Diaphragmatic Eventration Research Articles

A Neonate with Eventration of Diaphragm

A term male neonate weighing 2720 gm was born to Gravida 2 lady by normal vaginal route. The immediate post natal period was uneventful. At 12 hrs of life, the baby developed poor feeding and fast breathing and was shifted to NICU. The initial evaluation revealed decrease in air entry on left infraaxillary and infrascapular region. The lab investigation showed features of sepsis. The CXR showed raised hemidiaphragm with intact continuity on left side. The neonate was started on CPAP, antibiotics and IV fluids and was prepared for surgery.

Gastric Volvulus with Eventration of Diaphragm

Gastric volvulus with eventration of diaphragm is an uncommon occurrence. We report here case of a middle-aged woman who came with left-sided chest pain since 1 month, and occasional history of breathlessness in supine position. She was advised to have chest radiograph and ECG done. ECG was within normal limits. On chest radiograph, there was smooth, round, well-defined elevation of left hemidiaphragm with air fluid levels below it. Mediastinum was shifted towards right side. Based on that, barium meal was advised which showed contrast filling with alteration of axis of stomach. Organoaxial type of gastric volvulus is confirmed.

Eventration of diaphragm with gastric volvulus: A case report

Gastric volvulus is a rare but potentially life threatening cause for upper gastrointestinal obstruction. It is an abnormal rotation of one part of the stomach around another which can manifest with acute, intermittent or chronic symptoms. Historically first reported case of gastric volvulus was in 1866 by Berti and the first operation for this condition was performed in 1897 by Berg. Since then there are approximately 400 cases reported in the literature. We report a case of acute gastric volvulus associated with eventration of left hemidiaphragm in a 60 years old female who presented with features of gastric outlet obstruction.

Surgical Treatment for Congenital Lung Parenchyma and Non Lung Parenchyma Disorder: Center Experience

Objective: Non parenchyma lung disorders are rare entity with life threatening outcome. Early surgerical intervention is the clue for life saving and avoid life threatening complications. Methods: From Aug 2008 to dec 2014, 101 cases operated in Zagazig University Hospital for congenital non parenchyma disorder data are collected regarding preoperative, intra operative and post operative results. Results: The mean age of our patients was 27 month (1 week - 120 month). F\M 61\40. Mean symptom is respiratory distress and frequent chest infection. Tracho-esophygeal fistula 24 cases, Congenital diaphragmatic hernia 17, Diaphragmatic event ration 6, congenital lobar emphysema 37, cystic adenomatoid malformation (n=9), pulmonary sequestration (n=7) and arteriovenous malformation (n=1). Conclusion: Early surgerical intervention for parenchyma and non parachyanma l disorder is the primary curative to avoid life threatening complications.

Anaesthetic Management of an Adult Patient with Diaphragmatic Eventration

This case report presents the anaesthetic management of an adult male, who had epidermal inclusion cyst of neck with incidental findings of diaphragmatic eventration, dextro position of heart and pituitary macro adenoma, but the patient was clinically asymptomatic, planned for neck exploration and excision of cyst. Induction of anaesthesia was uneventful, Intra operatively patient became hypoxic and hypotensive probably due to increase in shunting fraction, norepinephrine infusion was started; blood pressure and oxygen saturation improved, at the end of surgery patient was successfully extubated, rest of the course was unremarkable.

Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report

Eventration of the diaphragm (ED) is a relatively rare condition. Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm in which all or part of the diaphragm is largely composed of fibrous tissue. Clinical manifestations range from asymptomatic to life threatening respiratory distress. Recurrent chest infections are also the presenting complaints in patients. We report a 7year old boy who presented with recurrent chest infections with left diaphragm eventration treated by plication successfully.

PRENATAL DIAGNOSIS AND SURGICAL INNOVATIONS IN CONGENITAL DIAPHRAGMATIC HERNIA: EVALUATION OF PRE- AND POST-OPERATIVE MANAGEMENT

Introduction. Congenital diaphragmatic hernia (CDH) is still today considered a challenge from surgeons. Considerable progress in prenatal diagnosis, intensive care unit of neonates and surgical techniques, with the possibility to perform minimally access surgery, widely increased survival rates. The aim of this study is to analyze our series about long and short-term outcomes, also considering the progress made by minimally invasive techniques. Methods. The study was performed at Pediatric Surgery of Siena. It is a retrospective study that analyzed all patients with CDH (Bochdalek) treated in the last 14 years, from 2000 to 2013. Sex, side of the defect, presence of prenatal diagnosis, age of onset and symptoms, associate malformation, herniated organs, surgical technique and site of surgery, complications, recurrences, survival and followup were analyzed. Results. We included 23 patients. Five of them, were ruled out because of affected by diaphragmatic eventration or acquired diaphragmatic hernia. Forteen patients (77%) presented left CDH and 4 patients (23%) a right one. The male female ratio were 14:4. Prenatal diagnosis was performed in 5 patients (27,5%) at a mean gestational age of 29 weeks. Forteen patients (77%) had an early onset of symptoms (first day of life). Most common symptoms were respiratory distress and cyanosis; 4 patients (23%) had a late onset of symptoms, at a mean age of 9 months, and most common symptoms were failure to thrive and vomiting. Seven patients (39%) had associated malformation: common mesenterium (5 pts-71%). The colon was the most commonly herniated organ, present in 15 patients (83%), followed by small intestine in 13 patients (72%), stomach in 11 patients (61%), spleen in 9 patients (50%) and liver in 4 patients (23%). Seventeen patients (94,5%) underwent open surgery: 10 of them (59%) underwent a subcostal laparotomy approach, 7 of them (41%) underwent a supraumbelical laparotomy approach; 1 patient (5%) underwent minimally access surgery with thoracoscopy access. We performed performed surgery in the intensive care unit in 3 patients (16,5%). Six patients (33%) developed minor postoperatory complications. No patient had recurrence. Four patients died so we report a mortality rate of 23%. A follow-up investigation, with an average duration of 87 months, it is still going on in 5 patients (27,5%). Conclusions. The our survival rate was 77% and it reflects the encouraging reported data in the recent literature. These results are due to the reliability of the new resuscitation strategies, such as high-frequency oscillatory ventilation and the use of NO, the ability to perform surgery in the neonatal intensive care unit and, especially, to successfully perform minimally invasive surgery in newborn. The improvement of the survival showed the increasing of long-term morbidity end the requirement of a multidisciplinary followup. For these reasons, a multidisciplinary pathway for the management of young patients has been created, to follow them in a standardized way as early as the prenatal diagnosis.

Right-sided diaphragmatic eventration with gastric volvulus and abnormal rotation of liver

Background: Diaphragmatic eventration is permanent elevation of an immobile hemidiaphragm. It is commonly described on the left side and very rarely on the right side. It usually is associated with acute gastric volvulus with strangulation. Sometimes it is complicated with malrotation of abdominal contents. Mesenteroaxial volvulus is usually primary, without an underlying diaphragmatic defect. Case Presentation: A 50-year-old male presented with occasional shortness of breath and intermittent abdominal pain for past four months. Chest examination revealed decreased movements on right side. Chest X-ray showed elevated right hemidiaphragm and minimal left sided mediastinal shift. Fluoroscopy revealed decreased movement of the right hemidiaphragm. Contrast enhanced CT scan of the chest and abdomen revealed that right hemidiaphragm was raised and reaching up to the level of horizontal fissure. Mild basal atelectasis was present in underlying lung parenchyma. There was herniation of liver with mild rotation, right kidney, hepatic flexure of colon, few jejunal loops, abdominal fat and few mesenteric vessels into the right thoracic cavity. Upper gastrointestinal contrast study revealed displacement of antrum above the gastroesophageal junction. A diagnosis of eventration of right diaphragm with abnormal rotation of liver and mesenteroaxial gastric volvulus was made. Conclusion: The prompt diagnosis of right diaphragmatic eventration with mesenteroaxial gastric volvulus and abnormal rotation of liver is critical to avoid catastrophic complications of ischemia, perforation and strangulation as early management in such cases without gastric necrosis is associated with less postoperative morbidity and mortality.

Partial monosomy 3q26.33-3q27.3 presenting with intellectual disability, facial dysmorphism, and diaphragm eventration

Şahin, Yavuza,b; Kiper, Pelin Ö.b; Alanay, Yaseminb; Liehr, Thomasc; Utine, Gülen E.b; Boduroğlu, Korayb Author Information

Video-Assisted Minithoracotomy Diaphragmatic Plication: Respiratory Effects in Adults.

Objectives The objective of this study was to analyze the clinical respiratory and spirometric effects of video-assisted minithoracotomy diaphragmatic plication (VAM-T DP) in the treatment of diaphragmatic eventration. Methods A retrospective longitudinal study of 18 patients who underwent a VAM-T DP in our service between February 2005 and July 2011 was performed. Data of patient characteristics, preoperative clinical variables, and postoperative results (3, 6, and 12 months) were collected for statistical analysis using the software package SPSS 13.0 for Windows (Wilcoxon test, Friedman test, and Z-test). Results The main clinical respiratory and spirometric variables improved significantly and remained stable over 1 year. Conclusions VAM-T DP is a viable and safe procedure that improves the spirometry values and offers stable results during the first year. To our knowledge, the present series is the second largest published report in English relating to this procedure in adults.

A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results.

Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique. The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique. Nine patients have undergone thoracoscopic plication at a median age of 3months (range 0.2-13.2 mos.) and a median weight of 4.5kg (range 2.3-8.2kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17months. This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.

P-234 * LONG-TERM RESULTS OF DIFFERENT SURGICAL CORRECTION TECHNIQUES IN DIAPHRAGMATIC EVENTRATION

Objectives: Diaphragmatic eventration is defined by the long lasting or permanent elevation of the diaphragm without defects. There is no definite data about the benefit of different surgical technical corrections of the diaphragmatic location in adults. The aim of the study is to verify the benefit of different surgical correction techniques. Methods: Between January 2008 and November 2011, 26 consecutive adult patients with diaphragmatic elevation who underwent thoracotomy were retrospectively analyzed. Correction of the diaphragm was achieved either by accordion plication (n = 10) or by double-breasted plication (n = 16) through thoracotomy. Operative outcomes with clinical (Medical Research Council-MRC Dyspnoea score), radiological and functional improvement trends were compared between the groups after 12 and 24 months. Results: The mean follow-up was 18.7 ± 5.2 months (range 12-32). Most of the patients (77%) were operated for left-sided diaphragmatic eventration. The mean MRC dyspnoea score was 3.0. The mean elevation of the diaphragm was calculated as 5.7 ± 2.5 (3-11) cm. There was no statistically significant difference between both groups in age, gender, aetiology, preoperative spirometric values, degree of diaphragmatic elevation and time to surgery. However, in the double-breasted plication group drainage was statistically increased. Although the corrected diaphragm was statistically well preserved in the double-breasted plication group, this re-positioned diaphragm showed no effect on the value of spirometry and MRC score. No complication was noted specifically related to techniques. Conclusions: The results of the study show that radiological prospect of corrected diaphragm is well preserved with double-breasted plication, but respiratory function was not affected by the technique. Disclosure: No significant relationships.

Exome sequencing identifies ZFPM2 as a cause of familial isolated congenital diaphragmatic hernia and possibly cardiovascular malformations

Using exome sequencing we identify a heterozygous nonsense mutation in ZFPM2 as a cause of familial isolated congenital diaphragmatic hernia in 2 affected siblings. This mutation displays variable phenotypic expression being present in a third sibling with a mild diaphragmatic eventration and a cardiovascular malformation. The same variant is seen in 2 additional family members, both of whom are asymptomatic, thus highlighting that ZFPM2 haploinsufficiency is associated with reduced penetrance. Our finding adds further evidence for ZFPM2 having a role in diaphragm and cardiovascular development.

English

We report a 64 year old female who presented with epigastric pain and intractable vomiting not respond to treatment and we were not able to pass nasogastric tube. Chest x -ray shows eventration of left sided hemi diaphragm, upper gastro intestinal contrast study conform the diagnosis of gastric volvulus. Plication of left hemidiaphragm with anterior gastropexy was performed through an abdominal approach. Postoperatively the patient's symptoms improved. Acute gastric volvulus carries a mortality rate of 42-56%, secondary to gastric ischemia, perforation or necrosis. 1 Emergency physicians should have suspicion about gastric volvulus when treating patients with abdominal pain and persistent vomiting. The patient should go for surgical consultation as early INTRODUCTION: In diaphragmatic eventration, permanent elevation of an immobile hemidiaphragm occurs in which peripheral muscular attachment is normal with no interruption in peritoneal or pleural layers. It usually remains asymptomatic in early life and presents later with respiratory and occasionally gastrointestinal complications. This may lead to displacement of abdominal organs, especially the stomach. Gastric volvulus is an uncommon complication of eventration of diphragm.2 There are two types of gastric volvulus: organoaxial and mesenteroaxial. The most common type is organoaxial, in which the stomach rotates along the longitudinal axis and is associated with paraesophageal hernias. The mesenteroaxial type, in which the stomach rotates between the lesser and greater curvatures, is believed to be idiopathic, causing chronic symptoms. 3 The presence of persistent vomiting and epigastric pain despite initial antiemetic treatment should trigger one to think of gastric volvulus, despite the patient appearing very stable and healthy. Diagnosis of gastric volvulus, which can have significant morbidity and mortality can be easily missed. Early radiological imaging with x-ray or computed tomography (CT) can facilitate the management of the patient. Eventration of diaphragm is defined as an abnormal elevation of an intact diaphragm and most often is characterized by a developmental abnormality of the diaphragm musculature. 4 It usually remains asymptomatic in early life and presents later with respiratory and occasionally gastrointestinal complications. The abnormally wide diaphragmatic space provides the potential for abnormal rotation of stomach around itself. This abnormal rotation is known as gastric volvulus. It is of two varieties. One is organoaxial (more common) and other is mesentero-axial. We present a case of 60 year old female with eventration of left hemidiaphragm with chronic intermittent organo-axial gastric volvulus.

A Survey of Pulmonary Function Abnormalities Following Thoracotomy

To study the incidence and type of pulmonary function abnormalities after thoracotomy in children. Children below 12y of age who had undergone thoracotomy for any condition and have at least 2y follow up were included in the study. Detailed assessment of the patients included history and general examination, clinical assessment of pulmonary function, bedside tests to assess pulmonary function and laboratory pulmonary function test using portable spirometer. Fifty two patients were included in the study. Twenty-seven were cases of esophageal atresia with trachea-esophageal fistula (EATEF), nine pulmonary metastasis from abdominal solid tumors, six mediastinal masses, three hydatid cyst, three eventration of diaphragm, two bronchiectasis, and one each of H-type TEF and congenital esophageal stenosis. The mean age at the time of evaluation was 6.3y (range 2-18y). While all the patients were clinically assessed, only 25 (48%) were eligible for bedside tests and 23 (44%) for spirometery. The incidences of abnormalities picked were: dyspnea during exercise 8/52 (15.4%), dyspnea on exercise and on climbing stairs 1/52 (2%), decreased breath holding time 2/25 (8%), abnormal incentive spirometry 1/25 (4%), mild restrictive pattern on pulmonary function test (PFT) 11/23 (47.8%), moderate restrictive pattern on PFT 2/23 (8.7%). None had an obstructive pattern on PFT. Though the incidences of pulmonary function abnormalities were high, these were of mild grade. Close follow up of patients after thoracotomy would be needed for early pick up and appropriate management of these abnormalities to prevent long-term consequences.

Right atrial compression due to diaphragmatic eventration after liver transplantation: Successful treatment by diaphragmatic plication

Right atrial compression due to diaphragmatic eventration after liver transplantation: Successful treatment by diaphragmatic plication

Eventration of diaphragm with dextrocardia and type 2 respiratory failure: A rare entity

Eventration of the diaphragm is a rare condition where the muscle is permanently elevated, but retains its continuity and attachments to costal margin. In this condition, all or part of the diaphragm is largely composed of fibrous tissue with a few or no interspersed muscle fibers. It can be complete or partial. It is seldom symptomatic and often requires no treatment. We present a 70-year-old male who came with progressive breathlessness and was admitted with type 2 respiratory failure, and on evaluation was found to have complete eventration of the left diaphragm with herniation of colon and stomach in the left chest with dextrocardia. Aim of reporting this rare case is to highlight the importance of history taking, good physical examination, and imaging in the diagnosis of diaphragmatic eventration.

Eventration of diaphragm with a rare association

AbstractEventration of the diaphragm is a rare anomaly of unknown origin characterized by a permanent high position of one or rarely both the leaflets of the diaphragm, providing a potential space for the displacement of abdominal viscera on the affected side(s). The etiology, diagnosis, and management of this condition remains a controversial subject. We report a rare case of infiltrating squamous cell carcinoma of the esophagus in a patient with eventration of the diaphragm and gastric volvulus who presented to us with retrosternal discomfort. To the best of our knowledge, this rare association has not been reported in the literature, although one case of esophageal adenocarcinoma arising from Barrett’s esophagus in association with eventration of the diaphragm has been reported previously. This case again emphasis the varied associations of an eventration of the diaphragm.

Dyspnea in pregnancy: An unusual cause

Eventration of diaphragm is usually asymptomatic, but can present with symptoms ranging from mild dyspnea to a life‑threatening emergency. It can pose a management dilemma when diagnosed incidentally especially during the pregnancy. We report a case of eventration of diaphragm diagnosed during pregnancy and managed conservatively with a favorable feto-maternal outcome. Keywords : Dyspnea, eventration of diaphragm, pregnancy

Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in the COPDGene® Study

Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.