Traumatic diaphragmatic hernia (TDH) is an uncommon but potentially fatal consequence of blunt or penetrating thoracoabdominal trauma, often overlooked during initial assessment. It occurs in approximately 0.8%–6% of blunt trauma and up to 17% of penetrating injuries, with left-sided ruptures predominating due to hepatic protection of the right hemidiaphragm. The condition may present acutely with respiratory distress and abdominal symptoms, or chronically after years of latency, often manifesting as bowel obstruction or respiratory compromise. Diagnosis remains challenging because of non-specific clinical features and coexisting injuries. Chest radiography has limited sensitivity, while multidetector computed tomography (CT) currently represents the gold standard for detection, revealing signs such as diaphragmatic discontinuity, visceral herniation and the characteristic ‘collar sign’. Ultrasonography, particularly focussed assessment with sonography in trauma, may aid early screening in resource-limited settings. Surgical repair is the cornerstone of management. Acute cases typically warrant an abdominal approach to address associated intra-abdominal injuries, whereas chronic or delayed presentations often necessitate a thoracic route to facilitate adhesiolysis. Minimally invasive techniques, including laparoscopy and thoracoscopy, have gained acceptance in selected patients. Mesh reinforcement is recommended for large or complex defects to prevent recurrence. Despite advances in imaging and surgical care, TDH continues to carry considerable morbidity and mortality, especially when diagnosis is delayed or when strangulated viscera are present. Prompt recognition, appropriate imaging and timely surgical intervention are crucial to improving outcomes in this rare but significant injury.
Aparna et al. (Thu,) studied this question.