Traumatic intrapericardial diaphragmatic hernia.

Fifty-eight cases of traumatic intrapericardial diaphragmatic hernia were found in the literature and another delayed case added. The majority of patients presented after traffic accidents, with cardiopulmonary or abdominal symptoms. Most of the associated lesions to the bony skeleton were on the left side of the body. Chest X-rays and contrast studies, CAT scans, and echocardiography were helpful in establishing the diagnosis. We do not consider pneumoperitoneum to be a reliable procedure, nor to be used as a diagnostic aid. In the acute phase an abdominal approach is preferred to the transthoracic approach because the complete diaphragm can be inspected and concomitant abdominal lesions dealt with. Left thoracotomy should not be performed in the acute phase to prevent errors as reported in our patient.