- 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