The difference between eventration and hernia was recorded by Bisgard in , who describes eventration as an abnormally high, or elevated position of one leaf of the diaphragm as a result of paralysis, or atrophy of varying degree of the muscle fibers. Diaphragmatic plication, Diaphragmatic exenteration, Atelectasis. To receive news and publication updates for Case Reports in Surgery, enter your email address in the box below. Journal List Maedica Buchar v. National Center for Biotechnology Information , U. Digestive symptoms, such as nausea, vomiting, flatulence, abdominal pain, epigastralgia, constipation, anorexia, difficulty in gaining weight, and varying degrees of gastroesophageal reflux, may coexist [ 21 ].
Authors contribution Johann Paulo S. Partial presentation is frequent in the anteromedial region of the right hemidiaphragm, whereas complete presentation is commonly found in the left hemidiaphragm [ 12 ]. 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. Gastrointestinal symptoms may be present including epigastric discomfort, heartburn, bloating constipation and weight loss. Among minimally invasive surgical techniques, diaphragmatic plication has established its success as a very effective method with lower morbidity 1- 3,5,6. Additionally, an eventrated or paralyzed hemidiaphragm may have very little or no PM. 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 ].
Journal List Maedica Buchar v. The criteria to define a congenital chest kidney involve rotational anomaly, long ureter, abnormally high vessels, and deviation of the lower pole [ 16 ].
A posterolateral thoracotomy was continued at the level of the seventh intercostal space, with the hemidiaphragm being thinned, although with moderate thickness of muscle fibers Figure 8. She post-operatively had atelectasis on the left lung.
Among symptomatic patients, the most common symptom is dyspnea. Plication was done with 1st layer of imbricating silk heavy sutures buttressed by a second layer of interrupted absorbable sutures.
Both chest radiography and ultrasonography are not useful in the differentiation of eventration and diaphragmatic hernia. Author information Copyright and License information Disclaimer. Pulmonary function tests PFTs are important for a dyspneic patient with an elevated hemidiaphragm for highlighting the forced vital capacity and forced expiratory volume in 1 second, showing a restrictive pattern. As reported by his family, our old male patient who was found dead at home, had suffered from poliomyelitis when he was a child, and also treated for respiratory tract diseases.
Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation
Edgar A Baltazar MD — data analysis and interpretation. The high dome without contraction causes pulmonary collapse causing atelectasis, bronchial or parenchymal infections, or alterations in myocardial excitability due to mediastinum deviation [ 20 ]. 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.
A dual mesh of polypropylene-PTFE was placed for reinforcement and fixed at the level of diaphragmatic periphery Figure Notable hepatic displacement towards the left hemiabdomen that causes gastric compression. We consider it important to report this case due to the inaccurate diagnosis of diaphragmatic eventration, owing to the coexistence of an intrathoracic ectopic kidney, location of the defect on the right side, sex of the patient, and the age of the patient at the time of diagnosis.
The pedicle of the intrathoracic right kidney ran through the foramen of Bochdalek Figure 7. The treatment must restore an active and effective contraction and improve the respiratory activity. The present case was a woman of 17 years of age, with infrequent presentation of complete right defect [ 12 ].
The right hemithorax presented invasion of the thin loops, right colon, and kidney. Central trachea and normal left hemithorax.
Case Reports in Surgery. Although, this is a case report, the patient consented to this publication. We proceeded by performing posterolateral thoracotomy at the level of the stucy intercostal space, with the hemidiaphragm incision to visualize the peritoneal viscera and avoid injury. The ureter was long to reach the excessive bladder distance but did not enter ectopically [ 2935 ].
The image shows the abolition of the paradoxical movement, and although the diaphragm can remain motionless, there is stuudy recurrence of symptoms [ 25 ]. Discussion Management of diaphragmatic eventeration varies greatly on the symptoms of the patients.
Case Reports in Surgery
This induces a progressive amyotrophy and stretching of all muscular fibers of the dome. The pleural effusion through the chest tube was high and remained constant in the first 4 weeks and decreased 2 weeks later, after which we had removed the thoracic tube.
Chest radiographs are the initial and most commonly performed imaging to evaluate the diaphragm. There is indication for surgical intervention only in the presence of symptoms .
There was an improvement of respiratory symptoms. Chest Xray taken on the first operative day showing atelectasis on the left lung. The difference between diaphragmatic hernia and eventration is important; in the latter, there is no true defect.
Diaphragmatic Eventration: Autopsy Case Report
A barium swallow was done clearly showing gastric contents located in the left hemithorax and no defects were noted in the left diaphragm.
Groth and Andrade [ 3 diaphrafmatic differentiated the congenital etiology of true eventration from the acquired one. Plication by posterolateral thoracotomy is achieved through the sixth, seventh, or eighth intercostal space, using U points, mattress stitch, continuous suture, or stapling [ 3 ].