Diaphragmatic hernia has been termed "the great masquerader" and is second only to duodenal ulcer in the frequency with which it presents symptoms involving the upper gastrointestinal tract. Roentgenographic and esophagoscopic studies, in conjunction with an accurate history, of patients with upper gastrointestinal and/or lower thoracic pain often demonstrate a diaphragmatic hernia as the offender. Brick3 reports that a diagnosis of hiatal hernia is made in approximately 9% of patients who have roentgenographic examination of the upper gastrointestinal tract.
Roentgenologists and gastroenterologists who observe hiatal hernias during routine studies of the upper gastrointestinal tract seem prone to minimize these findings. On the other hand, the surgeon who observes the patient after serious complications develop may logically conclude that all diaphragmatic hernias are dangerous, and his concern for patients affected with these hernias, as well as those occurring elsewhere in the body, is based on complications encountered, i. e., incarceration,
HENDRICK JW. Results of Treatment of Diaphragmatic Hernia. AMA Arch Surg. 1958;77(5):774–779. doi:10.1001/archsurg.1958.01290040122015