Wounds of the Diaphragm

Abstract

Diaphragmatic hernia is a frequent sequel to gunshot wounds of the thorax and abdomen. Gross injuries to the diaphragm are usually detected easily at operation, but the literature from the last war shows a surprising number of cases in which the diaphragmatic wound was unsuspected or overlooked. In these cases the missile was either deflected to a site well away from the diaphragm or had passed through the body, leaving an entrance and exit wound apparently not in the path of the diaphragm. The following case showed some interesting features which suggest that the immediate diagnosis of diaphragmatic wounds can be made by a careful X-ray examination. The patient was a male aged 35 years, admitted to hospital fourteen hours after being wounded by a bomb. There was a small penetrating wound on the left side of the head and a larger wound about the level of the fifth left interspace posteriorly. The size of the bomb and the patient's distance from it excluded blast injury. On admission the temperature was 10...