CASE STUDY DIAPHRAGMATIC EVENTRATION
The prosthetic mesh is used in cases of extreme amyotrophy [ 4 ] by placing it on the surface of the muscle, fixing it in the peripheral diaphragmatic inserts, and preventing recurrence at the ends of the plication; some authors are reluctant to use it due to the possibility of infection and increased cost of surgery, although these criteria are relative, if properly managed. Phrenic nerve injury is one of the frequent causes, especially at delivery, followed by neoplastic infiltration, compressions, or surgical interventions [ 4 , 17 , 18 ]. This paper did not require an ethical approval since it is retrospective case report in nature. The latter is also an acquired condition due to phrenic nerve injury paralysis or paresis. Thus, follow-up is important in patients who underwent plication of diaphragmatic eventration to assess recurrences and its long term complications. According to the most accepted theory, the kidney reaches the adult location at the eighth gestational week followed by the superior accelerated migration of the metanephros and the delay in mesonephros involution before completing the diaphragmatic development, that is, before the fusion of the pleuroperitoneal membrane.
It consists of the elevation of one, or less likely, both hemidiaphragms causing protrusion of the intra-abdominal viscera to the affected hemithorax. We highlight the importance of good physical examination and judicious use of imaging modalities among patients suspected of diaphragmatic eventeration. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. Simple cases of diaphragmatic eventration may not require intervention when not associated with adverse symptoms. We describe the case of a year-old girl with dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years and presumable repeated episodes of bronchial asthma since her childhood.
Video assisted thoracoscopic plication of the left hemidiaphragm in symptomatic eventration in adulthood. The diaphragm presented thickness with muscle fibers, which suggested a normal embryonic development and later perinatal traumatic injury of the phrenic nerve.
We describe the case of a year-old girl with dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years and presumable repeated episodes of bronchial asthma since her childhood.
Intra-operatively, there was no note of gastric volvulus only that the fundus was elongated with the cardia reaching high up to the left quadrant of the abdomen. Axial section with the kidney in a posterior position and mild mediastinal compression. This drainage was probably due to the presence of foreign bodies mesh that led us to administer octreotide to the patient.
Diaphragmatic Eventration: Autopsy Case Report
Bowel loops can be seen in the thorax if a radiopaque contrast agent is used [ 10 ]. The prosthetic mesh is used in cases of extreme amyotrophy [ 4 ] by placing it on the surface of the muscle, fixing it in the peripheral diaphragmatic inserts, and preventing recurrence at the ends of the plication; some authors are reluctant to use it due to the possibility of infection and increased cost of surgery, although these criteria are relative, if properly managed.
View at Google Scholar C. Similar to the previous findings, the computed tomography images in this case revealed the kidney to be located in the posterior mediastinum with a complete normal rotational process. Impression was diagrammatic hernia versus eventeration. We did an abdominal approach to evaluate the abdomen because the patient had epigastric discomfort.
Both his feet were introverted, and splayed.
Bowel loops occupying the right hemithorax. Diahpragmatic asymptomatic patients, there are no data comparing the surgical treatment and the conservative approach or the adequate surgical time from the onset of symptoms, especially in the group with phrenic nerve injury; patients with phrenic injury after cardiac surgery may show improvement in the first or second year.
Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation
It consists of the elevation of one, or less likely, both hemidiaphragms causing protrusion of the intra-abdominal viscera to the affected hemithorax. The diagnosis of diaphragkatic renal ectopia usually occurs in adults.
Eur J Pediatr Surg. Sagittal section of the right hemithorax showing occupation by intestinal loops and mesentery. Note that it surrounds the kidney posteriorly since it remained in the intrathoracic position. The latter is also an acquired condition due to phrenic nerve injury paralysis or paresis.
The right kidney and its respective pedicle in the posterior intrathoracic situation. Patchy areas of transparency, and extreme flacidity were seen on diaphragmatic crura Figure 2.
The stretching of the stomach was probably the cause of the epigastric discomfort in this patient. Computed tomography and magnetic resonance imaging can be used to accurately determine the elevation of the dome, the viscera in the intrathoracic position, and associated injuries; tumors can be seen in the base of the pulmonary, cervical, or renal ectopia, as in the present case.
Our patient presented this diaphragmatic continuity on computed tomography, which was initially overlooked and required laparoscopic intraoperative detection, as described by Mantoo and Mak [ 22 ]. Complications after abdominal plication of a diaphragmatic eventration commonly include atelectasis and rarely, abdominal compartment syndrome and splenic injury after mobilization of the left upper quadrant abdominal structures.
Support Center Support Center. Laparoscopic plication is carried out from the posterior to the anterior position and then from the medial to the lateral, of which a detailed description is made by Groth and Andrade [ 317 ].
Microscopically, there is paucity or absence of muscular fibers and diffuse fibro elastic changes. Ultrasonography has also been used to visualize the PM of the diaphragm. On external examination at autopsy, deformity of the lower extremity secondary to polimyelitis, and an obliquely coursing scar tissue 5 cm in length at the same level with the costal arch on the right axillary line were seen.
Incentive spirometry and deep breathing exercises were started with resolution of the atelectasis after 1 week post-operatively. The scan showed bowel loops in the left hemithorax with no masses noted in the chest Fig. Congenital diaphragmatic eventration is characterized by aplasia of the diaphragm muscle 2. She post-operatively had atelectasis on the left lung.