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True hernias of the diaphragm are those which have a sac of peritoneum, or pleura or both. The nontraumatic type occur through preformed openings or at their margins. Their occurrence is probably dependent on an acute or chronic increased intra-abdominal pressure. The preformed openings are as follows:
The esophageal foramen.
The foramen of Morgagni, at the junction of the sternum and the seventh costal cartilage on either side.
The foramen of Bochdolek, posteriorly between the lumbar and costal division of the diaphragm.
The point of entrance for the sympathetic nerve, between the external and median crura.
Hernias through, or at the side of, the esophageal opening are much the most common. In no case has a hernia passed through the orifices of the aorta or vena cava. In most cases, the hernia enters the left pleural cavity. Often it is found in the posterior mediastinum, especially in early hernia, but
ABBOTT DP. THE EARLY DIAGNOSIS OF TRUE HERNIA OF THE DIAPHRAGM. JAMA. 1924;83(24):1898-1899. doi:10.1001/jama.1924.02660240012003