CASE STUDY DIAPHRAGMATIC EVENTRATION

The abdominal approach is widely accepted approach because this allows ready access to both diaphragms and it permits abdominal exploration for evaluation of other gastrointestinal symptoms experienced by the patient [6]. Abstract We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. Gastrointestinal symptoms may be present including epigastric discomfort, heartburn, bloating constipation and weight loss. Potential benefits of diaphragmatic plication are still uncertain in the long term period. It is a relatively rare anomaly in adults [ 14 ]. Incentive spirometry and deep breathing exercises were started with resolution of the atelectasis after 1 week post-operatively.

External examination revealed a corpse with a height of cm, and weighing 85 kg. Sagittal section of the right hemithorax showing occupation by intestinal loops and mesentery. In the present case, the laparoscopic approach was used for diagnosing eventration and not diaphragmatic hernia; it also helped in the partial reduction of intestinal loops and release of adhesions of the colon in the roof of the hemidiaphragm. Our patient was treated chronically for bronchial asthma, with episodes of seizures and recurrent bronchial infections. Guarantor I am the guarantor, Johann Paulo Guzman. Deeper sole arch angle, and flexed toes, more prominent flexion of the thumb, atrophic and relatively thinner extremities below the knees were observed.

The right hemithorax presented invasion of the thin loops, right colon, and kidney. We proceeded by performing posterolateral thoracotomy at the level of the seventh intercostal space, with the hemidiaphragm incision to visualize the peritoneal viscera and avoid injury. Journal List Maedica Buchar v. Source of funding This paper was not funded and it has no study sponsors.

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

Our patient was treated chronically for bronchial asthma, with episodes of seizures and recurrent bronchial infections. Chest Xray taken on the first operative day showing atelectasis on the left lung. Incision of the laminated and elongated hemidiaphragm with the presence of muscle fibers. The patient stayed in the hospital for 12 days with an adequate evolution of the respiratory symptomatology and the operative wound.

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It is also believed that alterations in the development of adrenal glands and the liver can vary the position of the kidney [ 910 ].

case study diaphragmatic eventration

But we still recommend surgical therapy as soon as diagnosis is confirmed. The prosthetic mesh is used in cases of extreme amyotrophy [ 4 ] by placing it on the surface of the muscle, fixing it in the peripheral diaphragmatic inserts, and preventing recurrence at the ends of the plication; some authors are reluctant to use it due to the possibility of infection and increased cost of surgery, although these criteria are relative, if properly managed.

Bowel loops occupying the right hemithorax. There are about published cases, mainly in male adults with the involvement of the left evenrtation [ 78 ].

stury Ptister-Goedeke and Brunier described four types of thoracic ectopic kidneys: Postoperative radiological view of both hemithoraces, showing right lung expansion, renal silhouette, and the hemidiaphragmatic line. The difference between diaphragmatic hernia and eventration is important; in the latter, there is no true defect.

Diaphragmatic Eventration: Autopsy Case Report

However, none of these mechanisms is completely clear. The patient was started on incentive spirometry and deep breathing exercises Fig. The lesion of this nerve can be a consequence of neurological pathologies such as myelitis, encephalitis of diverse viral origins, postherpetic neuralgia, polio, tetanus, or diphtheria [ 410 ].

The image shows the abolition of the paradoxical movement, and although the diaphragm can remain motionless, there is no recurrence of symptoms [ 25 ]. The symptomatology is related when there is a diaphragmatic defect, as in the current case, or when the kidney presents lithiasis, obstruction, or tumor.

case study diaphragmatic eventration

Clifton and Wulkan [ 27 ] reports the use of PTFE in patients with hernias and eventrations with an excellent description of the operative technique in neonates.

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This finding is usually incidental, and the first case diagnosed was reported in by Wolfromm in a woman aged 42 years. Contrast coronal section showing both hemithoraces. It consists of the elevation of one, or less likely, both hemidiaphragms causing protrusion of the intra-abdominal viscera to the affected hemithorax.

In the present case, the laparoscopic approach was used for diagnosing eventration and not diaphragmatic hernia; it also helped in the partial reduction of intestinal loops evrntration release of adhesions of the colon in the roof of the hemidiaphragm.

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

Baseline arterial blood gases taken were within normal limits. In this patient, she presented evehtration symptoms similar to diaphragmatic hernia, thus a combination of imaging modalities help in the diagnosis in this patient.

For the radiological evaluation of diaphragmatic elevation, conventional PA, and lateral diaphrag,atic radiograms were used. Chest Ct-scan with IV and oral contrast was requested to further outline the anatomy. Plication of the diaphragm [ 3417 ] improves respiratory mechanics by increasing tidal volume and maximal respiratory capacity.

The pathology shows a translucent membrane of up to almost the normal muscle thickness, with the 3 layers of its structure and normal diaphragmatic inserts. We did an abdominal approach to evaluate the abdomen because the patient had epigastric discomfort. Potential benefits of diaphragmatic plication are still uncertain in the long term period. It was sutured with prolene 0.

Diaphragmatic eventration is a rarely seen asymptomatic pathology which is generally diagnosed incidentally