[Diagnosis and treatment of traumatic diaphragmatic hernia with delayed presentation].
OBJECTIVE
To evaluate the clinical picture, diagnostic techniques and most appropriate treatment in traumatic diaphragmatic hernia with delayed presentation on the basis of personal experience and in the light of other published studies.


METHODS
Review of cases treated.


METHODS
Patients treated in University General Surgery wards.


METHODS
Those patients in whom diagnosis was made some time after trauma and after the acute event were selected from a group of patients with traumatic diaphragmatic hernia.


METHODS
All patients underwent surgery to reduce hernia and repair the diaphragmatic lesion.


METHODS
All clinical findings were examined together with the tests performed and the type of treatment carried out.


RESULTS
The diagnosis was made between 3 months and 3 years after the injury. Three patients presented manifest symptoms of high intestinal occlusion on entry. Radiological alterations were present in standard chest X-rays in all patients and digestive tract contrast radiography was positive for the diagnosis of hernia in 3 out of 4 cases in which it was performed; a preoperative diagnosis of hernia was obtained in 4 cases. Patients were operated using a thoracotomy (3 cases) or combined laparothoracotomy access (2 cases); the diaphragmatic lesion, localised in all cases in the cupula of the left hemidiaphragm, was repaired using separate sutures in non-reabsorbable material without the use of grafts. One patient died postoperatively owing to septic complications.


CONCLUSIONS
traumatic diaphragmatic hernia with delayed presentation involves severe complications that increase morbidity and operating mortality.
Montresor
E
E
Dipartimento di Scienze Chirurgiche, Policlinico Borgo Roma, Verona.
Mangiante
G
G
Lupi
A
A
Di Guida
V
V
Falezza
G
G
Attino
M
M
Ragni
E
E
Vassia
S
S
Aurola
P
P
D000293:Adolescent; D000328:Adult; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D013997:Time Factors