Korean mummy's hernia diagnosed 300 years later

This diagnosis is 300 years too late. An autopsy of a Korean mummy entombed in the 17th century shows that the middle-age man suffered from a potentially painful hernia during his lifetime, according to a new study.

A 17th-century male mummy, called the Andong mummy, who was diagnosed with a 
diaphragmatic hernia [Credit: doi:10.1371/journal.pone.0099779.g003]

The mummy, only discovered last year, had been buried in a royal tomb of Korea's Chosun (or Joseon) Dynasty in Andong, a city in modern-day South Korea. The well-preserved remains belonged to a man who was about 45 years old and 5 feet, 3 inches (160.2 cm), the researchers said in their report published this month in the journal PLOS ONE. Based on his topknot hairstyle, archaeologists concluded that the man was married.

Before he died, the middle-age man may have roamed the streets of Andong with pain in his chest and abdomen. Perhaps he was sometimes short of breath or nauseated. But he wouldn't have known what was wrong with him; doctors have only been able to diagnose his condition, known as Bochdalek-type congenital diaphragmatic hernia (CDH), with the advent of radiological imaging technologies, such as X-ray and computed tomography (CT) scans, in the 20th century.

The Korean mummy showed a herniated liver (Lv) and herniated organs stretching from 
the abdominal to the thoracic cavities, shown here in these CT images 
[Credit:doi:10.1371/journal.pone.0099779.g003]

Bochdalek hernias arises from a birth defect that causes a hole in the diaphragm, the dome-shaped muscle that stetches across the bottom of the lungs. Other organs in the abdomen might push through this hole into the chest cavity, compressing one or both of the lungs and moving the heart.

A computed tomography (CT) scan of the mummy hinted that something was wrong with the placement of the man's organs. An autopsy confirmed that there was indeed a hole in his diaphragm and that several of his organs were herniated, including the right lobe of his liver, part of his stomach and part of his colon, the scientists said.

A hernia (arrows) showed up on the right side of the diaphragm during dissection 
of the Korean mummy. The left part of the diaphragm (B) shows no signs of any defect,
 the researchers said [Credit: doi:10.1371/journal.pone.0099779.g003]

The researchers, led by Yi-Suk Kim of Ewha Womans University in Seoul, South Korea, looked for other complications that may have been caused by the man's condition, such as perforation or strangulation of his herniated organs, which often causes death in Bochdalek CDH patients today. However, the scientists found no such evidence for these problems.

"This means that the CDH itself might not have been the main cause of death in his case," the authors wrote. "He could have lived with CDH in this lifetime while experiencing a few signs of respiratory disturbances. We suspected that the functional defects caused by the CDH in the present male mummy case might have been largely compensated for as he grew older."

The researchers pointed to a modern example for comparison: a 50-year-old Chinese woman who suffered from a "tremendous" Bochdalek hernia, but showed few clinical signs of the condition. According to her case report, detailed in the Journal of Cardiothoracic Surgery, a CT scan revealed that her abdominal organs had invaded the left side of her chest cavity, crushing her left lung and pushing her heart against her right lung. And yet, the patient only complained of mild shortness of breath.

Author: Megan Gannon | Source: LiveScience [July 10, 2014]