With penetrating injury without herniation, diaphragm injury cannot be ruled out with CT
Needs trauma laparoscopy or laparotomy
With soiling, may need to extend the wound radially to wash the chest out, close the diaphragmatic defect by pulling ends up with allis and suturing with continuous non-absorbable suture then placing a chest drain, then dealing to abdo washout
Left side more common due to absence of liver on this side
And right-handed assailant
Be suspicious with thoracoabdominal injury below T5
Large defects may need PTFE patch best placed via thorax
Later complications include hernia with incarceration
Procedure
Principles
Reduction of abdominal contents
Closure of defect
Minimised contamination
Method
Grasp defect edges with allis clamps
Lavage of chest and abdomen
Debride edges to healthy tissue
Suture from deepest extent, towards myself with 0 Prolene or Nylon (permanent monofilament) in continuous fashion