CO exposure in our patients was acute, accidental, and occurred during the winter months. Serious symptoms, such as syncope, occurred more often in patients having increased COHb levels, but normal COHb levels could not be used to rule out CO poisoning.

Although acquired diaphragmatic rupture is often associated with trauma, rarely it may be spontaneous (atraumatic). Spontaneous diaphragmatic rupture is one of the rarest thoracoabdominal emergencies, and is harder to detect in patients without visceral damage. Diagnosis may be delayed by several months or even years. A sceptical approach, combined with thorough physical examination and the correct interpretation of the chest X-ray, are very important in diagnosis. In this report we present a patient who was admitted to the emergency department with stomach pain, nausea, vomiting and hiccups lasting for 3 days, and was diagnosed with spontaneous diaphragmatic rupture. The patient was treated with thoracotomy, and the defect was repaired primarily. (JAEM 2014; 13: 209-11)

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