Massive diaphragmatic eventration: plication

Abstract

Diaphragmatic eventration (DE) is a distinctive condition characterised by the abnormal elevation or displacement of a portion of the diaphragm, often leading to a protrusion of abdominal contents into the thoracic cavity. Unlike diaphragmatic hernias, eventrations involve a congenital or acquired weakness of the diaphragmatic muscle itself rather than a structural defect. Congenital eventrations typically arise from the incomplete development or muscular hypoplasia of the diaphragm, while acquired forms may result from trauma, surgery, or neurological disorders affecting the phrenic nerve. Clinical manifestations vary widely, with some individuals remaining asymptomatic, while others may experience respiratory difficulties, especially when lying down. The case involves a 65-year-old female with a history of breathlessness exacerbated in the lying position, improved when upright. Examination revealed low oxygen saturation, absent breath sounds on the left chest, and bowel sounds in that region. Chest X-ray and HRCT indicated bowel loops in the left chest due to eventration of the left hemidiaphragm. Surgical intervention involved thoracotomy, identifying a lax left hemidiaphragm, mobilising abdominal contents, and performing plication with proline 1-0. Closure was completed with an intercostal drainage (ICD) in the left thoracic cavity. Postoperative period was uneventful. This case emphasises the significance of prompt diagnosis and surgical intervention in managing DE, showcasing the effectiveness of thoracotomy, hemidiaphragm plication, and ICD placement.