Traumatic diaphragmatic hernia history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Awni D. Shahait, M.D.[2], The University of Jordan

Diaphragmatic ruptures present in two ways. In the acute form, the patient has recently experienced blunt trauma or a penetrating wound to the chest, abdomen, or back. The clinical manifestations are essentially those of the associated injuries, but occasionally, massive herniation of abdominal viscera through the diaphragm causes respiratory insufficiency.

In the chronic form, the diaphragmatic tear is unrecognized at the time of the original injury. Some time later, symptoms appear from herniation of viscera: pain, bowel obstruction, etc. Respiratory symptoms in such cases are rare.

The grading of severity has been proposed by Grimes,^[1] who discussed diaphragmatic rupture in phases: acute, latent and the obstructive phase. The acute presentation is in the patient with poly trauma associated with multiple intra abdominal and chest injuries. The latent phase is when herniation occurs through undetected diaphragmatic ruptures and rents. The obstructive phase is when the loop herniating obstructs and the patient develops distension and strangulation.

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