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From question on page 1484

The thoracoabdominal computed tomography scan revealed the presence of liquid and bowel in the left hemithorax. Parietal thickening and enhancement strongly suggested bowel infarction. The heart and mediastinum were shifted to the right side. An exploratory laparotomy was performed. The oesophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemi diaphragm through which herniated a massively dilated transverse colon and jejunum, with evidence of infarction. Transverse colectomy and resection of 2 m of jejunum were performed with direct diaphragm repair. A chest tube was placed in the left hemithorax. The postoperative course was uneventful. The patient was discharged from hospital 10 days after surgery.

One should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Although uncommon, strangulation of the colon and small bowel through a rent in the diaphragm should be considered when there is radiological evidence of herniation.