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Mon Nov 24 13:56:45 GMT 2008

Thank you for clarifying that as the location distinction was something I
was not aware of..  I never thought about it from that perspective since
I've never seen a diaphragmatic injury directly (meaning, in person and not
on imaging) in a person that was not deceased.

On Mon, Nov 24, 2008 at 1:33 AM, Dr Timothy Hardcastle <
dr.tchardcastle at absamail.co.za> wrote:

> Stephen
>
> I suspect it has to do with the part of the diaphragm injured. Most of the
> hernias present in those with holes in the fibrous central tendon - the
> bit that rises high up during expiration - thus being prone to injury
> during a chest stab - one is inclined to shout "ouch" = expiration.
>
> As to why some herniate then - the injuries to the musclular portion I
> would postulate heal themselves, while tendonous injuires do not -
> negative pressure in the chest can slowly drag bowel into the gap. Most, I
> suspect, get blocked by that good policeofficer of the abdomen - omentum
> and are not heard about again.
>
> Regards
> Tim
>
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
> > On Sun, Nov 23, 2008 at 8:07 PM, McSwain, Norman E Jr.
> > <nmcswai at tulane.edu>wrote:
> >
> >> Tim
> >>
> >> Sorry for the late response but I was on in-house trauma call yesterday
> >> and
> >> had to nap this afternoon. Yes, I know I am a wimp
> >>
> >> As you know, Scott Frame (when he was a fellow with me) did some small
> >> animal research that demonstrated the almost 100% of the mice with a
> >> hole in
> >> the diaphragm that was the side of the diameter of the small bowel would
> >> develop a hernia. My personal experience (I know, poor data) we do not
> >> see
> >> as many hernias in humans.
> >
> > I am not sure why
> >
> >
> > Perhaps it has something to do with the fact that we are bipedal
> creatures
> > and the position most of us are in most of the time allows for gravity to
> > aid in keeping our bowels in the proper compartment.  This is just a stab
> > in
> > the dark and I could be wrong, but that would be my guess.
> >
> >
> >
> > --
> > Stephen L. Richey, CRT
> > Aviation Injury Research Project Leader
> > Saginaw Valley State University
> > Work E-mail: slrichey at svsu.edu
> > Home Office Phone: 248-366-4452
> >
> > "Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."- Martin
> > Luther, before the Diet of Worms, 16. April 1521
> > --
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> >
>
>
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-- 
Stephen L. Richey, CRT
Aviation Injury Research Project Leader
Saginaw Valley State University
Work E-mail: slrichey at svsu.edu
Home Office Phone: 248-366-4452

"Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."- Martin
Luther, before the Diet of Worms, 16. April 1521

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