Traumatic diaphragmatic injuries.

Although numerous articles have been written over the past two decades with regard to the treatment of traumatic diaphragmatic hernia, little has actually changed during that time. The ability to make the diagnosis has somewhat improved because of the technologic advances in CT; however, it remains true that the best tool to guide the clinician toward the appropriate diagnosis is a high index of suspicion in patients with blunt or appropriate penetrating trauma. Although laparoscopic or thoracoscopic management of such patients may become prevalent with increasing experience, at present the open approach and simple repair remain the mainstays of management. The patient's survival still depends more on the severity of concomitant nondiaphragmatic injuries and in many cases the diaphragmatic laceration is the least worrisome and least morbid of the patient's injuries. Operative repair results in a good outcome in most patients in the absence of other serious injuries.