A total of 11 patients were treated as traumatic diaphragmatic hernia at Presbyterian Medical
Center during past 5 years (1971~1975). The final outcome can be summarized as follows:
1) Traumatic diaphragmatic hernia is, significantly evident that the left sided diaphragm
exceeds the right site of traumatic diaphragm in a ratio of 10: 1.
2) In surgical intervention the majority of cases (7 patients) were performed on the basis of
emergency treatment and remaining 4 patients were treated after a considerable time lapse ranging from 2 months to 6 years between the injury and onset of symptoms.
3) Nature of trauma to the diaphragm; 6 cases were indirect and blunt trauma, 4 cases were direct penetrating trauma, into diaphragm, 1 case was erosion by thoracostomy tubes following
empyema drainage.
4) Signs and symptoms of traumatic rupture of diaphragm resulted mainly 8 cases of respe-y ratory, symptoms (tachypnea, dyspnea) and 6 cases of derangement of gastrointestinal symptoms including peptic ulcer symptoms, tarry stool and acute abdomen.
5) In 3 cases there occurred pelvic bone fracture and one of them associated urinary bladder, rupture.
6) Diagnostic accuracy was.much improved with radiological studies such as plain films.of-the chest, U.G.I.S., barium enema and liver scan.
7) In surgical management, transthoracic approach is advocated in right diaphragmatic hernia, left diaphragm hernia and direct penetrating trauma in left chest wall. Transabdominal approach advocated in acute abdomen status including bladder rupture case, confirmed cases of colonic herniation into chest cavity and organoaxial rotation of stomach into chest cavity.
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