Stabbing injuries are now common, and the number of haemodynamically stable patients with penetrating injuries of the chest and upper abdomen who are treated conservatively has increased. The case we present supports a more aggressive approach to penetrating thoracic injuries that occur between the horizontal planes bounded by nipple line and umbilicus (junctional zone).

No universally accepted strategy for managing this condition exists. Some doctors use advanced cross sectional imaging1 complemented by clinical acumen; others adopt a more invasive approach—laparoscopy or thoracoscopy.2

We present a case where a missed injury to the diaphragm caused by penetrating thoracic trauma resulted in serious morbidity. We conclude that conservative management of such injuries results in a considerable risk of occult hernia of the diaphragm with potentially life threatening sequelae.