title: Delayed presentation of posttraumatic diaphragmatic hernia.
abstract: BACKGROUND
  Missed diaphragmatic injuries after trauma may present with herniation of intraabdominal organs into the thoracic cavity. We aimed to review our patients who presented with delayed posttraumatic diaphragmatic hernia.
  
  
  METHODS
  A retrospective review of the medical records of patients with delayed diagnosis of posttraumatic diaphragmatic hernia between 2001 and 2009 was performed.
  
  
  RESULTS
  Ten patients with a mean age of 44.3 years were included. Six patients were female. Blunt injuries (n: 7) were more common. Mean duration between trauma and presentation to the hospital was 5.9 years (4 months - 19 years). Nine patients had left-sided diaphragmatic hernia. All patients had chest X-ray and most were diagnostic (n: 8). Additional diagnostic imaging with computerized tomography (CT) and magnetic resonance (MR) was used in seven patients. For the repair, laparotomy incision was chosen for seven patients and thoracotomy incision for two patients. One patient underwent left thoracoabdominal approach. Mesh repair was used in seven patients. Postoperative mean hospitalization was 10.6 days. Empyema and atelectasis were the morbidities in one patient. No postoperative mortality was detected.
  
  
  CONCLUSIONS
  Delayed presentation of posttraumatic diaphragmatic hernia is a serious challenge for trauma surgeons. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and/or perforation of the herniated organ.
authors.affiliation: Department of General Surgery, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey. hismailok@yahoo.com
authors.forename: Ismail
authors.initials: I
authors.lastname: Okan
authors.forename: Gürhan
authors.initials: G
authors.lastname: Baş
authors.forename: Sedat
authors.initials: S
authors.lastname: Ziyade
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoğlu
authors.forename: Ramazan
authors.initials: R
authors.lastname: Eryılmaz
authors.forename: Deniz
authors.initials: D
authors.lastname: Güzey
authors.forename: Aydın
authors.initials: A
authors.lastname: Zilan
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult