Traumatic diaphragmatic hernia.

The etiology, diagnosis and management of traumatic diaphragmatic hernias were discussed, and a personal series of 61 hernias was reviewed. The need for a greater clinical awareness of the condition was stressed. Chest roentgenograms were shown to be the most effective diagnostic method, and thoracoscopy was recommended in all hernias that occurred within 24 hours of the injury. Barium contrast studies of the gastrointestinal tract have limitations, and caution was advised with these methods when dealing with patients presenting in acute crisis. Computerized tomographic scanning is becoming increasingly more valuable in the investigation of this condition, but the author hesitates to recommend its routine use. A plea was made for the abdominal approach to diaphragmatic hernias. The value of this approach was illustrated by the successful repair of 58 of 61 hernias through a laparotomy.