CASE STUDY DIAPHRAGMATIC EVENTRATION

However, it has been argued that these methods lacked discriminative power as for diaphragm paralysis, and fluoroscopic evaluations were reported as more helpful in the revealment of anatomical, and functional status of the diaphragm 7. Cases presented with acute respiratory distress secondary to diaphragmatic eventration 6 have been also reported in the literature, but some of the cases have been detected incidentally 4. A dual mesh was interposed to reinforce the suture by fixing prolene 0 in the periphery. The postsurgery improvement encourages its selection in the majority of patients [ 23 ], especially in children, taking into account the lung growth that occurs up to about 10 years. Though on histopathological examination, congestion, and severe edema of diaphragmatic muscle fibers were found, in the literature independent from acute-chronic respiratory disease, morphological changes in cases with diaphragmatic injury were reported as presence of inflammatory cells 8. Groth and Andrade [ 3 ] differentiated the congenital etiology of true eventration from the acquired one.

It consists of the elevation of one, or less likely, both hemidiaphragms causing protrusion of the intra-abdominal viscera to the affected hemithorax. Discussion Management of diaphragmatic eventeration varies greatly on the symptoms of the patients. This explains how the elevated diaphragm in this patient after surgical plication afforded symptomatic relief even if radiological studies showed significant elevation of the affected diaphragm compared to the contralateral side. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic me dicine. 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 ]. Diaphragmatic eventration is a rarely seen asymptomatic pathology, which is generally diagnosed incidentally The right kidney and its respective pedicle in the posterior intrathoracic situation.

The cardiac examination was unremarkable with regular cardiac rate, rhythm and no murmurs were noted. Acquired diaphragmatic eventration can be caused by phrenic nerve injury resulting in diaphragmatic elevation, and paralysis.

Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation

There are reports that diaphragmatic eventration diagnosed even as late 70 years old, highlighting the dogma that this is an asymptomatic disorder does not need all the time surgical therapy. Baseline arterial blood gases taken were within normal limits.

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case study diaphragmatic eventration

It represents diapuragmatic clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion to define details and try to understand the etiopathogenesis; in addition, they should plan an adequate and individualized surgical repair making use, as far as stjdy, of the minimally invasive procedures that are currently used. Plication was done with 1st layer of imbricating silk heavy sutures buttressed by a second layer of interrupted absorbable sutures.

Case Reports in Surgery

Diaphragmatic eventration can be a congenital or acquired disorder. Incentive spirometry and deep breathing exercises were started with resolution of the atelectasis after 1 week post-operatively. An incision was made for hemidiaphragm plication.

Reconstructions in coronal and sagittal planes are useful [ 1422 ]. In our case, bilateral diaphragmatic elevation into chest cavity, diaphragmatic eventration, intrathoracic herniation of the stomach, spleen, and small intestines on the left, and liver on the right side were observed.

Axial section eventratin the kidney in a posterior position and mild mediastinal compression.

Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation

View at Google Scholar P. Clifton and Wulkan [ 27 ] reports the use of PTFE in patients with hernias and eventrations with an excellent description of the operative technique in neonates. To receive news and publication updates for Case Reports in Surgery, enter your email address in the box below.

Plication was done using 2 layered imbricated vertical mattress sutures. Among minimally invasive surgical techniques, diaphragmatic plication has established its success as a very effective method with lower morbidity 1- 3,5,6. Diaphragmatic plication, Diaphragmatic exenteration, Atelectasis. Lung tsudy collapsed in the right hemithorax and occupied by the small intestine, right colon, mesentery, right kidney, and its corresponding pedicle.

case study diaphragmatic eventration

In infants, the symptoms are severe due ddiaphragmatic the poor development of the thoracic cage and weakness of the intercostal muscles that cause paradoxical breathing and require the use of mechanical ventilation [ 313 ]. Literature states that the plicated diaphragm is still immobile and even though elevated, plication prevents paradoxical motion during breathing [9]. Our case is not common, as it refers to an adult woman with a right thoracic kidney and is associated with diaphragmatic eventration type 2.

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This is achieved with diaphragmatic plication and can be performed via thoracotomy or using a minimally invasive laparoscopic or thoracoscopic route, with or without the interposition of a prosthetic material [ 4 — 6 ]. Paresis or diaphragmatic paralysis is an acquired condition resulting from certain abnormalities that affect the neuromuscular axis between the cervical spinal cord and the diaphragm.

case study diaphragmatic eventration

Histopathological microscopic e xamination of the diaphragm muscle revealed very severe edema Figure 3. None of these mechanisms can explain the alteration by itself. Postoperative radiological view of both hemithoraces, showing right lung expansion, renal silhouette, and the hemidiaphragmatic line. Author information Copyright and License information Disclaimer.

Diaphragmatic Eventration: Autopsy Case Report

It is possible to show uninterrupted continuity of the diaphragm to differentiate eventration from hernia, a fact that determines the surgical criteria in case the patient is asymptomatic. Patient had an unremarkable post-operative stay with resolution of symptoms.

She post-operatively had atelectasis on the left lung. Whether surgery indeed improved lung functions in these vastly asymptomatic patients, these questions could be an active area of research in the long term outcomes of these patients.

View at Google Scholar O. Although the patient had follow-up up until 2 years, long term benefits in these patients are yet still to be determined.

The difference between diaphragmatic hernia and eventration is important; in the diaphragmqtic, there is no true defect. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic medicine.

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