Place an NG tube when possible. This will help in diagnosis if the NG tube appears in the chest on chest x-ray. Aspiration of gastric contents also helps to decompress any abdominal herniation and lessen the abdominoperitoneal gradient that favors herniation into the chest. Consider placing a chest tube to drain any associated hemothorax or pneumothorax. Perform this with caution to prevent injury to herniated abdominal contents within the pleural cavity.
Most surgeons recommend chest tube placement prior to transfer to another facility.
If this is not required immediately in the definitive care institution, it may be delayed and completed in the operating room. Surgical repair is necessary, even for small tears, because the defect will not heal spontaneously. The parietoperitoneal pressure gradients favor enlargement of the defect with herniation of abdominal contents. Surgical management usually employs the transabdominal approach to allow a complete trauma laparotomy to search for other injuries. A thoracotomy may be necessary for repair, especially in right-sided injuries or when significant herniation has occurred.