatic diaphragmatic hernias. The man’s initial symptoms were vague and could have been attributed to various common conditions. However, the underlying diaphragmatic defect ultimately led to a fatal respiratory compromise. It is important to note that while traumatic diaphragmatic injuries are more common, congenital hernias can remain asymptomatic for years and then manifest unexpectedly.

Recognizing the Risks and Seeking Help

While nontraumatic diaphragmatic hernias are rare, this case serves as a critical reminder for both medical professionals and the public. Vague symptoms like persistent epigastric discomfort, chest pain, or unexplained respiratory issues should prompt further investigation. Diagnostic imaging, such as CT scans, can be invaluable in identifying these hernias and preventing potentially fatal outcomes. If you experience any of these symptoms, especially with no known history of trauma, consult your healthcare provider to rule out any underlying conditions. Early diagnosis and intervention can save lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/paf.0000000000000342, Alternate LINK

Title: Sudden Death In An Adult Due To Nontraumatic Diaphragmatic Hernia

Subject: Pathology and Forensic Medicine

Journal: American Journal of Forensic Medicine & Pathology

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Hideaki Kato, Yasuhiro Aoki, Jun Ohtaki, Yoshimi Nakamura, Mohammed Hassan Gaballah, Mamiko Fukuta, Katsumasa Kobayashi

Published: 2017-12-01

Everything You Need To Know

What exactly is a nontraumatic diaphragmatic hernia, and why is it considered a 'silent killer'?

Nontraumatic diaphragmatic hernias occur when abdominal organs push into the chest cavity through a defect in the diaphragm, without any prior trauma. This is distinct from traumatic diaphragmatic hernias, which result from injuries. A key challenge is their subtle presentation, where symptoms can be vague, potentially leading to delayed diagnosis and severe outcomes such as respiratory failure and even death. Early diagnosis through imaging techniques like CT scans is crucial.

How are diaphragmatic hernias classified, and what are the key differences between traumatic and congenital types, such as Bochdalek hernias?

Diaphragmatic hernias are broadly classified into traumatic and congenital types. Traumatic hernias stem from chest or abdominal injuries. Congenital hernias, like Bochdalek hernias, arise from birth defects. While congenital hernias are often detected in infancy, some can remain asymptomatic until adulthood, making diagnosis difficult. The varying presentation in adults, differing from the respiratory distress seen in infants, adds to the complexity. Delayed detection can result in life-threatening complications.

In the case of the 43-year-old man, what specific symptoms did he experience, and what did the postmortem examination reveal about the diaphragmatic hernia's impact?

The 43-year-old man experienced epigastric discomfort and recent respiratory symptoms. A postmortem CT scan revealed that his stomach had herniated into the left pleural cavity, compressing his left lung and causing a shift in the mediastinum. This resulted in respiratory failure, which was determined to be the cause of death. Autopsy key findings included a large diaphragmatic defect in the left posterolateral area, herniation of abdominal organs into the left pleural cavity, compression of the left lung and mediastinal shift, and marked distention of the stomach with fluid and food residue.

What steps should someone take if they experience symptoms that might indicate a diaphragmatic hernia, and why is early diagnosis so critical?

If experiencing persistent epigastric discomfort, chest pain, or unexplained respiratory issues, especially without a history of trauma, it's crucial to seek medical attention. These symptoms can be indicative of underlying conditions, including nontraumatic diaphragmatic hernias. Diagnostic imaging, such as CT scans, can help identify these hernias early, preventing potentially fatal outcomes. Early diagnosis and intervention are vital for saving lives.

How can congenital diaphragmatic hernias remain undetected for so long, and what implications does this have for adults who may be at risk?

While traumatic diaphragmatic hernias are more common, congenital hernias, such as Bochdalek hernias, can remain asymptomatic for years and then manifest unexpectedly in adulthood. Unlike infants who often show clear signs of respiratory distress, adults may experience vague symptoms like abdominal or chest pain, making diagnosis challenging. This silent progression underscores the importance of vigilance, especially in individuals with unexplained respiratory or abdominal symptoms. Further complicating matters, the mediastinal shift caused by the herniation can compress major blood vessels, exacerbating the respiratory compromise.