Congenital diaphragmatic hernia (CDH) is a rare anatomical birth defect, causing the diaphragm fails to fuse completely, leaving a defect and causing herniation of the abdominal viscera towards the thoracic cavity. Though most cases of CDH are symptomatic and diagnosed in the early stages of life some asymptomatic cases may go undetected and later detect as incidental or may present with respiratory or gastrointestinal symptoms. We report a case of late-onset CDH which leads to a rapidly fatal medical emergency causing challenges in clinical diagnosis. An eight-year-old previously healthy schoolgirl was admitted to a primary care hospital following recurrent upper abdominal pain, nausea, and vomiting for a duration of 3 consecutive days. According to the parents she has taken treatment from a general practitioner. She was afebrile, hypotensive, tachycardic, and drowsy and was found unresponsive during transfer to a tertiary care hospital and was pronounced dead. On opening the thoracic cavity, it was noted that some of the abdominal contents like the entire stomach, duodenum, and proximal part of the small intestine, splenic flexure of the transverse colon were present within the left hemi thorax causing left lung hypoplasia, thoracic midline shift, intestinal compression, and elevated luminal pressure causing gastric erosions and chemical peritonitis. This case highlights the importance of higher clinical vigilance and the value of early diagnosis and timely medical attention to relatively uncommon but surgically correctable conditions like CDH.

Background: Auto erotic asphyxia (AEA) is described as an activity where persons intentionally induces hypoxia in order to increase the sexual excitement. This could be a group or solitary activity, observed commonly in adolescents or yo ung adult males. According to available literature deaths due to autoerotic asphyxia has not been reported in Sri Lanka. This is a case report on the death of a young adult male due to incomplete hanging with sexual paraphernalia. Case description: A 22 year old male was found partially hanging in his bed room with the door closed. The lower half of the body was naked and he was in an upright kneeling position with a ligature around his neck. The ligature was a cotton sheet with a slipped noose on the right side of the neck and tied a wooden bar under the roof. There was a mobile phone, pieces of a shattered mirror and a chair on the floor close to the body. There was dried seminal fluid on the left hand and on the floor close to the body. Conclusion:The state of partial hanging was used to reach the state of asphyxia. Prolonged compression of neck or failure to adopt self-rescue mechanisms may have led to death. The findings at the scene correspond to what is reported in the literature on auto erotic asphyxia. This case report highlights the importance of scene visit, in determining manner of death.