Diaphragmatic rupture during G-maneuvers in a T33 jet trainer

A 26-year-old white male, radar operator, participated in a flight in a U.S. Air Force T33 jet trainer. The patient experienced nausea and vomiting followed by several episodes of retching during maneuvers of positive acceleration. Upon landing, he noted severe epigastric pain and shortness of breath. After 3 h of persistent symptoms, he presented to the base hospital's emergency department where he was diagnosed as having diaphragmatic herniation of abdominal viscera into the left hemithorax. At laparotomy, a large traumatic paraesophageal tear was discovered. The abdominal viscera were reduced and the defect repaired. The postoperative course was uncomplicated. The pathophysiology of blunt, nonpenetrating diaphragmatic herniation is discussed. Another mechanism for diaphragmatic rupture resulting from the forces of vomiting and acceleration is proposed.