Traumatic Diaphragmatic Hernia: Report of Two Cases

Traumatic diaphragmatic hernia (TDH) can be difficult to recognize. We present 2 cases of TDH. One case is a 23-year-old man, who suffered from a blunt injury with acute TDH from a motor vehicle accident. The other case is a 60-year-old male who had chronic TDH due to a violent penetrating injury more than 20 years previously. Immediate herniation is most often associated with a large tear of the diaphragm, but the symptoms of the herniation are usually obscured by other associated injuries. The diaphragmatic repair should be approached through a laparotomy due to the high incidence of simultaneous intra-abdominal organ injury. If small tears of the diaphragm are not repaired initially, progressive abdominal visceral herniation may occur because of the pressure gradient between the thoracic and peritoneal cavities. A thoracotomy provides excellent exposure to divide the adhesions between the trapped viscera and lung parenchyma. We emphasize that there are two types of TDH: acute and chronic. Each of these two types has its own treatment modality.