title: Delayed traumatic diaphragmatic hernia: A case-series report and literature review.
abstract: BACKGROUND
  Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias.
  
  
  METHODS
  Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi'an Jiaotong University from 1998 to 2014 were analyzed retrospectively.
  
  
  RESULTS
  Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected.
  
  
  CONCLUSIONS
  Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage.
authors: Department of General Surgery Department of Hepatobiliary Surgery, the First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an Shaanxi, P.R. China.
authors: Jing
authors: J
authors: Lu
authors: Bo
authors: B
authors: Wang
authors: Xiangming
authors: X
authors: Che
authors: Xuqi
authors: X
authors: Li
authors: Guanglin
authors: G
authors: Qiu
authors: Shicai
authors: S
authors: He
authors: Lin
authors: L
authors: Fan
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D057210:Delayed Diagnosis / Q000517:prevention & control; D005500:Follow-Up Studies; D006549:Hernia, Diaphragmatic, Traumatic / Q000209:etiology* / Q000503:physiopathology*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome