[Sudden maternal death in late pregnancy: congenital diaphragmatic defect causing prolapse of the intestine into the thoracic cavity (author's transl)].

Near the end of her first pregnancy, a 17-year-old patient developed sudden epigastric pain followed shortly afterwards by restlessness, paleness and respiratory distress. A diagnosis of pneumothorax was made from the chest radiogram. Shortly after this examination the patient died from cardiocirculatory failure. Autopsy revealed a congenital defect of the diaphragm with prolapse of abdominal organs into the thoracic cavity and displacement of the heart and mediastinum. The strangulated, gas-filled stomach was situated in the thoracic cavity and showed hemorrhagic erosions of the mucosa and a circumscribed mural defect which had obviously developed in the prefinal stage. This case as well as similar ones reported in the literature underline the necessity for a rapid diagnosis of unclear epigastric pain in late pregnancy. In the case of "diaphragmatic hernia" early surgery is indicated.