Traumatic diaphragmatic hernia in children.

Because of its rarity in children the diagnosis of diaphragmatic hernia due to trauma is often delayed, sometimes resulting in gastrointestinal or respiratory complaints or obstruction of the small intestine. Eleven children with rupture of the diaphragm were seen between 1950 and 1977. All injuries were due to blunt trauma sustained in automobile-related accidents; all involved the left hemidiaphragm. Nine children had associated injuries, most commonly fractures, and injury to the head and spleen. In six children the diaphragmatic rupture was recognized and treated at the time of injury. The other five presented with gastrointestinal or respiratory symptoms from 2 months to 3 years after the trauma. Repair was through the abdomen in 10 patients and the chest in 1. There was only one death from an associated severe craniocerebral injury. Complications developed in five surviving patients but were relatively minor.