History and Physical Examination

Clinical findings in patients with acquired diaphragmatic hernia may include the following:

Marked respiratory distress
Decreased breath sounds on the affected side
Palpation of abdominal contents upon insertion of a chest tube
Auscultation of bowel sounds in the chest
Paradoxic movement of the abdomen with breathing
Diffuse abdominal pain

Workup

Simon LV, Lopez RA, Burns B. Diaphragm Rupture. Treasure Island, FL: StatPearls; 2022. [Full Text].
Lee K, Kashyap S, Atherton NS. Diaphragm Injury. Treasure Island, FL: StatPearls; 2022. [Full Text].
Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Am J Emerg Med. 2004 Nov. 22 (7):601-4. [QxMD MEDLINE Link].
Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008 Mar. 85 (3):1044-8. [QxMD MEDLINE Link].
Lu J, Wang B, Che X, Li X, Qiu G, He S, et al. Delayed traumatic diaphragmatic hernia: A case-series report and literature review. Medicine (Baltimore). 2016 Aug. 95 (32):e4362. [QxMD MEDLINE Link].
West JB. Pulmonary Physiology and Pathophysiology: An Integrated, Case-Based Approach. 2nd ed. Philadelphia: Wolters Kluwer; 2007. 1-30; 116-33.
Jacobs R, Honore PM, Hosseinpour N, Nieboer K, Spapen HD. Sudden cardiac arrest during pregnancy: a rare complication of acquired maternal diaphragmatic hernia. Acta Clin Belg. 2012 May-Jun. 67 (3):198-200. [QxMD MEDLINE Link].
Mahamid A, Peleg K, Givon A, Alfici R, Olsha O, Israeli Trauma Group., et al. Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls. Am J Emerg Med. 2017 Feb. 35 (2):214-217. [QxMD MEDLINE Link].
Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G, et al. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg. 2008 Jun. 33 (6):1082-5. [QxMD MEDLINE Link].
Ramsay PT, Feliciano DV. The management of diaphragmatic injuries. Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia: Elsevier; 2017. 1170-5.
Hamoudi D, Bouderka MA, Benissa N, Harti A. Diaphragmatic rupture during labor. Int J Obstet Anesth. 2004 Oct. 13 (4):284-6. [QxMD MEDLINE Link].
Hayden JD, Davies JB, Martin IG. Diaphragmatic rupture resulting from gastrointestinal barotrauma in a scuba diver. Br J Sports Med. 1998 Mar. 32 (1):75-6. [QxMD MEDLINE Link].
Seda Neto J, M Costa C, Fonseca EA, Vincenzi R, Pugliese R, Rocha JIX, et al. Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation. Pediatr Transplant. 2022 May. 26 (3):e14203. [QxMD MEDLINE Link].
Emamaullee JA, Nekrasov V, Gilmour S, Kneteman N, Yanni G, Kohli R, et al. Case series and systematic review of acquired diaphragmatic hernia after liver transplantation. Pediatr Transplant. 2018 Dec. 22 (8):e13296. [QxMD MEDLINE Link].
Mansour KA. Trauma to the diaphragm. Chest Surg Clin N Am. 1997 May. 7 (2):373-83. [QxMD MEDLINE Link].
Zaidi ZA, Tebha SS, Sethar SS, Mishra S. Incidental Finding of Right-Sided Idiopathic Spontaneous Acquired Diaphragmatic Hernia. Cureus. 2021 Jun. 13 (6):e15793. [QxMD MEDLINE Link]. [Full Text].
Sliker CW. Imaging of diaphragm injuries. Radiol Clin North Am. 2006 Mar. 44 (2):199-211, vii. [QxMD MEDLINE Link].
Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics. 2012 Mar-Apr. 32 (2):477-98. [QxMD MEDLINE Link].
Xenaki S, Lasithiotakis K, Andreou A, Chrysos E, Chalkiadakis G. Laparoscopic repair of posttraumatic diaphragmatic rupture. Report of three cases. Int J Surg Case Rep. 2014. 5 (9):601-4. [QxMD MEDLINE Link]. [Full Text].
Kumar A, Karn R, Khanal B, Sah SP, Gupta R. Laparoscopic approach for diaphragmatic hernia repair in adult: our experience of four cases. J Surg Case Rep. 2020 Jun. 2020 (6):rjaa178. [QxMD MEDLINE Link]. [Full Text].
Gupta AK, Pansari M, Yi S, Genuit T, Rodriguez A. Transdiaphragmatic-pericardial Hernia: Case Report of an Unusual Condition Managed by Utilization of a Robotic Surgical System. Cureus. 2020 Apr 16. 12 (4):e7689. [QxMD MEDLINE Link]. [Full Text].
Counts SJ, Saffarzadeh AG, Blasberg JD, Kim AW. Robotic Transthoracic Primary Repair of a Diaphragmatic Hernia and Reduction of an Intrathoracic Liver. Innovations (Phila). 2018 Jan/Feb. 13 (1):54-55. [QxMD MEDLINE Link].
Perrone G, Giuffrida M, Annicchiarico A, Bonati E, Del Rio P, Testini M, et al. Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. World J Surg. 2020 Dec. 44 (12):4012-4031. [QxMD MEDLINE Link].
Silva GP, Cataneo DC, Cataneo AJM. Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis. Acta Cir Bras. 2018 Jan. 33 (1):49-66. [QxMD MEDLINE Link].
Antoniou SA, Pointner R, Granderath FA, Köckerling F. The Use of Biological Meshes in Diaphragmatic Defects - An Evidence-Based Review of the Literature. Front Surg. 2015. 2:56. [QxMD MEDLINE Link]. [Full Text].
Liao CH, Chu CH, Wu YT, Fu CY, Hsieh FJ, Wang SY, et al. The feasibility and efficacy of laparoscopic repair for chronic traumatic diaphragmatic herniation: introduction of a novel technique with literature review. Hernia. 2016 Apr. 20 (2):303-9. [QxMD MEDLINE Link].

Media Gallery

Preoperative chest radiograph in a 53-year-old woman who was a restrained passenger in an automobile accident. Note the bowel contents in the left hemithorax. Nasogastric tube can be seen in the thorax.
Postoperative chest radiograph in a 53-year-old woman who was a restrained passenger in an automobile accident.

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Author

Anne T Saladyga, MD General Surgery Resident, Department of Surgery, William Beaumont Army Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Daniel S Schwartz, MD, MBA, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, MBA, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey C Milliken, MD Former Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California, Irvine, School of Medicine; Current Professor Emeritus University of California

Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, SWOG, Western Surgical Association

Disclosure: Nothing to disclose.

Acknowledgements

Jason M Johnson, DO Resident Physician, Department of General Surgery, Spartanburg Regional Medical Center

Disclosure: Nothing to disclose.

Sidney R Steinberg, MD, FACS Program Director, Department of General Surgery, Spartanburg Regional Healthcare System; Consulting Surgeon, Department of Surgery, WG Hefner Veterans Affairs Medical Center

Sidney R Steinberg, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Surgical Education, South Carolina Medical Association, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.