In differential diagnosis in the presence of atypical symptoms referable to the upper abdomen or cardiorespiratory system, diaphragmatic hernia must be given serious consideration by clinicians and roentgenologists. This condition, which is not now an uncommon finding during the roentgen examination of the gastro-intestinal tract, may or may not give rise to clinical signs and symptoms. It is interesting to note that previous to 1923, Pancoast and Boles1 were able to find only 47 cases in the literature, whereas, in recent years many reports containing long series of cases have appeared. In our own series, there are 31 cases which were found during the routine examination of 2,213 stomachs, an incidence of 1.4 per cent.
For the purpose of clarifying the classification of diaphragmatic hernia, it will be well to include associated conditions commonly accepted as herniae. Although many classifications have been presented and are of interest, insofar as determining whether the hernia is true or false, congenital or acquired, etc., many give little aid in determining the type of treatment that is to be given the patient. Probably one of the most practical classifications is the following one presented by Marks,2 and which we feel gives the clinician the maximum amount of information from the roentgen examination.
Esophagus very short
Entire stomach in the thorax above the diaphragm
Diaphragmatic hernia with short esophagus.
Part of the stomach above the diaphragm with a congenitally short esophagus
Hiatus hernia—esophagus of normal length.
Esophagus not. . .