ABSTRACT
An elevated diaphragm may be due to eventration or paralysis. Diaphragm elevation is often asymptomatic and found incidentally on imaging. Fluoroscopic testing can be used to differentiate eventration (no paradoxic motion) from paralysis (paradoxic motion). Regardless of etiology, a diaphragm plication is indicated in all symptomatic patients with an elevated diaphragm. Plication can be approached either from a thoracic or abdominal approach, though most thoracic surgeons perform minimally invasive thoracoscopic plication. The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphragm. Diaphragm plication is safe, has excellent outcomes, and is associated with symptom improvement.
Subject(s)
Diaphragmatic Eventration , Respiratory Paralysis , Humans , Diaphragm , Diaphragmatic Eventration/surgery , Diaphragmatic Eventration/complications , Respiratory Paralysis/etiology , Respiratory Paralysis/surgery , Respiratory Paralysis/diagnosis , Respiratory Paralysis/physiopathologyABSTRACT
A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.
Subject(s)
Cat Diseases , Diaphragmatic Eventration , Hernia, Diaphragmatic , Female , Cats , Animals , Diaphragmatic Eventration/surgery , Diaphragmatic Eventration/veterinary , Diaphragm/surgery , Hernia, Diaphragmatic/veterinary , Cat Diseases/diagnostic imaging , Cat Diseases/surgeryABSTRACT
The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).
Subject(s)
Diaphragmatic Eventration , Laparoscopy , Humans , Diaphragmatic Eventration/surgery , Diaphragmatic Eventration/complications , Retrospective Studies , Quality of Life , Diaphragm/surgery , Laparoscopy/methodsABSTRACT
Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10-stapled resection, 9-suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other.
Subject(s)
Diaphragmatic Eventration , Humans , Diaphragmatic Eventration/surgery , Diaphragmatic Eventration/etiology , Prospective Studies , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methods , Diaphragm/surgery , Pain, PostoperativeABSTRACT
Diaphragm plication has recently become a standard operation for diaphragm eventration. The surgical experience for the patient has improved with the development of minimally invasive operations, but the operator's convenience has not improved significantly. We performed video-assisted thoracoscopic surgery for a diaphragm oblique resection using endostaplers in 10 patients. The total operation time was 39.5 minutes; all patients' symptoms disappeared postoperatively. This presentation will help more thoracic surgeons simplify this operation on the diaphragm.
Subject(s)
Diaphragmatic Eventration , Surgeons , Humans , Diaphragm/surgery , Diaphragmatic Eventration/surgery , Thoracic Surgery, Video-Assisted , Minimally Invasive Surgical ProceduresABSTRACT
A 61-year-old male patient with bilateral lung transplantation was admitted to the outpatient clinic with increasing respiratory distress for a month. Bilateral diaphragm eventration was observed in his examinations. Bilateral diaphragm plication was successfully performed abdominally in the patient who had a complaint despite supportive treatment. The respiratory capacity of the patient returned to normal. The abdominal approach may be a good alternative option in cases where intrathoracic surgery cannot be performed due to adhesions in patients with eventration after lung transplantation. KEY WORDS: Acquired eventration, Diaphragm, Lung transplantation.
Subject(s)
Diaphragmatic Eventration , Lung Transplantation , Male , Humans , Middle Aged , Diaphragmatic Eventration/complications , Diaphragmatic Eventration/surgery , Diaphragm/surgery , Thorax , HospitalizationABSTRACT
BACKGROUND: Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. CASE PRESENTATION: We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient's history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. CONCLUSION: Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis.
Subject(s)
Atrial Fibrillation , Cleft Palate , Diaphragmatic Eventration , Heart Septal Defects, Atrial , Hernias, Diaphragmatic, Congenital , Female , Infant , Humans , Diaphragmatic Eventration/diagnostic imaging , Diaphragmatic Eventration/surgery , Cleft Palate/diagnostic imaging , Diaphragm/diagnostic imaging , Heart Septal Defects, Atrial/diagnostic imagingABSTRACT
WT1 disorder is caused by a heterozygous variant in the gene WT1 (Wilms' tumor suppressor gene 1), and is clinically diagnosed as Denys-Drash, Meacham, or Frasier syndrome, on a phenotypic continuum that presents as abnormalities of the urogenital system and gonads. Rarely, manifestations appear in the lung, especially in Frasier syndrome. Here we describe the first noted case of congenital diaphragmatic eventration with pulmonary dysplasia in a child with Frasier syndrome. A c.1432+5G > A mutation in intron 9 of WT1 was found. We also summarize pulmonary diseases associated with WT1 mutations in WT1 disorder.
Subject(s)
Diaphragmatic Eventration , Frasier Syndrome , Child , Humans , Frasier Syndrome/genetics , Lung , Mutation , WT1 Proteins/geneticsABSTRACT
Extreme mediastinal shift due to major diaphragm eventration is complex when mitral-valve repair is required. We report the case of a 59-year-old woman with diaphragmatic eventration who had 2 recent episodes of heart failure due to arrythmia associated with severe mitral-valve regurgitation (regurgitant orifice area 47 mm2). Forced expiratory flow-volume in the first second and vital capacity (VC) were at 32% and 33%, respectively,decreasing to 20% and 30% when she was in a supine position. We found it impossible to repair the valve first because of the extreme mediastinal shift and respiratory dysfunction. Therefore, we decided to perform diaphragm plication first followed 3 months later by mitral valve repair. Six months after the cardiac operation, the patient showed significant clinical improvement. Forced expiratory flow-volume in the first second and vital capacity increased to 58% and 55%, respectively. The decision to perform the thoracic operation first, followed by the cardiac operation, was the key to improving the patient's respiratory function and to medializing the heart to safely support cardiac surgery.
Subject(s)
Diaphragmatic Eventration , Heart Failure , Mitral Valve Insufficiency , Diaphragm/diagnostic imaging , Diaphragm/surgery , Diaphragmatic Eventration/surgery , Female , Heart Failure/complications , Heart Failure/surgery , Humans , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgeryABSTRACT
We encountered a case of high insertion of the right diaphragm complicated with congenital diaphragmatic hernia that was diagnosed based on thoracoscopic findings. A full-term male baby was suspected of having right congenital diaphragmatic hernia or diaphragmatic eventration on postnatal imaging. He only had episodes of mild but prolonged symptoms following upper respiratory tract infection and his course was otherwise uneventful during outpatient monitoring. At 1 year old, the elevated liver volume remained large, which might eventually interfere with his lung growth, so thoracoscopic exploration was planned. Thoracoscopy revealed liver prolapse from a diaphragmatic defect. In addition, the anterior to lateral inserted part of the diaphragm was high, with the anterior part reaching the fourth rib. We repaired only the diaphragmatic defect without repositioning the diaphragm, and the postoperative course was uneventful. High insertion of the diaphragm should be considered as a differential diagnosis of congenital diaphragmatic eventration.
Subject(s)
Diaphragmatic Eventration , Hernias, Diaphragmatic, Congenital , Diaphragm/diagnostic imaging , Diaphragm/surgery , Diaphragmatic Eventration/complications , Diaphragmatic Eventration/diagnostic imaging , Diaphragmatic Eventration/surgery , Hernias, Diaphragmatic, Congenital/complications , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Hernias, Diaphragmatic, Congenital/surgery , Humans , Infant , Male , Thoracoscopy/methods , ThoraxABSTRACT
Diaphragmatic eventration is a rare condition, and its association with dextrocardia is even a rarer clinical entity. Patients are usually asymptomatic, but the typical features include rapid breathing and recurrent respiratory infections. Here we present a rare case of a seven months old infant, who presented with cough, noisy breathing and chest retraction. The patient was diagnosed to have dextrocardia with diaphragmatic eventration with pneumonia by chest imaging and was treated in coordination with the medical team for underlying pneumonia. Afterwards, plication of the diaphragm was done through the trans-abdominal approach and the symptoms gradually improved postoperatively. For dextrocardia, since there were no structural abnormalities, the patient was kept in regular follow-up in the pediatric cardiology unit. Though most patients are asymptomatic, diaphragmatic eventration increases the risk of recurrent chest infection and hampers the quality of life of the patient, so timely diagnosis and intervention will greatly improve their quality of life. Keywords: dextrocardia; diaphragm; diaphragmatic eventration.
Subject(s)
Dextrocardia , Diaphragmatic Eventration , Child , Dextrocardia/diagnosis , Dextrocardia/diagnostic imaging , Diaphragmatic Eventration/complications , Diaphragmatic Eventration/diagnosis , Diaphragmatic Eventration/surgery , Humans , Infant , Quality of Life , Rare Diseases/complications , ThoraxABSTRACT
Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring, cleft lip and hypospadias, as well myocarditis and congenital heart disease have been reported. We present a case of a preterm female neonate born with ascites, hydrothorax and congenital diaphragmatic eventration (CDE), with a prenatal diagnosis of congenital diaphragmatic hernia (CDH). The neonate was born prematurely at 32 weeks gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room, transferred in the Neonatal Intensive Care Unit (NICU) and supported with high frequency oscillatory ventilation (HFOV). The diagnosis of CDH was sonographically estimated from the 20th week of gestation and surgical correction was decided. During surgery CDE was diagnosed instead of CDH and despite postoperatively care the neonate developed disseminated intravascular coagulation and finally died in the 40th hour of life. Along with the identification of parvovirus B19 in the pleural fluid by PCR, the biopsy of the diaphragm revealed connective tissue, full of vasculature and absence muscle tissue. Although only cytomegalovirus, rubella, and toxoplasmosis were considered to be associated with CDE, parvovirus B19 might also be related to this congenital diaphragmatic malformation. In CDE, the function of the lungs can be compromised as a consequence of the compression applied by the abdominal organs. The neonatologists should include this condition in their differential diagnosis for a more direct and effective management.
Subject(s)
Diaphragmatic Eventration , Erythema Infectiosum , Parvovirus B19, Human , Cesarean Section , Diaphragm/abnormalities , Diaphragmatic Eventration/diagnosis , Female , Humans , Infant, Newborn , Male , PregnancyABSTRACT
BACKGROUND: Diaphragmatic plication can be performed with various surgical approaches. The aim of this study was to assess the safety and effectiveness of robotic-assisted plication. METHODS: We retrospectively reviewed consecutive patients who underwent diaphragmatic plication from 2017 to 2021. RESULTS: Eighteen patients underwent 20 operations, 11 of which were performed with robotic-assisted thoracoscopic surgery (RATS) and 9 with open transthoracic approach. RATS was associated with shorter operating time (80 vs. 120 min; p = 0.04), less blood loss (20 vs. 100 ml; p = 0.01), shorter chest-drain duration (1 vs. 3 days; p = 0.01), and shorter length of stay (3 vs. 7 days; p = 0.04). The median grade in the Medical Research Council dyspnoea scale improved from four to two in both groups. CONCLUSIONS: Robotic-assisted diaphragmatic plication is a safe procedure that can significantly improve dyspnoea and is associated with shorter hospitalisation compared to open approach.
Subject(s)
Diaphragmatic Eventration , Respiratory Paralysis , Robotic Surgical Procedures , Diaphragmatic Eventration/surgery , Dyspnea , Humans , Respiratory Paralysis/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Partial mesentericoaxial gastric volvulus associated with acquired eventration of the left dome of the diaphragm is very rare. We present the case of a 65-year-old man who presented with features of gastric outlet obstruction. He had a prior history of laryngeal cancer for which total laryngectomy was done, and adjuvant radiotherapy was administered. He was subsequently diagnosed with eventration of the left dome of the diaphragm and partial gastric volvulus. The patient recovered completely with conservative management and was discharged.
Subject(s)
Diaphragmatic Eventration , Stomach Volvulus , Aged , Diaphragm , Humans , Male , Paralysis , Phrenic Nerve , Stomach Volvulus/diagnostic imaging , Stomach Volvulus/etiology , Stomach Volvulus/surgeryABSTRACT
Thoracoscopic plication for congenital diaphragmatic eventration in an adult. Diaphragmatic eventration is known to be abnormal elevation of diaphragm and congenital causes are due to abnormal diaphragm muscle development. Here we report surgical treatment of congenital diaphragmatic eventration. A 45-year-old woman who complained of cough was admitted to our hospital. She had history of cough and was diagnosed as diaphragmatic eventration in childhood. Chest X-ray showed elevated left hemidiaphragm with a bowel gas underneath. Under the diagnosis of congenital eventration of left hemidiaphragm, plication of the left diaphragm by video-assisted thoracoscopic surgery (VATS) was performed. One month after surgery, severe cough disappeared completely.
Subject(s)
Diaphragmatic Eventration , Adult , Diaphragm/diagnostic imaging , Diaphragm/surgery , Diaphragmatic Eventration/diagnostic imaging , Diaphragmatic Eventration/surgery , Female , Hospitalization , Humans , Middle Aged , Thoracic Surgery, Video-AssistedSubject(s)
Diaphragmatic Eventration , Adult , Diaphragm , Female , Humans , Magnetic Resonance Imaging , PregnancyABSTRACT
Background: Thoracoscopic diaphragmatic plication has gained popularity in the treatment of congenital diaphragmatic eventration (CDE), but the therapeutic effect and prognosis have rarely been compared with nonendoscopic surgery. Materials and Methods: The medical records of 77 children who had received treatment for CDE in our institution from September 2006 to January 2019 were retrospectively analyzed. According to the repair approach, the children were divided into a thoracoscopic plication group and a modified small incision plication group. The perioperative characteristics and follow-up details after diaphragm plication were compared between the two groups. Results: Among 77 children with CDE, 44 cases were in the thoracoscopic plication group and 33 cases were in the modified small incision plication group. All the cases of CDE were unilateral, with 13 cases on the left side and 64 cases on the right side. There were no differences in the preoperative characteristics between the two groups. The modified small incision plication group had a higher bleeding volume (P = .000) and a greater proportion of patients needing chest drainage (P = .000), whereas the differences in the total and postoperative hospital stays (P = .088, P = .247, respectively) did not significantly differ between the two groups. There were no differences in postoperative improvement in the location of the diaphragm between the two groups or between the right and left lesions (P = .438, P = .677, respectively). The total follow-up time was 2-11 years. No recurrence was reported during this period in either of the groups, but the incidence of postoperative thoracic deformities was higher in the modified small incision plication group (P = .013). Conclusions: Compared with the modified small incision plication, thoracoscopic plication has the advantages of smaller blood loss, a low percentage of intrathoracic drainage tube usage, and no occurrence of thoracic deformities.