title: Delayed presentation of traumatic diaphragmatic hernia: a diagnosis of suspicion with increased morbidity and mortality.
abstract: BACKGROUND
  Diaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality.
  
  
  OBJECTIVE
  The objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications.
  
  
  METHODS
  Eleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress.
  
  
  RESULTS
  Out of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy.
  
  
  CONCLUSIONS
  A small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
authors.forename: Farooq Ahmad
authors.initials: FA
authors.lastname: Ganie
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
authors.forename: Hafeezulla
authors.initials: H
authors.lastname: Lone
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Lone
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
authors.forename: Mohd Lateef
authors.initials: ML
authors.lastname: Wani
authors.affiliation: Department of General Surgery, Kidney Hospital, Srinagar, India.
authors.forename: Shabir Ahmad
authors.initials: SA
authors.lastname: Ganie
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
authors.forename: Nasir-U-Din
authors.initials: NU
authors.lastname: Wani
authors.affiliation: Department of J and K Health Services, University of Kashmir, Kashmir, India.
authors.forename: Masaratul
authors.initials: M
authors.lastname: Gani
keywords: Delayed Diagnosis; Hernia, Diaphragmatic, Traumatic; Wounds, Nonpenetrating