Diaphragmatic Eventration Research Articles

A Newborn Infant with Giant Omphalocele and Peeling Skin

A male infant with a prenatal diagnosis of giant omphalocele and left-sided diaphragmatic eventration is noted to have skin peeling 11 days after birth. The infant was admitted to the NICU and maintained on mechanical ventilation. Chest ultrasonography on the day of birth revealed a small left pleural effusion and diaphragmatic eventration. The team placed a peripherally inserted central catheter on the second day after birth to provide parenteral nutrition for a prolonged period. The infant failed a trial of extubation 4 days after birth. On the following day, the team evaluated the infant for sepsis because of clinical instability. A complete blood cell (CBC) count demonstrated a normal white blood cell count, normal platelets, and no …

Induced Controlled Pneumothorax: A Useful Maneuver for Laparoscopic Left Diaphragmatic Eventration Repair

Abstract Introduction: Left diaphragmatic eventrations can be operated laparoscopically or thoracoscopically. The laparoscopic approach has one challenge: the left diaphragm, which is usually force...

Neonatal brachial plexus injury with diaphragmatic eventration

Our case report describes obstetric right brachial plexus injury leading to Erb's palsy and Klumpke's palsy with ipsilateral paralysis of diaphragm in a 9-month-old baby without Horner's syndrome. The baby required initial right brachial plexus root exploration and nerve grafts, later requiring surgical plication of diaphragm. Now, the baby is free of bronchopneumonia and is in recovering phase of upper limb motor and sensory function.

横隔膜弛緩症を合併した先天性幽門閉鎖症の 1 手術例

横隔膜弛緩症を合併した先天性幽門閉鎖症の 1 手術例

Diaphragmatic plication for eventration or paralysis

Diaphragmatic eventration are congenital developmental defects affecting the muscular portion of the diaphragm, while the normal attachment to sternum ribs and dorsolumbar spine are maintained. Clinically diaphragm eventration is impossible to differentiate from acquired paralysis. In contrast to true diaphragmatic eventration, diaphragm paralysis is a more common acquired condition that can result from a number of abnormalities that affect the neuromuscular axis between the cervical spinal cord and the diaphragm. In most cases, patients with eventration or paralysis are asymptomatic and diagnosis is made as an incidental finding on a chest radiograph or as a diagnosis of exclusion in patient with dyspnoea. It is important to determine the start of the symptoms: generally patients with paralysis can recall the moment of the onset of symptoms or when the dyspnoea started or worsened while patients with eventration may not be able to determine a specific starting point. The only goal of diaphragmatic plication is to manage dyspnea. Therefore surgery is warranted exclusively for symptomatic patients. There are two main techniques to manage diaphragmatic elevation due to eventration or paralysis in open surgery through a thoracotomy access: central imbrication technique and radial plication technique. Diaphragmatic plication should be only performed on symptomatic patients with evidence of elevated diaphragm not caused by any other pathologic process other besides paralysis and eventration. The choice of plication approach is up to the surgeon’s expertise, training and preference. Improvement in dyspnoea is the most important measure of clinical success.

Miniinwazyjna chirurgia torakoskopowa ze wsparciem laparoskopowym w leczeniu ewentracji przepony

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Panko S, Karpitski A, Zhurbenko G, et al. Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management. Medical Studies/Studia Medyczne. 2017;33(1):26-30. doi:10.5114/ms.2017.66953. APA Panko, S., Karpitski, A., Zhurbenko, G., Shestiuk, A., Boufalik, R., & Vakulich, D. et al. (2017). Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management. Medical Studies/Studia Medyczne, 33(1), 26-30. https://doi.org/10.5114/ms.2017.66953 Chicago Panko, Siarhei, Aliaksandr Karpitski, Gennadij Zhurbenko, Andrej Shestiuk, Rotislav Boufalik, Denis Vakulich, and Alaksandr Ignatjuk. 2017. "Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management". Medical Studies/Studia Medyczne 33 (1): 26-30. doi:10.5114/ms.2017.66953. Harvard Panko, S., Karpitski, A., Zhurbenko, G., Shestiuk, A., Boufalik, R., Vakulich, D., and Ignatjuk, A. (2017). Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management. Medical Studies/Studia Medyczne, 33(1), pp.26-30. https://doi.org/10.5114/ms.2017.66953 MLA Panko, Siarhei et al. "Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management." Medical Studies/Studia Medyczne, vol. 33, no. 1, 2017, pp. 26-30. doi:10.5114/ms.2017.66953. Vancouver Panko S, Karpitski A, Zhurbenko G, Shestiuk A, Boufalik R, Vakulich D et al. Minimally invasive thoracoscopic surgery with laparoscopic assistance approaches in diaphragmatic eventration management. Medical Studies/Studia Medyczne. 2017;33(1):26-30. doi:10.5114/ms.2017.66953.

Surgical blade retrieval from Abdomen by Laparotomy after 5 yrs! -Case report and Review of literature on retained foreign bodies in abdomen.

Foreign bodies forgotten or missed in abdomen include cotton sponges, artery forceps or other instruments, pieces of broken instruments or irrigation sets and rare tubes. Presence of retained surgical blade as foreign body is uncommon and significant patient safety challenge. Most common etiologies for presence of such foreign bodies are accidental, traumatic or iatrogenic. Most common surgically retained foreign body is the laparotomy sponge. We report the management of a case with a rare foreign body in the abdomen i.e. surgical blade and repair of congenital diaphragmatic hernia. A 38 yrs female reported to us with X-ray lumbo-sacral spine showing radio-opaque object in abdomen. We further investigated the patient and CT scan abdomen revealed –A metallic foreign body in the left hypochondrium just beneath the left lobe of liver; it was seen in close proximity to the transverse colon gut loops and left Diaphragmatic Eventration hernia –herniation of stomach, large bowel loop and omental fat into left hemithorax. Traditionally, diaphragmatic hernia was repaired by laparotomy and foreign body was removed after exact localization on C-arm.

Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication.

BackgroundSurgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO2) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy.MethodsEleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO2 gas and group without using CO2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence.ResultsThe improvement of forced expiratory volume at 1 second in the group using CO2 gas and the group not using CO2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84). The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO2) and 15.6±0.89 (without CO2) (p=0.03). During follow-up (17±17 months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred.ConclusionThoracoscopic plication under single lung ventilation using CO2 insufflation could be an effective, safe option to flatten the diaphragm.

An Unusual Cause of Lobulated Lung Mass

Eventration of the diaphragm is caused by weakened musculature of the diaphragm. This can occur in one or both hemidiaphragms. Symptoms may be minimal and it is usually detected incidentally on chest radiograph which would show an elevation of the diaphragm. We report and discuss a case of eventration of right diaphragm in a patient presented with a lobulated lung mass on chest radiograph.

A Rare Cause of Dyspnea in Pregnancy: Diaphragmatic Eventration

A Rare Cause of Dyspnea in Pregnancy: Diaphragmatic Eventration

Extralobar Pulmonary Sequestration with Accompanying Ipsilateral Diaphragmatic Eventration

Extralobar Pulmonary Sequestration with Accompanying Ipsilateral Diaphragmatic Eventration

Video-assisted minimally invasive diaphragmatic plication: feasibility of a recognized procedure through an uncharacteristic hybrid approach.

Diaphragmatic plication is an approved surgical procedure for treatment of symptomatic diaphragmatic paralysis and eventration. We aim to define our minimally invasive technique of plication and objectively assess our surgical outcomes of the largest series reported in the literature so far, using pulmonary function tests. Symptomatic patients whom were planned to undergo plication using video-assisted mini-thoracotomy between December 2009 and December 2015 were the cohort of this retrospective study. Single camera port and a utility incision (3-4cm) were used for access. Data of patient demographics with preoperative and postoperative spirometric results were collected for statistical comparison. Procedure (30 left, 7 right) was completed in 37 (27 male, 10 female) patients. One patient was excluded because of insufficient objective postoperative comparison criteria due to previous permanent tracheostomy. Mean length of surgery was 48.8±19.7 (range: 30-70)min. Postoperative overall morbidity was 8.3%, with no mortality. The mean length of hospital stay was 3.1±1.7days. All patients except one (97.3%) were asymptomatic on discharge and on follow-ups. Significant improvement in measurements of forced expiratory volume in 1st second was observed on postoperative measurements (P<0.001), with a mean overall increase of 13% in whole cohort. No recurrence was detected throughout a mean follow-up of 19months. Diaphragmatic plication via video-assisted mini-thoracotomy is an effective and curative surgical procedure which can be performed successfully with low morbidity rates. As it combines the rapidity and economical benefits of open thoracotomy with the advantages of video thoracoscopic procedures such as fast recovery and short postoperative hospital stay, it can be preferred as a safe and effective alternative hybrid method compared to standard open or closed techniques, for symptomatic patients with non-functional hemidiaphragm.

Synchronous Morgagni and Bochdalek Hernias: A Case Report of a Unique Approach to a Rare Finding

Introduction: Multiple unilateral congenital diaphragmatic hernias (CDH) are extremely rare, described only five times in the medical literature. Concurrent ipsilateral Bochdalek and Morgagni hernias are rarer still with only two cases previously described. In all reported cases of multiple concurrent defects, the hernias were repaired in an open fashion, either via a thoracotomy or laparotomy with both of the two combined Bochdalek and Morgagni hernias repaired via laparotomy. Case Presentation: In this case report we have a 2-day-old who developed respiratory distress and on CT scan was found to have a congenital diaphragmatic hernia (CDH) or eventration. This patient is ideal for this case report because he meets a lot of the previously established criteria for minimally invasive repair of congenital diaphragmatic hernias - minimal respiratory compromise, no congenital heart defects - and he has synchronous defects which have very rarely been seen before. Here we present the first reported case of concurrent ipsilateral Bochdalek and Morgagni hernias repaired in a one-stage minimally invasive fashion, approaching the Bochdalek hernia thoracoscopically and the Morgagni laparoscopically. The patient had a quick recovery post-operatively and he continues to do well. Conclusions: From this experience, we argue that in the right circumstances a completely minimally invasive approach can be taken for synchronous congenital diaphragmatic hernias.

Minimally Invasive Surgery in Neonatal Patients: A Review

Laparoscopic and thoracoscopic surgery have gradually become accepted diagnostic and therapeutic modalities in the management of neonatal surgical conditions. In the hands of experienced surgeons, minimally invasive surgery (MIS) has reduced the need for open procedures. In children younger than 1 year, the advantages of MIS are evident in avoiding the sequelae of open surgery. MIS has shown outcomes comparable to those with open surgery. The recent literature in the PubMed database was reviewed, using the keywords “minimally invasive surgery,” “neonatology,” “pediatric surgery,” “laparoscopy,” and “thoracoscopy.” The review included retrospective and institutional reports of MIS published since January 2000.The results were used to develop a review of the current state of MIS in the neonatal population. The use of minimally invasive techniques in neonatal surgical conditions was successful in the hands of experienced surgeons. Some procedures currently performed include gastrostomy, pyloromyotomy for hypertrophic pyloric stenosis, gastroesophageal reflux surgery, the Ladd procedure for intestinal malrotation, colonic pull-through procedures for Hirschsprung disease and other anorectal malformations, repair of diaphragmatic eventration and congenital diaphragmatic hernia, duodenal atresia, esophageal atresia/tracheoesophageal fistula, pulmonary lobectomy, surgery for necrotizing enterocolitis, and ligation of patent ductus arteriosus. Further formal training of surgeons in these techniques and the development of new and improved instrumentation can reduce the rates of open surgery and its sequelae in the neonatal population.

Thoracoschisis secondary to a mesenchymal hamartoma associated with diaphragmatic eventration

Abstract Thoracoschisis is an extremely rare congenital anomaly associated with limb body wall defect and diaphragmatic hernia. We describe a case of a female infant who was noted at birth to have tissue coming through a left sided thoracic defect next to an accessory nipple. The stomach bubble was displaced superiorly on radiographs. At surgery the tissue was attached to the left lateral lobe of the liver and was protruding through the chest wall via an intercostal defect below an eventrated diaphragm. The tissue was resected and the defect closed. Pathological examination was consistent with a mesenchymal hamartoma. The diaphragm may have formed abnormally in this case due to the presence of the mesenchymal hamartoma in this location.

Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient

Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2 g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 h after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus. El vólvulo gástrico agudo es un problema infrecuente como causa de obstrucción gastrointestinal. Paciente varón de 60 años que acude a urgencias por dolor epigástrico severo acompañado de distensión abdominal, con hematemesis en 2 ocasiones. A la exploración física: hemodinámicamente estable, con distensión abdominal en epigastrio, ruidos abdominales disminuidos; la citometría hemática mostró: hemoglobina 8.2 g/dl y hematocrito de 27%. La radiografía de abdomen mostró: elevación del hemidiafragma izquierdo y gran dilatación de estómago; por lo que se le colocó sonda nasogástrica. Por endoscopia no se observó sangrado activo, siendo imposible alcanzar el duodeno por torsión gástrica. El estudio con medio de contraste mostró: estómago invertido dentro del tórax y con torsión gástrica axial. La tomografía de tórax y abdomen confirmó los hallazgos, con diagnóstico de vólvulo gástrico por eventración. Se procedió a efectuar laparoscopia, encontrando: hemidiafragma izquierdo elevado, así como estómago, ángulo esplénico del colon, bazo y cola del páncreas. Se realizó gastrectomía lineal (manga gástrica). La evolución fue satisfactoria; se inició alimentación por vía oral 72 h después de la cirugía, y el paciente fue dado de alta, con seguimiento de 8 años, en los que permanece asintomático. El médico de Urgencias debe mantener un alto índice de sospecha en pacientes que presentan signos y síntomas sugestivos de oclusión intestinal alta. El manejo con gastrectomía lineal (manga gástrica) es una excelente alternativa para evitar la recidiva.

Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals.

North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64% among all admissions. Of these individuals, 13.65% (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.

Diaphragmatic Eventration in Sisters with Asparagine Synthetase Deficiency: A Novel Homozygous ASNS Mutation and Expanded Phenotype.

Asparagine Synthetase Deficiency (ASNSD; OMIM #615574) is a newly described rare autosomal recessive neurometabolic disorder, characterised by congenital microcephaly, severe psychomotor delay, encephalopathy and progressive cerebral atrophy. To date, seven families and seven missense mutations in the ASNSD disease causing gene, ASNS, have been published. We report two further affected infant sisters from a consanguineous Indian family, who in addition to the previously described features had diaphragmatic eventration. Both girls died within the first 6 months of life. Whole exome sequencing (WES) was performed for both sisters to identify the pathogenic mutation. The clinical and biochemical parameters of our patient are compared to previous reports. WES demonstrated a homozygous novel missense ASNS mutation, c.1019G > A, resulting in substitution of the highly conserved arginine residue by histidine (R340H). This report expands the phenotypic and mutation spectrum of ASNSD, which should be considered in neonates with congenital microcephaly, seizures and profound neurodevelopmental delay. The presence of diaphragmatic eventration suggests extracranial involvement of the central nervous system in a disorder that was previously thought to exclusively affect the brain. Like all previously reported patients, these cases were diagnosed with WES, highlighting the clinical utility of next generation sequencing in the diagnosis of rare, difficult to recognise disorders.

Organoaxial gastric volvulus with diaphragmatic eventration and wandering spleen: an unusual association

Organoaxial gastric volvulus occurs when the stomach rotates around a transverse line between the pylorus and gastroesophegeal junction. It is potentially life threatening because delayed diagnosis and treatment may result in perforation, infarction and gangrene of stomach. As it is a rare entity high index of suspicion is required to prevent high morbidity and mortality. Primary Gastric volvulus has been seen in association with congenital asplenia or "wandering spleen" or with diaphragmatic hernia or diaphragmatic eventration. We report a case of 17 year female (perhaps the first in literature) who had wandering spleen, diaphragmatic eventration and gastric volvulus a congenital anomaly rare to find and a brief review of literature.

Diaphragmatic Eventration : Review of Current Knowledge, Diagnostic, and Management Options

The diaphragmatic eventration [DE] is a rare pathology, commonly asymptomatic, but can result in dyspnea and recurrent respiratory infections. Can be caused can a congenital defect or be acquired by phrenic nerve injury. Your diagnosis occurs primarily through the visualization of the elevation of the diaphragmatic dome affected on chest xrays applied at random. Your management depends on the clinical symptoms, which if present, surgical treatment and minimally invasive techniques the procedure of choice.