Traumatic diaphragmatic hernia.

The records of 36 patients with traumatic diaphragmatic hernia (TDH) were reviewed. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Seven acute TDHs were due to blunt and seven to penetrating trauma. Four chronic TDHs were due to blunt and 18 to penetrating trauma. Chest pain, abdominal pain, or dyspnea occurred in each acute case and in 18 of 22 chronic cases. Plain chest roentgenograms were abnormal in 33 of 36 cases. Pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Supradiaphragmatic bowel, pathognomonic of TDH, was evident in seven acute and eight chronic hernias. Celiotomy was routinely employed in acute hernias, celiotomy or thoracotomy in chronic hernias. There were three deaths, two with associated CNS injury and one with chronic pulmonary disease.