title: Chronic traumatic and congenital diaphragmatic hernias: presentation and surgical management.
abstract: BACKGROUND
  The diagnosis of chronic diaphragmatic hernias, whether due to congenital defects or trauma, may be difficult to make and may rely on clinical suspicion in the setting of persistent nondiagnostic radiographic findings. Repair is indicated to avoid catastrophic cardiopulmonary compromise and/or incarceration of abdominal organs.
  
  
  OBJECTIVE
  To review the varied presentations and treatment of chronic diaphragmatic hernia.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University of Washington and Harborview Medical Center, Seattle, Washington.
  
  
  METHODS
  Between 1997 and 2001, nine patients presented with chronic diaphragmatic hernia (two congenital cases, seven post-traumatic cases). Four cases involved the right diaphragm. The following clinical features were noted: asymptomatic, chest radiograph showing bowel herniation (n=1); chest wall mass (n=1); asymptomatic with the chest radiograph showing marked elevation of hemidiaphragm (n=1); dyspnea with the chest radiograph showing marked elevation of hemidiaphragm (n=1); diarrhea and heartburn (n=1); generalized gastrointestinal upset (n=1); recurrent pneumonia (n=2); recurring effusions (n=4); and dyspnea on exertion (n=5).
  
  
  METHODS
  Diagnosis was confirmed by chest radiograph in two patients, chest computed tomography scan in one patient, barium studies in three patients and thoracoscopy in three patients. All hernias were repaired via thoracotomy, and two hernias were repaired with artificial patch.
  
  
  CONCLUSIONS
  Patients with chronic diaphragmatic hernias present with a variety of symptoms and radiographic findings. When radiology or symptoms suggest bowel involvement, barium studies are appropriate. In other cases, chest computed tomography scans and/or thoracoscopy are useful. Repair is accomplished through the ipsilateral chest, with primary repair of the diaphragm preferred over patch repair.
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Harborview Medical Center, Seattle 98104-2420, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Sattler
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Canty
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.forename: J Michael
authors.initials: JM
authors.lastname: Scully
authors.forename: Eric
authors.initials: E
authors.lastname: Vallieres
authors.forename: Timothy
authors.initials: T
authors.lastname: Pohlman
authors.forename: Riyad
authors.initials: R
authors.lastname: Karmy-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008297:Male; D008875:Middle Aged