After this meal his stomach swelled
to an enormous extent and tore the diaphragm on the right side,
causing immediate death.
The diaphragm may be ruptured by external violence (a fall on the
chest or abdomen), or by violent squeezing (railroad accidents,
etc.), or according to Ashhurst, by spasmodic contraction of the
part itself. If the injury is unaccompanied by lesion of the
abdominal or thoracic viscera, the prognosis is not so
unfavorable as might be supposed. Unless the laceration is
extremely small, protrusion of the stomach or some other viscera
into the thoracic cavity will almost invariably result,
constituting the condition known as internal or diaphragmatic
hernia. Pare relates the case of a Captain who was shot through
the fleshy portion of the diaphragm, and though the wound was
apparently healed, the patient complained of a colicky pain.
Eight months afterward the patient died in a violent paroxysm of
this pain. At the postmortem by Guillemeau, a man of great
eminence and a pupil of Pare, a part of the colon was found in
the thorax, having passed through a wound in the diaphragm. Gooch
saw a similar case, but no history of the injury could be
obtained. Bausch mentions a case in which the omentum, stomach,
and pancreas were found in the thoracic cavity, having protruded
through an extensive opening in the diaphragm.
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