Historical Vignette: Traumatic diaphragmatic hernia apparently was described by Sennertus, who in 1541 reported an instance of delayed herniation of viscera through an injured diaphragm. The first two deaths were described by Ambrose Paré in 1578, one from strangulated bowel. Ambroise Paré, in 1579, described the first case of diaphragmatic rupture diagnosed at autopsy. The patient was a French artillery captain who initially survived a gunshot wound of the abdomen, but died 8 months later of a strangulated gangrenous colon, herniating through a small diaphragmatic defect that would admit only the tip of the small finger. It was not until 1853 that ante mortem diagnosis of traumatic rupture of diaphragm was made by Bowditch. The first successful diaphragmatic repair was reported by Riolfi in 1886 in a patient with omental prolapse, and Naumann in 1888 repaired the defect with herniated stomach. The largest and the most comprehensive collective review was

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Background: The aim of the present study was to investigate the incidence and outcome for gunshot wounds (GSW) patients within a metropolitan city in the western region of Sweden, as well as the predictive value of the triage and decision system used in the Prehospital as well as the hospital setting. Methods: All patients with GSW admitted to the Sahlgrenska University Hospital during a three-year period were included in this retrospective analysis. Data were collected from the pre hospital and hospital records. Results: There were a total of 44 patients with 88 GSW, ranging from 1 to 8 in each patient. Injuries to neck/head, thorax and abdomen (n=22) were equally present as Injuries in the extremities (n=22). The average ISS score was 14±16 and the overall mortality after 30 days was 14%. In patients with injuries in the extremities no mortality was seen. Conclusions: The incidence of GSW in Sweden is still low, as well as GSW related hospital mortality. The present triage and decision system, using both vital signs and injuries in a prehospital trauma algorithm, has a good predictive value for the two-tiered trauma team activation system used.

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