Trauma to the diaphragm.

Traumatic diaphragmatic hernia is being seen with increasing frequency. Early recognition is of upmost importance because catastrophic complications may occur at any time following the diaphragmatic disruption. A high index of suspicion, history of previous thoracoabdominal trauma, physical examination of the chest, and roentgenographic evidence should aid in early and definitive diagnosis. All patients with serious body injury should have upper and lower gastrointestinal series performed before hospital discharge. Right-sided herniation occurs with more frequency than previously reported. In managing these injuries, the transabdominal route should be used in acute ruptures; chronic herniation should be approached through the chest, with the addition of a separate laparotomy when indicated.