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Balamurugan G, Bhandarwar A, Wagh A, Bakhshi G, Ansari K, Bhondve S, Dhimole N, Jawale H. Comparison of short-term outcomes of video-assisted thoracoscopic (VATS) plication of diaphragmatic eventration - a six-year prospective cohort study. Updates Surg 2024; 76:279-288. [PMID: 37436542 DOI: 10.1007/s13304-023-01583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
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.
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Affiliation(s)
- G Balamurugan
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India.
| | - Ajay Bhandarwar
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Amol Wagh
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Girish Bakhshi
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Kashif Ansari
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Supriya Bhondve
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Nikhil Dhimole
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
| | - Hemant Jawale
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India
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Konstantinidi A, Liakou P, Kopanou Taliaka P, Lampridou M, Kalatzi N, Loukas I, Tavoulari EF, Mitropoulos K, Koulopoulos K, Sokou R. Congenital Diaphragmatic Eventration in the Neonatal Period: Systematic Review of the Literature and Report of a Rare Case Presenting with Gastrointestinal Disorders. Pediatr Rep 2023; 15:442-451. [PMID: 37606445 PMCID: PMC10443257 DOI: 10.3390/pediatric15030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The term congenital diaphragmatic eventration (CDE) refers to an anatomical abnormality of the diaphragm. It is a very rare condition; however, early and prompt diagnosis is of very great importance due to possible life-threatening complications. Most severely affected patients are neonates, usually presented with respiratory distress symptoms. The aim of this study was to systematically review the existing literature and to consolidate data on CDE in neonates as well as to report a case of a neonate with congenital diaphragmatic eventration of the left hemidiaphragm and clinical signs and symptoms of the gastrointestinal tract. METHODS An electronic search of the PubMed and Scopus databases was performed regarding studies evaluating the clinical presentation, diagnosis methods, treatments, and outcomes of CDE in the neonatal population. RESULTS Data from 93 studies were integrated into our review, reporting 204 CDE cases, and according to them, the male/female ratio was 1/1 with a predominance of right-sided eventration. The diagnosis was primarily established by chest X-ray; surgical intervention was the most frequent treatment. The recurrence rate was 8.3% (9/109 cases). CONCLUSIONS Early and accurate diagnosis of CDE and repair of the diaphragm can prevent complications, reduce morbidity, and improve the quality of patient's life.
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Affiliation(s)
- Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Paraskevi Liakou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Paschalia Kopanou Taliaka
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Maria Lampridou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Nicoletta Kalatzi
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Ierotheos Loukas
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Konstantinos Mitropoulos
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Konstantinos Koulopoulos
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
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Sallout B, Alshebli D, Sallout L, Al Baqawi B, Faden MS. Fetal Diaphragmatic Eventration: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:993-997. [PMID: 33412306 DOI: 10.1016/j.jogc.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Congenital diaphragmatic eventration (CDE) is a rare congenital malformation that is well described in the pediatric literature. In contrast to congenital diaphragmatic hernia (CDH), there is no physical defect in the diaphragm with CDE. Prenatal differentiation of the two pathologies represents a diagnostic and prognostic challenge. CASE A 26-year-old nulliparous woman was evaluated for a fetal thoracic mass. At 22 weeks, detailed morphology ultrasound revealed a multi-cystic structure in the left side of the thorax. Differential diagnosis included cystic congenital adenomatoid pulmonary malformation and CDH. Left diaphragmatic eventration was added to the differential diagnosis when serial ultrasound at 36 weeks showed the left hemidiaphragm as a thin membrane bulging into the fetal chest with the left kidney in a higher position underneath. The male infant was delivered vaginally at 373 weeks. CT imaging at 2 days of life showed findings consistent with left diaphragmatic eventration with protrusion of small bowel loops and the left kidney underneath. The infant was successfully extubated 3 days later and remained on nasal cannula until discharge on day 17 of life. At 6 months, the infant required operative repair owing to increasing shortness of breath. CONCLUSION CDE is a rare and difficult diagnosis to consider prenatally. Probable associated features may aid diagnosis. Additional, larger case series are needed to improve prenatal differentiation of this condition.
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Affiliation(s)
- Bahauddin Sallout
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Danya Alshebli
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Luai Sallout
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Badi Al Baqawi
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Majed S Faden
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia.
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P P, Karmacharya R, Vaidya S, Singh A, Thapa P, Dhakal P, Dahal S, Bade S, Bhandari N. Case report of eventration of diaphragm due to an unknown febrile illness causing phrenic nerve palsy and other multiple nerve palsies. Ann Med Surg (Lond) 2020; 54:74-78. [PMID: 32382413 PMCID: PMC7201156 DOI: 10.1016/j.amsu.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Diaphragmatic eventration can be congenital or acquired. Diagnosis is delayed due to no symptoms or very mild ones and is generally done by imaging modalities. This condition is managed by plication of the affected part of diaphragm by various surgical approaches. PRESENTATION OF CASE A forty seven years lady presented with one year long history of abdominal pain, bloating and fullness after meals who was being treated in line of peptic acid disorder. She had developed bilateral foot drop after typhoid fever at seventeen years of age. Clinical examination and imaging with chest x-ray, chest ultrasound and computed tomography scan suggested eventration of left hemidiaphragm. Plication of eventration of left hemidiaphragm was done via mini thoracotomy of the left thorax. There were no postoperative complications and she was discharged on the sixth postoperative day. DISCUSSION Acquired eventration of diaphragm is commonly due to traumatic phrenic nerve palsy but rarely can be associated with a history of infection causing nerve palsies. Thoracic ultrasound is an emerging modality for diagnosis supporting X-rays and CT Scans. Plication of eventration with minimally invasive techniques has less number of hospital stay and less pain compared to open approaches. CONCLUSION Non-traumatic diaphragmatic eventration due to acquired phrenic nerve palsy following an unknown febrile illness is a rare case to be reported in Nepal. The aim of treatment is expansion of intra-thoracic space which is done by plication of the diaphragm.
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Affiliation(s)
- Pradhan P
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - R.M. Karmacharya
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Vaidya
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - A.K. Singh
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - P Thapa
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - P Dhakal
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Dahal
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Bade
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - N Bhandari
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
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Congenital diaphragmatic eventration with absent left phrenic nerve in the fetal pig. Anat Sci Int 2019; 95:143-152. [PMID: 31414371 DOI: 10.1007/s12565-019-00499-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
We encountered a fetal pig with eventration of the diaphragm and pulmonary hypoplasia accompanied by phrenic nerve agenesis. The fetal pig was female measuring 34 cm in crown-rump length and about 1500 g in body weight. The diaphragm was a complete continuous sheet, but comprised a translucent membrane with residual muscular tissue only at the dorsolateral area of the right leaf of the diaphragm. The left leaf protruded extraordinarily toward the thoracic cavity. The left phrenic nerve was completely absent, while there was a slight remnant of the right phrenic nerve that supplied the dorsolateral muscular area of the right leaf. Both lungs were small, and the number of smaller bronchioles arising from the bronchioles was decreased to about half of that of the normal lung. Additionally, the right and left subclavius muscles and nerves could not be identified. These findings imply that the diaphragm, the subclavius muscle and nerves innervating them comprise a developmental module, which would secondarily affect lung development. It is considered that the present case is analogous to the animal model of congenital eventration of the diaphragm in humans.
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Laparoscopic Repair of Diaphragmatic Eventeration in Adults: Plication With Mesh Repair. Surg Laparosc Endosc Percutan Tech 2019; 28:e91-e93. [PMID: 29889109 DOI: 10.1097/sle.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diaphragmatic eventeration is a rare congenital anomaly consisting of defect of diaphragm muscular development, which can be diagnosed with chest radiography and clinical evaluation. Diaphragmatic plication is a well-established treatment for diaphragmatic eventeration, which can be done through the thoracic or abdominal route, and minimally invasive became the trend in recent years. METHODS The study retrospectively analyzed 3 cases of diaphragmatic eventeration with the procedure of laparoscopic diaphragmatic plication with mesh repair from August 2016 to April 2017. A detailed review of medical records and the perioperative data including patient characteristics, operative details, and postoperative hospital stay was conducted. RESULTS Laparoscopic diaphragmatic plication with mesh repair for diaphragmatic eventeration was successfully completed for 3 patients. The mean operation time was 125 minutes (range, 120 to 135 min), and the mean blood loss was 13.3 mL (range, 10 to 15 mL). The postoperative intercostal neuralgia was detailed evaluated and intervention as necessary. All patients were followed up at 1, 3, and 6 months after procedure, and the recoveries were uneventful. CONCLUSIONS Laparoscopic diaphragmatic plication with mesh repair provides a new operative view, which may be a safe and feasible alternative in the surgical management of diaphragmatic eventeration.
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Is surgical plication necessary in diaphragm eventration? Asian J Surg 2017; 39:59-65. [PMID: 26117205 DOI: 10.1016/j.asjsur.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. METHODS Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control; then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters-forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs-conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey-using a questionnaire that consisted of multiple choice questions with answer options such as "better," "the same," and "worse"-to understand preoperative and postoperative symptom levels in the 12(th) month of postoperative control. RESULTS According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1(st) postoperative month, 6(th) postoperative month, and 12(th) postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. CONCLUSION Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group; surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.
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Podgaetz E, Garza-Castillon R, Andrade RS. Best Approach and Benefit of Plication for Paralyzed Diaphragm. Thorac Surg Clin 2017; 26:333-46. [PMID: 27427528 DOI: 10.1016/j.thorsurg.2016.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diaphragmatic eventration and diaphragmatic paralysis are 2 entities with different etiology and pathology, and are often clinically indistinguishable. When symptomatic, their treatment is the same, with the objective to reduce the dysfunctional cephalad excursion of the diaphragm during inspiration. This can be achieved with diaphragmatic plication through the thorax or the abdomen with either open or minimally invasive techniques. We prefer the laparoscopic approach, due to its easy access to the diaphragm and to avoid pain associated with intercostal incisions and instrument use. Short-term and long-term results are excellent with this technique.
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Affiliation(s)
- Eitan Podgaetz
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA.
| | - Rafael Garza-Castillon
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
| | - Rafael S Andrade
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
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Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults. Minim Invasive Surg 2016; 2016:9032380. [PMID: 28074156 PMCID: PMC5198190 DOI: 10.1155/2016/9032380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n = 13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands.
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Wu S, Zang N, Zhu J, Pan Z, Wu C. Congenital diaphragmatic eventration in children: 12 years' experience with 177 cases in a single institution. J Pediatr Surg 2015; 50:1088-92. [PMID: 25783408 DOI: 10.1016/j.jpedsurg.2014.09.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study sought to summarize the diagnostic and treatment aspects of congenital diaphragmatic eventration (CDE) in children by retrospectively analyzing their medical records to identify and understand the complications of CDE, its treatment, and to evaluate the long-term outcomes of diaphragmatic plication. METHODS The medical records of children who received treatment for CDE from January 2000 to December 2011 at the Children's Hospital of Chongqing Medical University, China were analyzed. Data analyzed included the following: age, sex, symptom, location of eventration, associated anomalies, surgical procedures, complications, and survival and follow up details after diaphragmatic plication. RESULTS The medical records of 177 children (boys: 128, girls: 49, mean age: 10.28±2.35 months) with CDE were included in this study. Specific symptoms of eventration of the diaphragm were reported for 86 cases; and the typical symptoms included rapid breathing, vomiting, and recurrent respiratory infections. Except for a bilateral case, all the other patients had unilateral CDE. Associated malformations were observed in 31 cases (17.5%), hypoplastic lung (10 cases) was the most common followed by congenital heart disease (9 cases), and cryptorchidism (3 cases). Interestingly, 91 patients were asymptomatic. Diaphragmatic plication was performed in all symptomatic patients (86 cases, 48.5%) and none had recurrence. CONCLUSIONS Clinical symptoms of CDE varied in severity, ranging from asymptomatic conditions to life-threatening respiratory distress. Timely accurate diagnosis and treatment of symptomatic CDE could effectively resolve respiratory morbidity and reduce complications. The diaphragm plication surgery provided good results among the study population with no recurrence.
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Affiliation(s)
- Shengde Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zang
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University
| | - Jin Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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Wu L, Shi J, Chen Q, Jiang G. Congenital multiple eventrations of the right diaphragm in adulthood. J Thorac Cardiovasc Surg 2014; 148:735-6. [PMID: 24521958 DOI: 10.1016/j.jtcvs.2013.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jinyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Shanghai, China
| | - Qiankun Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China.
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Visouli AN, Mpakas A, Zarogoulidis P, Machairiotis N, Stylianaki A, Katsikogiannis N, Tsakiridis K, Courcoutsakis N, Zarogoulidis K. Video assisted thoracoscopic plication of the left hemidiaphragm in symptomatic eventration in adulthood. J Thorac Dis 2013; 4 Suppl 1:6-16. [PMID: 23304437 DOI: 10.3978/j.issn.2072-1439.2012.s001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/22/2012] [Indexed: 11/14/2022]
Abstract
Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of the diaphragm, which appears attenuated and membranous, maintaining its normal attachments and its anatomical continuity. It has been attributed to abnormal myoblast migration to the septum transversum and the pleuroperitoneal membrane. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm. Eventration results in diaphragmatic elevation (cephalad displacement). Most adults are asymptomatic and the diagnosis is incidentally made by chest radiography. The commonest symptom in the adults is dyspnoea, while orthopnoea, mild hypoxemia, tachypnoea, respiratory alkalosis, palpitations, and non specific gastrointestinal symptoms may be present. Surgery is indicated only in the presence of symptoms. The established surgical treatment is diaphragmatic plication. Various techniques and approaches have been employed. We present a simple surgical technique of a 3-port video assisted thoracoscopic plication of the left hemidiaphragm in the adult.
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Kansal AP, Chopra V, Chahal AS, Grover CS, Singh H, Kansal S. Right-sided diaphragmatic eventration: A rare entity. Lung India 2011; 26:48-50. [PMID: 20440395 PMCID: PMC2860415 DOI: 10.4103/0970-2113.48898] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm. It is a condition in which all or part of the diaphragm is largely composed of fibrous tissue with only a few or no interspersed muscle fibers. It can be complete or partial. Complete eventration of the right diaphragm, as seen in this adult patient, is relatively rare.
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Affiliation(s)
- A P Kansal
- Department of Chest and TB, Govt. Medical College, Patiala, India
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14
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Diaphragm plication for eventration or paralysis: a review of the literature. Ann Thorac Surg 2010; 89:S2146-50. [PMID: 20493999 DOI: 10.1016/j.athoracsur.2010.03.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/11/2022]
Abstract
Although etiology and pathology of symptomatic diaphragm paralysis and eventration are distinct, their treatments are the same: to reduce dysfunctional caudal excursion of the diaphragm during inspiration by plication. Minimally invasive diaphragm plication techniques have emerged as equally effective and less morbid alternatives to open plication. This review focuses on the etiology, pathophysiology, diagnosis, and treatment of diaphragmatic eventration or paralysis in adults.
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Groth SS, Rueth NM, Kast T, D'Cunha J, Kelly RF, Maddaus MA, Andrade RS. Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg 2010; 139:1452-6. [DOI: 10.1016/j.jtcvs.2009.10.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 08/29/2009] [Accepted: 10/07/2009] [Indexed: 10/20/2022]
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Kasznica J, Praagh RV, Philip AT. Right-Sided High Origin of Diaphragm Associated with Accessory Lobe of Liver, Lobulated Right Atrial Appendage, and Ipsilateral Phrenic Nerve Hamartoma: A Case Report. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Symptomatic diaphragmatic eventration is an uncommon condition and is sometimes impossible to distinguish clinically from paralysis. Patients who are asymptomatic require no treatment; patients who are symptomatic benefit significantly from diaphragm plication. The choice of plication approach is dependent upon the expertise of the surgeon.
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Affiliation(s)
- Shawn S Groth
- Department of Surgery, University of Minnesota, MMC 207, 420 Delaware Street, SE, Minneapolis, MN 55455, USA
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Jeanty C, Nien JK, Espinoza J, Kusanovic JP, Gonçalves LF, Qureshi F, Jacques S, Lee W, Romero R. Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:378-87. [PMID: 17366518 PMCID: PMC2391071 DOI: 10.1002/uog.3958] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia. METHODS We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies). RESULTS A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02). CONCLUSIONS The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- C Jeanty
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD, USA
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Gonzalez-Zamora JF, Perez-Guille B, Soriano-Rosales RE, Jimenez-Bravo-Luna MA, Gutierrez-Castrellon P, Ridaura-Sanz C, Alvarez FV. Video-assisted thoracoscopy for diaphragmatic plication: experimental study in a canine model. J Laparoendosc Adv Surg Tech A 2006; 15:661-6. [PMID: 16366879 DOI: 10.1089/lap.2005.15.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plication of a nonfunctional hemidiaphragm usually restores altered ventilatory mechanics. This study compared two techniques in performing diaphragmatic plication: video-assisted thoracoscopy (group A) and thoracotomy (group B). MATERIALS AND METHODS Twenty dogs with induced paralysis of the right hemidiaphragm were randomly assigned to one of the two groups. Evaluations were performed before and after plication of the respiratory frequency (f) and lung area (LA) of the affected side. Operative time, time to resumption of walking, ingestion of fluids and solid food, pain intensity, and postoperative complications were measured. RESULTS Group A had less pain after the surgery (P < 0.0001), earlier fluid ingestion (P < 0.05), and earlier resumption of walking (P < 0.019). Four weeks after the procedure, LA was similar in both groups, while a significant decrease in f was recorded in group A (P < 0.02). The remaining evaluated variables showed no differences. CONCLUSION Both approaches were effective. Pain recorded in the postoperative period was less and recovery was faster in group A. Complications and surgical times were similar. The video-assisted thoracoscopy is a safe and efficient option for performing diaphragmatic plication in dogs.
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Affiliation(s)
- Jose F Gonzalez-Zamora
- Laboratory of Experimental Surgery, Instituto Nacional de Pediatría, Mexico City, Mexico.
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Oh A, Gulati G, Sherman ML, Golub R, Kutin N. Bilateral eventration of the diaphragm with perforated gastric volvulus in an adolescent. J Pediatr Surg 2000; 35:1824-6. [PMID: 11101746 DOI: 10.1053/jpsu.2000.19271] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bilateral congenital eventration of the diaphragm almost uniformly presents in infancy with respiratory compromise and is associated with a high mortality rate. Delayed presentation of diaphragmatic eventration in older children and adults may be associated with acute gastric volvulus. Thus, any patient with abdominal pain, vomiting, or nonspecific gastrointestinal symptoms in association with abnormal diaphragmatic findings on chest x-ray should undergo further diagnostic workup with upper gastrointestinal series or computed tomography (CT) scan. Treatment of gastric volvulus requires immediate surgical repair to prevent subsequent necrosis and perforation. The authors describe a case report of bilateral congenital diaphragmatic eventration complicated by a perforated gastric volvulus in a 13-year-old boy. Emergent reduction of the volvulus, closure of the perforated stomach, plication of the diaphragm, and placement of gastrostomy was performed successfully.
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Affiliation(s)
- A Oh
- Flushing Hospital Medical Center, Flushing, NY, USA
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Vanamo K, Rintala R, Lindahl H, Louhimo I. Congenital eventration of the diaphragm - 45 years' perspective. Pediatr Surg Int 1996; 11:123-5. [PMID: 24057533 DOI: 10.1007/bf00183742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/1995] [Indexed: 11/28/2022]
Abstract
Fifty-five children with congenital eventration of the diaphragm were operated upon in a single tertiary-care children's hospital during the 45-year period from 1948 to 1992. The study was divided into three periods: 1948-1962, 1963-1977, 1978-1992. There were 14 patients in the first group, 26 in the second, and 15 in the third. Children later in the series presented earlier and with more acute symptoms. Mortality was related to severe pulmonary hypoplasia and associated anomalies, especially chromosomal defects: 14% during the first period, 27% during the second, and 7% during the third.
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Affiliation(s)
- K Vanamo
- Children's Hospital, University of Helsinki, SF-00290, Helsinki, Finland
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Coexistent diaphragmatic herniation and eventration: Embryologic rationale for therapeutic interventions. Clin Anat 1994. [DOI: 10.1002/ca.980070306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Affiliation(s)
- G J Gibson
- Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne
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Bove KE, Iannaccone ST. Atypical infantile spinomuscular atrophy presenting as acute diaphragmatic paralysis. PEDIATRIC PATHOLOGY 1988; 8:95-107. [PMID: 3399458 DOI: 10.3109/15513818809022282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two infants with progressive spinomuscular atrophy presented with severe diaphragmatic dysfunction, increasing to 9 the number of cases with this clinically distinctive variant of Werdnig-Hoffmann disease. The anterior horn cell lesion was generalized but was exceptionally severe in the cervical spinal cord of our cases. Fiber size disproportion in serial thigh muscle samples indicated that qualitative neuronal dysfunction preceded appearance of typical denervation. Shoulder girdle muscle biopsy may be more appropriate in these infants, whose prognosis appears to be universally poor.
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Affiliation(s)
- K E Bove
- Department of Pathology, Children's Hospital Medical Center, Cincinnati, Ohio 45229
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Obara H, Hoshina H, Iwai S, Ito H, Hisano K. Eventration of the diaphragm in infants and children. ACTA PAEDIATRICA SCANDINAVICA 1987; 76:654-8. [PMID: 3630683 DOI: 10.1111/j.1651-2227.1987.tb10536.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The study reviews 18 infants and children with eventration of the diaphragm who were treated over a period of eight years. The affected diaphragm and pulmonary tissue were examined by light and electron microscopy. The 18 patients, ranging in age from 10 days to 6 years, were divided according to Thomas' classification into a group with the congenital (10 patients) and a group with the acquired type (8 patients). Fifteen of these patients underwent surgery with diaphragmatic plication. On microscopic examination, biopsies of the lung showed atelectasis and pneumonia. These pathological changes became increasingly diffuse and severe with age. The diaphragm in patients with the congenital type of eventration was occupied by diffuse fibroelastic tissue. In patients with the acquired type, the cross-striated muscles of the diaphragm showed degenerative changes such as fragmentation, and interstitial fibrosis of the diaphragm became prominent with age. The results of this clinical study suggest that, in order to reduce the pathological changes in the lung, early surgical plication should be performed even in patients with the acquired type, if respiratory and digestive symptoms are noted.
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Moerman P, Fryns JP, Devlieger H, Van Assche A, Lauweryns J. Congenital eventration of the diaphragm: an unusual cause of intractable neonatal respiratory distress with variable etiology. AMERICAN JOURNAL OF MEDICAL GENETICS 1987; 27:213-8. [PMID: 3605197 DOI: 10.1002/ajmg.1320270124] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We describe two infants dying neonatally of respiratory failure despite all attempts at resuscitation. The most striking finding at autopsy was eventration and reduced muscle content of the diaphragm. Microscopic examination of the skeletal muscles, in combination with retrospective evaluation of the family history, disclosed severe X-linked centronuclear myopathy in the first patient and congenital myotonic dystrophy in the second. These disorders are probably more frequent than reported before. Their identification is important, not only for genetic counseling of the involved families but also for providing the neonatologist a sufficient explanation for the failure of resuscitation.
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Abstract
Bilateral congenital eventration of the diaphragms is a relatively rare occurrence, associated with an almost uniform mortality. We recently have had experience with three patients who underwent successful treatment of this anomaly. Each patient presented as a newborn with severe respiratory insufficiency. One had had a sibling who died shortly after birth with a congenital diaphragmatic hernia. One infant had associated respiratory distress syndrome. PA and lateral chest roentgenograms demonstrated the anomaly in each patient. In two, the use of ultrasound clearly demonstrated the presence of attenuated diaphragms and paradoxical motion. Each infant underwent transabdominal bilateral diaphragmatic plication, reinforced with transversus abdominis muscle, within the first 2 weeks of life. Two infants showed prompt improvement in arterial blood gases and were extubated following the operation. The infant with respiratory distress syndrome required a tracheostomy for continued mechanical ventilation. This infant developed a recurrent eventration of the left diaphragm 6 months after the initial operation and has undergone a secondary plication with clinical improvement. Unlike unilateral eventration, bilateral eventration of the diaphragms is associated with persistent and significant respiratory symptoms. Surgical plication should be performed urgently in all of these patients, before chronic pulmonary changes occur.
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Wright CD, Williams JG, Ogilvie CM, Donnelly RJ. Results of diaphragmatic plication for unilateral diaphragmatic paralysis. J Thorac Cardiovasc Surg 1985. [DOI: 10.1016/s0022-5223(19)38619-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baron RL, Lee JK, Melson GL. Sonographic evaluation of right juxtadiaphragmatic masses in children using transhepatic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 1980; 8:156-159. [PMID: 6767752 DOI: 10.1002/jcu.1870080214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
Eventration of the diaphragm, although a relatively rare clinical entity, should be considered in all patients with respiratory distress during the neonatal period, particularly in babies born after difficult delivery by breech presentation or forceps extraction. The diagnosis can be made in the majority of spontaneously breathing patients by chest roentgenography or by fluoroscopy. The treatment initially should be supportive, including assisted ventilation if needed. If the infant cannot be weaned off the respirator after a week to ten days of respiratory support, surgical correction of the elevated diaphragm should be carried out. The results of surgical treatment in these desperately sick infants is usually most gratifying.
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Othersen HB, Lorenzo RL. Diaphragmatic paralysis and eventration: newer approaches to diagnosis and operative correction. J Pediatr Surg 1977; 12:309-15. [PMID: 559736 DOI: 10.1016/0022-3468(77)90006-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Positive contrast peritoneography allows the preoperative demonstration of the exact diaphragmatic contour in suspected eventration or paralysis. Anatomical appearances of bilateral elevation or infracardiac involvement will indicate the need for abdominal rather than transthoracic approach for repair. The use of peritoneography should permit rapid evaluation of newborns with respiratory distress and allow repair before long-standing respirator support has produced pulmonary parenchymal damage.
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Iverson LI, Mittal A, Dugan DJ, Samson PC. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg 1976; 132:263-9. [PMID: 952354 DOI: 10.1016/0002-9610(76)90058-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Traumatic interruption of the phrenic nerve causing diaphragmatic paralysis occurs much more commonly than realized. Patients present with symptoms referable to the respiratory, gastrointestinal, or cardiovascular systems as a result of anatomic displacement of the respective organ (eventration). Symptoms often occur shortly after the injury but may be delayed for many years; consequently, prolonged follow-up of these patients is essential. If patients are symptomatic after trauma, judicious observation is dictated, since many will experience gradual return of normal diaphragmatic function over the succeeding six to twelve months. In those who remain significantly symptomatic, thoracotomy and imbrication of the eventration is a simple and effective surgical procedure.
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Orringer MB, Kirsh MM, Sloan H. Congenital and traumatic diaphragmatic hernias exclusive of the hiatus. Curr Probl Surg 1975:1-64. [PMID: 1120429 DOI: 10.1016/s0011-3840(75)80011-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Thomas TV. Upper abdominal mass following cervical node dissection. Chest 1975; 67:93-4. [PMID: 1235335 DOI: 10.1378/chest.67.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Abstract
Nine cases of diaphragmatic eventration are presented in infants, seven of whom required surgery. All were seen during the first 19 months of life and seven were less than 1 year old. Although differing from other studies, our cases show a predominance of right-sided lesions. Respiratory symptoms were present in most cases, and digestive symptoms appeared in a lesser number of cases. The radiological changes were pronounced in seven of the nine cases, the dome of the diaphragm reaching to the fourth to fifth intercostal spaces. Regarding surgical technique, the authors favour diaphragmatic plication through the thorax. This gave excellent clinical and radiological results and was without mortality or complications.
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Accessory diaphragm associated with congenital posterolateral diaphragmatic hernia, aberrant systemic artery to the right lower lobe, and anomalous pulmonary vein. J Thorac Cardiovasc Surg 1972. [DOI: 10.1016/s0022-5223(19)41784-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thomas TV. Herniation of the stomach presenting as a diverticulum. Postgrad Med 1971; 50:67-9. [PMID: 5002130 DOI: 10.1080/00325481.1971.11697663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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