Death due to late-presenting congenital diaphragmatic hernia in a 2-year-old child

Congenital diaphragmatic hernia (CDH) is classically regarded as a neonatal defect presenting with respiratory distress; however, not all CDH will present in this manner. Unlike newborn deaths related to CDH, where the mechanism of death is respiratory in nature, the mechanism of death in late-presenting CDH is not always due to respiratory compromise. In this case report, we present a death occurring in a 2 1/2-year-old child who presented to the emergency department with complaints of abdominal pain and emesis, and then rapidly decompensated and died. Autopsy revealed a CDH, with herniation of abdominal contents into the left thoracic cavity, with associated gastric volvulus, necrosis, and rupture.