A case of retrosternal diaphragmatic hernia.

Following the report of an example of bilateral parasternal diaphragmatic hernia (Warwick-Brown, 1952) an example of a type of hernia in this region is now described from a specimen encountered during a recent routine necropsy at St. Bartholomew's Hospital. This type of hernia has not been described before. The patient was a woman aged 70 who died in the post-operative period following the abdominoperineal excision of a carcinomatous rectum. The hernia was noted at operation, but had not been previously suspected. A triple diaphragmatic defect was present, comprising (a) a central gap between the two sternal slips of origin, (b) a dextro-lateral gap between the right sternal and the adjacent costal slips of the muscle, and (c) a sinistro-lateral gap situated between the left sternal and the left costal origins of the muscle (Fig. 1). These three diaphragmatic apertures were of equal extent. The central diaphragmatic defect gave passage to the peritoneal sac, while the two lateral defects each admitted a mass of extra-peritoneal fat. Each mass of fat was characterized by a peritoneal