Incarcerated and obstructed diaphragmatic hermia.

Diaphragmatic hernia is now recognized as a common abnormality of the upper gastro-intestinal tract, especially in elderly people (Harrington, 1948; Allison, 1951; Belsey, 1952). However, whereas strangulation is a common occurrence in most forms of hernia, it is rare in herniation through the diaphragm (Sellors and Papp, 1955). Carter and Giuseffi in 1948 were able to find only 39 cases of strangulated diaphragmatic hernia reported since 1798, to which they added four more of their own. Five years later, Pearson (1953) had been able to find another 33 cases, making 76 in all. Belsey (1952) stated that volvulus of the herniated stomach and strangulation were uncommon, and Aird (1957) considered that complete obstruction was exceptional. The treatment of completely obstructed or strangulated diaphragmatic hernias is usually surgical and most of the case reports have appeared in surgical journals. During the past 12 months, two patients with incarcerated, obstructed, diaphragmatic hernias have been admitted as emergencies to the wards of the Professorial Medical Unit at the Royal Hospital, Sheffield. One was admitted with a diagnosis of haematemesis, the other was in overt tetany. Because of the infrequency of complete obstruction of a diaphragmatic hernia and the difficulties in diagnosis, we thought it would be of interest to report these two cases.