Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study

Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.

SPONTANEOUS RUPTURE OF THE RIGHT CONGENITAL DIAPHRAGMATIC EVENTRATION ON THE RIGHT SUBJECTED TO SURGICAL CORRECTION IN A CHILD WITH MEGADOLICOCOLON

Спонтанний розрив гемідіафрагми у випадках вродженої діафрагмальної евентрації зустрічається вкрай рідко, у літературі повідомляють про унікальні випадки.In this context, the authors present the case of an 8-year-old child who was hospitalized in the coloproctology service for abdominal pain, lack of stool for more than 7 days, pronounced abdominal distension. The child suffers from Down's disease. In 2017, he was occasionally diagnosed with right diaphragmatic eventration and underwent surgical correction by thoracic approach. After a thorough evaluation, with signs suggestive of diaphragmatic hernia on the right, the child underwent surgery, intraoperatively the rupture of the right hemidiaphragm was found with intrathoracic ascension of the malrotated intestinal loops, transverse colon and omentum. The repair of the diaphragmatic eventration complicated by rupture was used using the “overcoat” folding procedure, on the suture line being carefully applied a collagen foil covered with components of the fibrin adhesive. The postoperative period passed without complications.Conclusion. Spontaneous rupture of the diaphragm is a rare complication in children with diaphragmatic eventration, especially on the right side, in this case obstruction of the malformative colon ascended intrathoracically with progressive dilation of the intestinal loops being responsible for distension with gradual thinning of the hemidiaphragm sac resulting malformation in diaphragmatic rupture with herniation and progressive obliteration of the pleural space. The case of rupture of the diaphragmatic eventration associated with megadolicocolon confirms that the respiratory symptoms characteristic of this clinical situation may be overshadowed by the predominance of signs of intestinal obstruction, without leading to sudden progressive clinical deterioration, which proved to be a misleading moment in diagnosis. certainty of this serious complication rarity.

Cervicothoracic lipoblastoma: three case reports and review of literature

Background Lipoblastoma is a rare benign mesenchymal tumor of embryonal fat affecting mainly children below 3 years of age. It presents usually as a painless rapidly growing soft lobular mass in the extremities, trunk, and less frequently in the head-neck region. Preoperative imaging is used to assess the extent of disease and aid surgical planning. Complete surgical excision without injury to surrounding vital structures is the treatment of choice. Case presentation We report three interesting lipoblastoma cases: mediastinal lipoblastoma with airway compression and ipsilateral diaphragmatic eventration, neck lipoblastoma with intrathoracic extension, and huge thoracic inlet lipoblastoma with compression of common carotid and Lt subclavian arteries, brachial plexus, and ipsilateral diaphragmatic eventration. Complete excision of lipoblastoma mass was done via neck incision in two cases, and the third case required thoracoscopic excision of intrathoracic remnant 6 months later. All three patients had an excellent outcome. Conclusions Management of cervicothoracic lipoblastoma is a surgical challenge due to the potential for rapid growth and extension to different fascial planes; however, successful excision can be achieved via a neck approach. Complete surgical excision is essential to prevent local recurrence and improve the outcome.

OV17 LAPAROSCOPIC REPAIR OF A DIAPHRAGMATIC EVENTRATION

Aim Diaphragmatic eventration (DE) is a rare condition affecting 0,05% of general population. DE is the abnormal elevation of a portion of a entire hemidiaphragm due to a lack of muscle or nerve function. It can be congenital or acquired. The most common cause of DE is cardiac surgery. It can be asymptomatic or present mild symptoms as dispnea, palpitations, pneumonia. Material and Methods 61 years old male with medical history of arterial hypertension, DMII, Hyperlipidemia. He had a motor vehicle accident with 6 to 9 left ribs fractures. One month later complained of dyspnea with shortness of air to normal activity. Rx: elevation of left diaphragm. CT scan: elevation of left diaphragm without rupture, passive atelectasis of inferior left lobe of the lung. He initiated respiratory physiotherapy without improvement of the symptoms. 4 months after the accident, we had a stroke with right hemiparesis. This situation produced worsening of the dyspnea. Physiotherapy was reinforced with recuperation of the hemiparesis, but poor improvement of the dyspnea. 10 months after the accident, surgery was indicated for plication of the diaphragm to improve the respiratory function. Results The video shows the radiological exams and the surgery performed. Laparoscopic diaphragmatic plication with a reinforcement with a coated mesh (Uncoated monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier). He was discharge 2 days after surgery. The patient improved significantly in his respiratory symptoms an imaging exams. Conclusions Posttraumatic DE must be treated surgically with low morbidity and good functional results.

Diaphragmatic eventration case report: a possible sequelae of past tuberculosis infection.

Diaphragm eventration, an abnormal elevation of the dome of the diaphragm, could be congenital or acquired. Acquired cases usually occur after an episode of trauma to the phrenic nerve, or may be attributed to infectious and inflammatory causes. We report an acquired eventration with a probable association with tuberculosis infection.

Diaphragmatic eventration plication repair with minimal access techniques: a case series

Diaphragmatic eventration is a rare pathological condition occurring in <0.05% individuals causing the diaphragm to permanently ascend into the chest due to partial or complete replacement of diaphragmatic musculature by fibroblastic tissue. Congenital diaphragmatic eventration rarely presents among adults with most patients remaining asymptomatic only to be diagnosed incidentally after chest radiography. Symptomatic patients can present with dyspnoea, orthopnoea, recurrent lower respiratory tract infections or gastrointestinal symptoms. Management varies according to symptoms with asymptomatic cases requiring no intervention and plication being the standard, well-described technique for symptomatic cases. Here we described two cases with eventration approached using different minimal access techniques.