Diaphragmatic hernia caused by trauma: experience with 35 cases.

Traumatic diaphragmatic hernia often is not recognized after the initial injury. Early recognition of this entity is of utmost importance since obstruction, strangulation, hemorrhage, viscus perforation, pleural fistula and empyema may occur at any time following the diaphragmatic disruption. A high index of suspicion, history of previous thoracoabdominal trauma, physical examination of the chest and roentgenographic evidence should aid in early and definitive diagnosis. Right-sided herniation should be considered in the differential diagnosis of masses about the right lower lung or diaphragm. Bilateral ruptures may also be encountered. Operation should be performed as soon as the diagnosis is made. In general, transabdominal route should be used in acute ruptures while chronic herniation should be approached through the chest.