Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • May be acute or chronic following either penetrating or blunt trauma-Acute form associated with respiratory distress-Chronic form marked by pain and bowel obstruction• Chest film showing NG tube, air fluid level, or abdominal vicera in the chest is diagnostic +++ Epidemiology + • Traumatic rupture of the diaphragm may occur as a result of penetrating wounds or severe blunt external trauma• Lacerations usually occur in the tendinous portion of the diaphragm, most often on the left side• Abdominal viscera may immediately herniate through the defect in the diaphragm into the pleural cavity (acute) or may gradually insinuate themselves into the thorax over a period of months or years (chronic)• In the acute form, the patient has recently experienced blunt trauma or a penetrating wound to the chest, abdomen, or back• In the chronic form, the diaphragmatic tear is unrecognized at the time of the original injury +++ Symptoms and Signs + • Acute herniation -Symptoms from concomitant injuries-Respiratory insufficiency• Chronic herniation -Pain-Bowel obstruction +++ Imaging Findings + • Chest film: A radiopaque area and occasionally an air fluid level if hollow viscera have herniated• If the stomach has entered the chest, the abnormal path of an NG tube may be diagnostic• US, CT scan, and MRI: Demonstrate the diaphragmatic rent + • In an acute traumatic setting, focus attention on life-threatening injury-Diaphragmatic herniation may be considered as a possible source of respiratory distress• In a patient with a history of abdominal trauma and a bowel obstruction, missed diaphragmatic hernia should be considered +++ Rule Out + • Atelectasis• Space-consuming tumors of the lower pleural space• Pleural effusion• Intestinal obstruction due to other causes + • Chest film• CT scan +++ When to Admit + • All acute cases• Chronic cases with evidence of bowel obstruction, severe pain + • Acute: Repair after stabilized or at the same time as other injuries are treated if multiple injuries.• Chronic-Symptomatic, urgent repair-Asymptomatic, elective repair +++ Surgery +++ Indications + • All diaphragmatic hernias should be repaired +++ Complications + • Respiratory insufficiency• Intestinal obstruction and perforation• Intestinal bleeding +++ Prognosis + • Excellent after surgical repair; very seldom recurrent +++ References ++Grover SB, Ratan SK. Simultaneous dual posttraumatic diaphragmatic and abdominal wall hernias. J Trauma. 2001;51:583. [PubMed: 11535916] ++Meyer G et al. Laparoscopic repair of traumatic diaphragmatic hernias. Surg Endosc. 2000;14:1010. [PubMed: 11116407] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.