Fifty-seven cases of diaphragmatic hernia and eventration.

During the last 20 years great advances have been made in the recognition of diaphragmatic hernia, and many series of cases reported by numerous authors have helped to place the diagnosis and treatment on a sound surgical basis (Dunhill, 1935; Barrett and Wheaton, 1934; Donovan. 1945; Morton, 1939; Harrington, 1940; Gross, 1946). More recently progress in thoracic surgery and anaesthesia has given a more direct approach to the lesion itself and has placed the treatment of diaphragmatic hernia on a basis comparable with the treatment of other types of herniation of the abdominal organs (Sweet, 1948; Truesdale, 1945 ; Allison, 1946). Since 1937, 46 cases of diaphragmatic hernia have been admitted to this unit. These are reviewed, and three additional cases, treated by Mr. G. A. Mason at the Nottingham General Hospital, have been included in the series. They are classified as (1) traumatic hernia (a) due to non-penetrating injuries; (b) due to penetrating injuries. (c) post-operative; and (2) non-traumatic herniae: (a) oesophageal hiatus hernia with normal oesophagus; (b) oesophageal hiatus hernia with pathological changes in the oesophagus; and (c) hernia through defects in the muscular and tendinous portions of the diaphragm. The subdivision of oesophageal hiatus hernia into those with and those without pathological changes in the oesophagus is necessary in view of the different problems of diagnosis and treatment involved. No attempt has been made to classify the cases into congenital and acquired types ; accurate differentiation is not always possible and is of academic interest only. Eight cases of eventration of the diaphragm seen over the same period are also reviewed. TRAUMATIC HERNIA