XXXX : a continuing challenge.

@entity1 @entity11367 @entity2914 @entity1230 @entity547 @entity1744 @entity130
@entity11367 is an uncommon but important problem in the @entity1 with @entity1230 . Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent symptoms of @entity1744 . From 1957 to 1982, we treated 41 @entity1 with @entity11367 . In 39 @entity1 (95%), @entity2914 followed blunt @entity130 . The herniation occurred on the right side in 14 @entity1 and on the left side in 29; it was bilateral in 2. Twenty-four @entity1 had diagnostic chest radiographs, and an additional 11 had abnormal but nondiagnostic studies. Peritoneal lavage was of little value in making the preoperative diagnosis. Twenty-three @entity1 underwent laparotomy only, 13 required thoracotomy alone, and 5 had combined laparotomy and thoracotomy. There were 7 deaths (17%) from associated injuries. Only one missed injury was encountered; a second delayed @entity547 , initially treated elsewhere, was repaired 45 years after the original @entity130 . @entity11367 should be suspected on the basis of an abnormal chest radiograph in the @entity130 victim with @entity1230 . Right-sided injuries occur more commonly than previously thought and often require dual incisions (laparotomy and thoracotomy) for diagnosis and treatment. The organization of emergency care for such @entity1 is critical in avoiding the potential of long-term sequelae.
