Diaphragm injuries occur with penetrating or blunt trauma and herniation can occur early or late. Rarely injured with blunt trauma. Rare with isolated penetrating trauma, i.e. there is a high degree of associated injuries. Mediastinal air and pleural effusion are clues to the diagnosis. Endoscopy and esophagogram, gastrograffin followed by barium, will confirm the diagnosis.
Treatment is immediate debridement with repair and drainage.
There is a selective approach to penetrating stab wounds . With a negative exam, explore locally to assess peritoneal penetration. If the peritoneum is penetrated perform an exploratory laparotomy. The history and physical examination are the best diagnostic methods in the awake blunt trauma patient. The complication rate is low with the open technique.