Late Recognition and Treatment of Traumatic Diaphragmatic Hernias

Traumatic diaphragmatic hernia

“…Pneumoperitoneum has been recommended as an aid to diagnosis (Schwindt and Gale, 1967), but adherence of gut or omentum to the edges of the defect may prevent the passage of air from the peritoneum into the pleural space. If either the pleura or peritoneum is intact, a hernia may occur without its being demonstrable by pneumoperitoneum (Orringer et al, 1975).…”

“…We consider a laparotomy preferable in the traumatic phase (Carter et al, 1951;Strug et al, 1974); the hernial contents can be easily reduced and intraperitonea1 injuries adequately treated. In the interval phase, including the phase of strangulation, because of adhesions to the diaphragmatic defect and intrathoracic structures, a thoracotomy is mandatory (Ebert et al, 1967;Schwindt and Gale, 1967; Le Roux and Williams, 1969). Both incisions can, if necessary, be extended into a thoracoabdominal incision (Melzig et al, 1976).…”

“…Any upper abdominal organ may herniate through the left hemidiaphragm, whereas on the right side the liver (Samaan, 1971) is usually the only herniated viscus. The stomach (Strug et al, 1974) or colon (Schwindt and Gale, 1967;Mansour et al, 1975) are the commonest organs to herniate. In acute penetrating trauma there is a high incidence of gastric perforation ( Table VZ).…”

Surgical management of chronic diaphragmatic hernias

“…In blunt thoraco-abdominal trauma, the overall incidence of DHs has been reported to be between 0.8% and 20% (8)(9)(10)(11). A great percentage of these hernias are acutely missed, due in part to the severity of the other associated injuries (12)(13)(14). The recent radiological preoperative standardization (especially by ultrasound and helical CT) has led to decrease the incidence of undiagnosed DHs (15,16).…”