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Arch Surg. 2009;144(7):694.

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Answer: Diaphragmatic Hernia With Intestinal Obstruction

The chest radiographs showed multiple air fluid levels in the left hemithorax. The contour of the diaphragm could not be seen on the left side and intestinal loops were seen in the chest. The stomach outline could be made out in the anterior left hemithorax. These findings with a history of trauma led to a diagnosis of traumatic diaphragmatic hernia of the left side (anterior) with herniation of the stomach and small-bowel loops with intestinal obstruction. Ultrasonography was done for confirmation.

The most common cause of acquired diaphragmatic hernias is either blunt or penetrating trauma. Blunt trauma accounts for 75% of ruptures, and penetrating trauma accounts for the majority of the rest. The incidence of diaphragmatic rupture is 0.8% to 1.6% in patients admitted to the hospital for blunt trauma. Motor vehicle accidents are the leading cause of blunt diaphragmatic injury, whereas penetrating injuries result from gunshot or stab wounds. . . . [Full Text of this Article]

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Arch Surg. 2009;144(7):693.
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