CT confirms left diaphragm rupture with portions of stomach, large bowel and small bowel herniating into the chest. Positive mass effect from the herniated contents causes mediastinal shift to the right and near complete collapse of the left lower lobe. The distal transverse colon is narrow at entering the hernia, then becomes significantly dilated when it sits anteriorly and then becomes collapsed suggesting closed obstruction of this segment. A left intercostal catheter has been placed into the herniated peritoneal contents rather than the pleural space and abuts several bowel loops. It is difficult to know if any iatrogenic bowel injury has occurred.
Other findings include; trace haemothoraces, small residual right anterobasal pneumothorax, displaced right rib fractures with flail segment, left anterior rib fractures, right scapula fracture, multiple thoracic fractures (some old and some new), mesenteric haematoma suggesting possible bowel injury and right iliac wing fracture.