Traumatic nonpenetrating diaphragmatic hernia: report of 5 cases with a brief review of the literature.

Five cases of nonpenetrating, traumatic diaphragmatic hernia collected from the records of Medical Center Hospitals, Norfolk, Virginia, are presented. Four cases involved the left side; one case involved the right side and is discussed in detail. A brief review of the literature, modes of presentation, diagnostic work-up, and theories of etiology are presented. The detailed report illustrates: (1) the frequently vague presenting symptoms, (2) the need for high index of suspicion in evaluating lesions associated with the diaphragmatic surface, (3) importance of a thorough history and physical, and (4) the invaluable aid of diagnostic pneumoperitoneum in establishing the diagnosis preoperatively, thereby allowing a completely planned surgical approach.