Hernias of the diaphragm can be divided into two major groups, those which are nontraumatic and include hiatus hernia, Morgagni hernia, and hernia of Bochdalek, and those which are traumatic in origin. Traumatic diaphragmatic hernias may further be subdivided into those which are caused by direct trauma to the diaphragm and those caused by indirect trauma. Direct trauma usually results from stab or gunshot wounds wherein the diaphragm is actually penetrated by the traumatic incident. Indirect trauma is commonly associated with severe injuries to the abdomen or chest secondary to high velocity or industrial accidents. The bursting effect secondary to the sudden compression of the lower chest or upper abdomen causes a rent in the diaphragm with herniation of the abdominal contents into the chest cavity. A rare cause of traumatic diaphragmatic hernia is the rupture through this structure of a contiguous inflammatory mass such as a subphrenic abscess.
COOLEY JC, ROGERS JCT. Traumatic Diaphragmatic Hernia. AMA Arch Surg. 1959;79(4):581-587. doi:10.1001/archsurg.1959.04320100047008