CASE STUDY DIAPHRAGMATIC EVENTRATION

Eur J Pediatr Surg. There are four types of congenital diaphragmatic defects: Since then, about cases have been reported [ 7 ]. The result is decreased respiratory mobility or paradoxical movement, causing poor lung expansion and hypoxia [ 13 ]. Diaphragmatic eventration is a rarely seen asymptomatic pathology, which is generally diagnosed incidentally Incentive spirometry and deep breathing exercises were started with resolution of the atelectasis after 1 week post-operatively.

The incidence of intrathoracic kidneys associated with diaphragmatic defects is 0. The renal vasculature and the ureter entered and exited the thorax through the foramen of Bochdalek. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used. Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax Figures 1 — 6 ; uniform and continuous diaphragmatic elevation throughout the hemithorax Figures 5 and 6 ; discrete mediastinal displacement caused by the right kidney Figure 3 ; and hepatic displacement towards the left hemiabdomen causing gastric compression Figure 4. Both thoracic cavities were extremely constricted Figure 1. Multiple imaging modalities are available for the pre-operative diagnosis of diaphragmatic problems.

Case Reports in Surgery

Surgical repair of congenital diaphragmatic eventration in a septugerian lady. Our patient was treated chronically for bronchial asthma, with episodes of seizures and recurrent bronchial infections. Preliminary investigation of the prosecutor evaluated the case as a suspect death, and sent the corpse to our institute for autopsy. The result is decreased respiratory mobility or paradoxical movement, causing poor lung expansion and hypoxia [ 13 ].

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Diaphragmatic Eventration: Autopsy Case Report

stuvy Plication was done using 2 layered imbricated vertical mattress sutures. On physical examination there were decreased breath sounds in the left thorax with note of gurgling bowel sounds.

case study diaphragmatic eventration

No radiologic evidence of gastric volvulus was noted Fig. The outcome was satisfactory. Among symptomatic patients, the most common symptom is dyspnea. It is useful to perform the tests in the evenfration and supine positions. It is also believed that alterations in the development of adrenal glands and the liver can vary the position of the kidney [ 910 ].

The difference between diaphragmatic hernia and eventration is important; in the latter, there is no true defect. This paper did not require an ethical approval since it is retrospective case report in nature.

Impression was diagrammatic hernia versus eventeration. Simple cases of diaphragmatic eventration may not require intervention when not associated with adverse symptoms. The ureter was long to reach the excessive bladder distance eventrstion did not enter ectopically [ 2935 ]. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic medicine. The overall cause of death of the diaphrgamatic patient was reported as heart failure.

Patient underwent plication of the diaphragm using the abdominal approach. According to Christensen [ 2 ], diaphragmatic eventration is either unilateral or bilateral and complete or stury. Please review csae privacy policy. Sagittal section of the right hemithorax showing occupation by intestinal loops and mesentery.

Plication was done with 1st layer of imbricating silk heavy sutures buttressed by a second layer of interrupted absorbable sutures. This results in the immobilization of the plicated diaphragm and reduction of the paradoxical movement and contralateral mediastinal involvement [ 25 ].

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I have no conflict of interest, this paper was not funded and all of the evenhration and expenses in the making of this paper is purely voluntary in nature. We highlight the importance of good physical examination and judicious use of imaging modalities among patients suspected of diaphragmatic eventeration.

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

Axial section with the kidney in a posterior position and mild mediastinal compression. In the general population, the frequency of ectopy is reported to range from 0. Diaphragmatic plication, Diaphragmatic exenteration, Atelectasis. The etiology of renal ectopia can encompass infectious problems such as schistosomiasis or pathologies prevalent in northern Peru, studu as malaria [ 919 ].

It can be unilateral or bilateral, but it usually involves the left hemidiaphragm [2]. This was safely performed given the proximity of the peritoneal viscera Figure 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. Open in a separate window.

The kidney in the posterior view.

case study diaphragmatic eventration

CASE STUDY DIAPHRAGMATIC EVENTRATION

Plication by posterolateral thoracotomy is achieved through the sixth, seventh, or eighth intercostal space, using U points, mattress stitch, continuous suture, or stapling [ 3 ]. 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. The right lung was found to be collapsed. Splenic injury following diaphragmatic plication; an avoidable life threatening complication. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea.

This induces a progressive amyotrophy and stretching of all muscular fibers of the dome. In addition, it has been reported that conservative approaches did not provide any benefit, and especially in symptomatic patients, dramatic improvements after surgical interventions were reported for very short periods 3,5. Support Center Support Center. This results in the immobilization of the plicated diaphragm and reduction of the paradoxical movement and contralateral mediastinal involvement [ 25 ]. Chest Ct-scan with IV and oral contrast was requested to further outline the anatomy. Correspondence should be addressed to Anibal Carrasco ; se. Both chest radiography and ultrasonography are not useful in the differentiation of eventration and diaphragmatic hernia.

Complications after abdominal plication of a diaphragmatic eventration commonly include atelectasis and rarely, abdominal compartment syndrome and splenic injury after mobilization of the left upper quadrant abdominal structures.

The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. 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.

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Diaphragmatic eventration is largely diagnosed in the pediatric age group. She had symptoms of intermittent dyspnea and occasional epigastric discomfort.

It represents a 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 possible, of the minimally invasive procedures that are currently used.

Bowel loops occupying the right hemithorax.

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. Thoracoscopy can be performed with two ports and minimum thoracotomy GelPort or using three or four ports; the detailed procedure is described by de Andrade Cordeiro et al. Patient had no previous history of trauma.

case study diaphragmatic eventration

Case Reports in Surgery. Diaphragmatic eventration in infants.

case study diaphragmatic eventration

The patient was started on incentive spirometry and deep breathing exercises Fig. A chest radiograph shows the elevation of the affected hemidiaphragm; a shadow of the left eventrated hemidiaphragm should be at least one intercostal space raised with respect to the right and stydy intercostal spaces if it is the opposite side [ 13 ].

Discussion Management of diaphragmatic eventeration varies greatly on the symptoms of the patients.

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 ]. Patient had an unremarkable post-operative stay diaphagmatic resolution of symptoms.

The surgical treatment pursues the improvement of ventilation by minimizing dysfunctional diaphragmatic excursion in the process of inspiration [ 3 ]; Yalcinkaya et al. Sstudy article has been cited by other articles in PMC. In this patient, she presented with symptoms similar to diaphragmatic hernia, thus a combination of imaging modalities help in the diagnosis in this patient.

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Diaphragmatic Eventration: Autopsy Case Report

She post-operatively had atelectasis on the left lung. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic medicine.

case study diaphragmatic eventration

Congenital diaphragmatic eventeration in an adult: A posterolateral thoracotomy was continued at the level of the seventh intercostal space, with the hemidiaphragm being thinned, although with moderate thickness of muscle fibers Figure 8. Long-term results of diahpragmatic plication in adults with unilateral diaphragm paralysis.

Central trachea and normal left hemithorax. Management of diaphragmatic eventeration varies greatly on the symptoms of the patients. Multiple imaging modalities are available for the pre-operative diagnosis eventratino diaphragmatic problems. Suture of the hemidiaphragmatic defect.

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

Published online Apr The etiology of renal ectopia can encompass infectious problems such as schistosomiasis or pathologies prevalent in northern Peru, such as malaria [ 919 ]. Surgical approaches for eventration cse thoracotomy, laparotomy, and thoracoscopy or laparoscopy [ 111 ].

The diagnosis of thoracic renal ectopia usually occurs in adults. Diaphragmatic eventration is a rarely seen asymptomatic pathology which is generally diagnosed incidentally There are four types of congenital diaphragmatic defects: