Diaphragmatic Eventration Research Articles

Thoracoscopic Plication for Diaphragmatic Eventration in a Neonate

Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration. A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months. To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.

Acute gastric volvulus with torsion wandering spleen: A rare surgical emergency

Gastric volvulus, wandering spleen and eventration of diaphragm share a common pathologic cause of absence or laxity of intraperitoneal ligaments. We hereby present a rare case of a 15-year-old male child with cerebral palsy presenting with organo-axial type of acute gastric volvulus resulting in gangrene of whole of stomach, associated with an infarcted wandering spleen, eventration of the diaphragm and cholelithiasis.

Imperforate anus associated with eventration of diaphragm.

Anorectal malformations (ARM) are associated with a myriad of congenital anomalies. The prevalence rates of associated anomalies range from 20% to 80%, commonest being urogenital anomalies. Other important associations and syndromes include Down syndrome and VACTERL (vertebral, anorectal, cardiac, trachea-esophageal, renal, limb) anomalies [1]. ARM has rarely been described in association with diaphragmatic anomalies [2-7]. Fewer than half a dozen cases of diaphragmatic hernia are recorded in the literature; but none of diaphragmatic eventration.

Imperforate Anus Associated with Eventration of Diaphragm

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A Rare presentation of Diaphragmatic Eventration in an old man

Diaphragmatic Eventration ( DE) is a rare condition where the muscle is permanently elevated but retains its continuity and attachments to the costal margins. It is seldom symptomatic and often requires no treatment. We present a 65yr old man with previously undiagnosed left sided congenital eventration who presented with predominantly abdominal symptoms and required elective plication

Video assisted thoracoscopic plication of the left hemidiaphragm in symptomatic eventration in adulthood.

Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of the diaphragm, which appears attenuated and membranous, maintaining its normal attachments and its anatomical continuity. It has been attributed to abnormal myoblast migration to the septum transversum and the pleuroperitoneal membrane. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm. Eventration results in diaphragmatic elevation (cephalad displacement). Most adults are asymptomatic and the diagnosis is incidentally made by chest radiography. The commonest symptom in the adults is dyspnoea, while orthopnoea, mild hypoxemia, tachypnoea, respiratory alkalosis, palpitations, and non specific gastrointestinal symptoms may be present. Surgery is indicated only in the presence of symptoms. The established surgical treatment is diaphragmatic plication. Various techniques and approaches have been employed. We present a simple surgical technique of a 3-port video assisted thoracoscopic plication of the left hemidiaphragm in the adult.

Congenital Eventration of Hemidiaphragm in an Adult

Congenital diaphragmatic eventration is a common condition in infancy but is a rare anomaly in an adult. The muscle is permanently elevated, but keeps its continuity and attachments to the costal margins, which differentiates diaphragmatic eventration from diaphragmatic hernia. We describe a case of congenital eventration of the left diaphragm in a 35-year-old male who underwent successful surgical repair.

Cystic mesenchymal hamartoma arising in intrathoracic heterotopic liver: A case report

Intrathoracic heterotopic liver tissue is an exceedingly rare clinical entity. In most patients, it is associated with other congenital defects, including cardiac anomalies, congenital diaphragmatic hernia, pectus excavatum, and intralobar pulmonary sequestration. Although heterotopic liver could potentially lead to the same benign liver diseases that can affect the mother liver, the association of heterotopic liver tissue with tumors in childhood is extremely rare. We describe a unique case of cystic mesenchymal hamartoma arising from an intrathoracic heterotopic liver that was found incidentally during a diaphragmatic eventration repair. Association of ectopic liver tissue with mesenchymal hamartoma has not previously been reported in the literature.

Diaphragmatic eventration and gastric volvulus treated by laparoscopic gastropexy

Diaphragmatic eventration and gastric volvulus treated by laparoscopic gastropexy

615 Congenital Lung Malformations Presenting with Similar Chest X-Ray Changes at Birth

Congenital defects of diaphragm or malformations of lung usually present in first few hours of birth and if left undiagnosed can lead to significant morbidity and mortality. Early accurate recognition...

Gastric volvulus in children: our experience

Gastric volvulus is an extremely rare disorder in the pediatric age group. It is a complex entity as to the etiology and management. The study was conducted to evaluate etiology, mode of presentation, management, and outcome in our patients with gastric volvulus. It was a retrospective study of 10 patients with gastric volvulus managed during May 2006 and October 2010. The medical record of these patients including history, clinical examination, investigations, operative notes, and the outcome was reviewed. Of the ten patients, seven were males and three females. The mean age of presentation was 2.87 years. Half (50 %) of the patients showed typical Borchardt triad whereas in other patients the presentation was variable. In eight patients, the diagnosis was precisely made with the help of radiological investigations. At operation, three patients had primary gastric volvulus, and seven had secondary gastric volvulus. The predisposing factors leading to secondary gastric volvulus were eventration of diaphragm, hiatus hernia, congenital diaphragmatic hernia, malrotation, and traumatic diaphragmatic rupture. Seven patients had organoaxial volvulus and three showed mesenterioaxial. Gastropexy was performed in three patients (primary gastric volvulus). In seven patients (secondary gastric volvulus), the predisposing anatomical defects were corrected without adding gastropexy in the regime. One patient with traumatic rupture of the diaphragm died. There was no recurrence in any patient over a mean follow up of 3.7 years (SD ± 1.27). Secondary gastric volvulus is prevalent with diaphragmatic defects sharing major contribution in the etiology. Classical Borchardt triad is seen in 50 % cases of pediatric gastric volvulus. Correction of predisposing factors alone is sufficient to manage secondary gastric volvulus in children.

Diaphragmatic eventration complicated by gastric volvulus with perforation

Eventration of the diaphragm with gastric volvulus is uncommon. Gastric perforation in these cases is rare and usually associated with acute gastric volvulus with strangulation. We describe a case of diaphragmatic eventration with chronic gastric volvulus with gastric perforation without strangulation in an elderly man.

Misdiagnosis of diaphragmatic rupture in a trauma setting

Distinguishing diaphragmatic eventration from rupture in the trauma setting can be a considerable challenge. We present a case involving a man suffering from chest pain and with a raised left hemidiaphragm on the chest radiograph after a motor vehicle injury. A review of the literature discusses the use of imaging modalities and subsequent surgical diagnostic procedures in the face of uncertainty.

Diaphragmatic eventration complicated by diaphragmatic herniation: when is plication indicated?

Diaphragmatic eventration complicated by diaphragmatic herniation: when is plication indicated?

Ruptured Diaphragmatic Eventration: A Rare Cause of Acute Postpartum Dyspnea

Rupture of a maternal diaphragmatic hernia (DH) during pregnancy is a rare but significant complication. We describe a case of a maternal ruptured DH, presenting as acute postpartum dyspnea, which required urgent operative repair. We report our surgical strategy and review the key concepts in the multidisciplinary management of this condition.

A Rash Case of Hiccups

A Rash Case of Hiccups

Prenatal diagnosis of right diaphragmatic eventration associated with fetal hydrops

Congenital diaphragmatic eventration (CDE) is a rare diaphragmatic abnormality. Clinical manifestations of CDE may mimic congenital diaphragmatic hernia. Prenatal differential diagnosis of eventration is critical because postnatal managing and prognosis of these conditions vary significantly. Sonographic features of CDE involve presence of abdominal organs in the thorax, shift of cardiac axis and mediastinum. Non-immune hydrops fetalis (NIHF) has been previously reported to be associated with intrathoracic masses as well as CDE. In this report, we present a case of congenital right diaphragmatic eventration associated with NIHF.

Eventration of Diaphragm with Gastric Duplication Cysts: A Rare Association

Eventration of diaphragm is defined as an abnormal and permanent elevation of the hemidiaphragm without defects. It may be congenital (muscular hypoplasia) or acquired (injury of the phrenic nerve). Diaphragmatic eventration has been reported alone or in association with other malformations. Here the authors are presenting a case of eventration of diaphragm with gastric duplication cysts because they could not find such association in the available English literature.

Pulmonary Sequestration and Diaphragmatic Eventration in a 6-month-old Infant

A congenital pulmonary malformation, such as pulmonary sequestration or congenital cystic adenomatoid malformation, should be suspected in infants with recurrent lower respiratory symptoms or unifocal infiltrations. The possibility of congenital pulmonary malformation associated with additional abnormalities, such as diaphragmatic hernia, is relatively high and can lead to misdiagnosis. We report a case of a 6-month-old girl who presented with relapsing respiratory infection and hematemesis. Computerized axial tomography scan and barium swallowing study were performed, revealing a suspected intralobar pulmonary sequestration associated with sliding gastric hernia. Since the patient's condition was complicated by sliding hernia, pneumonia and pleural effusion, a surgical procedure instead of cardiac catheterization with coil embolization was performed. During surgery, the absence of a sliding gastric hernia but a diaphragmatic eventration was noted. Only a partial portion of the left-side diaphragm was relaxing, making the barium swallowing study difficult to interpret. This case serves as a reminder that if pulmonary sequestration is suspected, a full work-up with a complete set of imaging studies should be ordered for the possible detection of associated gastrointestinal, respiratory and thoracic abnormalities.

Sciaticofemoral nerve block for varicose vein surgery in the patient with eventration of diaphragm, dextroposition of the heart and bicuspid aortic valve

Sciaticofemoral nerve block for varicose vein surgery in the patient with eventration of diaphragm, dextroposition of the heart and bicuspid aortic valve