March 1963

Traumatic Diaphragmatic Hernia

Author Affiliations

From the Departments of Surgery, Northwestern University Medical School and Cook County Hospital, and the Hektoen Institute for Medical Research of Cook County Hospital.

Arch Surg. 1963;86(3):363-373. doi:10.1001/archsurg.1963.01310090013003

The frequency of motor vehicle accidents and injuries resulting from physical violence calls for an increased awareness of the possibility of traumatic diaphragmatic hernia in the acutely injured patient.24 The course of events following disruption of the diaphragm is highly variable. Overshadowing injury to the bony skeleton, central nervous system, lungs, or abdominal viscera may obscure a diaphragmatic problem in the immediate post-traumatic period. Often the delayed occurrence of visceral strangulation represents the first manifestation of diaphragmatic injury.22 The most serious complication of a diaphragmatic hernia is strangulation, and the occurrence of symptoms of intestinal obstruction or pulmonary compression in a patient with a recent or old wound of the chest or upper abdomen should arouse suspicion.2

Traumatic diaphragmatic hernia is the result of a sudden penetrating or nonpenetrating type of injury. Blunt trauma, as encountered in modern vehicular accidents, may impose a bursting force in the

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