. The American journal of roentgenology, radium therapy and nuclear medicine . ound completely retracted, andreduced two-thirds in volume. Its normalposition was occupied by a mass havingthe appearance of brain tissue, whichproved to be the great omentum, andstomach. These had herniated into thethoracic cavity. These organs were dark,slate-colored, and presented an apparentstrangulation at the level of an opening inthe left side of the diaphragm. This holewas of the diameter of about a five-francpiece, and was situated about 10 or 12cm. from the anterior attachments of thediaphragm. An ulcerat
. The American journal of roentgenology, radium therapy and nuclear medicine . ound completely retracted, andreduced two-thirds in volume. Its normalposition was occupied by a mass havingthe appearance of brain tissue, whichproved to be the great omentum, andstomach. These had herniated into thethoracic cavity. These organs were dark,slate-colored, and presented an apparentstrangulation at the level of an opening inthe left side of the diaphragm. This holewas of the diameter of about a five-francpiece, and was situated about 10 or 12cm. from the anterior attachments of thediaphragm. An ulceration of the herniatedstomach was seen at the apex of the pouch,in the vicinity of the greater curvature. Death resulted from the strangulation ofthe gastro-epiploic hernia, this strangula-tion having produced an ulceration of thestomach, followed by a copious internalhemorrhage, with communication into thelung. (Fig. i.) This interesting anatomo-pathologicalobservation shows, first, that wounds ofthe diaphragm do not have any tendencytowards spontaneous healing; second, that. Fig. I the usual clinical methods of investigationare not capable of revealing a diaphrag-matic hernia definitely; third, that, it is ofthe utmost importance always to employ theradiological examination in every case ofwound of the thorax accompanied by digestivedisturbances, if the patients condition per-mits. Unfortunately this is not always thecase. Often a perforation of the diaphragmrequires an immediate surgical interven-tion. Such was the case with the two beau- 378 Radiological Diagnosis of Transdiaphragmatic Hernia of the Stomach tiful anatomical specimens loaned byMajor Martin, which are in the museumof the Val-de-Grace, numbers 2658 and2657. In the first instance, the case wasone of a wound from below upward, witha diaphragmatic hernia of the spleen andstomach, which led to death in 15 second case was a diaphragmatichernia of the stomach itself, from a wovmdextending from above downward
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