Traumatic Closed Rupture of the Diaphragm

1. Four cases of traumatic diaphragmatic hernia are described. Three of them were the result of nonpenetrating injury. The fourth with strangulation of the stomach, followed an esophagomyotomy. Two cases had a large avulsion of the sternocostal insertion of the diaphragm. 2. Fracture of the ribs is not a prerequisite for a rupture of the diaphragm, but often coexists as do other fractures of the skeleton. 3. Rupture of the diaphragm should be suspected after an injury of the trunk or an operation on the diaphragm on the basis of clinical or radiological data relative to either chest or epigastrium. 4. Early diagnosis is desirable and preoperative correction of shock mediastinal shift is essential. The timing of operation is sometimes a dilemma.