Incarcerated diaphragmatic hernia: report of an unusual case.

Traumatic diaphragmatic hernias, although quite common are frequently overlooked as a cause of intestinal obstruction. The hernia may produce significant symptoms acutely or manifest itself many years following the initial injury. A high index of suspicion is necessary to diagnose intestinal obstruction due to incarcerated diaphragmatic hernia. The operation should be performed through the transabdominal approach when hernia occurs acutely, and the transthoracic approach is recommended when herniorrhaphy is performed long after the time of injury. A case of incarcerated traumatic diaphragmatic hernia that occurred 19 years following a gunshot wound of the chest is reported. The intestinal obstruction was initially thought to be due to cancer of the splenic flexure of the colon.