Colonic obstruction following direct traumatic diaphragmatic hernia

We report two patients who were administered to our hospital with an obstruction of the colon. 4 months ago one of the patients had suffered a penetrating wound with a knife in the upper left abdomen. The other patient was wounded by gunshot in the left thorax 50 years ago. The x-ray of the lung showed the ruptured diaphragm as a sharp line in the left thorax and the enema with contrast fluid revealed a stop at the left colonic flecture. In both cases the rupture of the diaphragm was closed via an abdominal approach, the inspection of the colon did not discover any defect, The postoperative course was uneventful. In contrast to other authors we believe that the delayed rupture of the diaphragm in connection with a colonic obstruction should be repaired by an abdominal access.