Thoracoabdominal compartment syndrome complicating right-sided diaphragmatic eventration with co-existent unilateral renal agenesis

Diaphragmatic eventration (DE) associated with intestinal malrotation and renal agenesis is a rare entity. The authors report a case of a 69-year-old man who had symptoms of heart failure. He had a previous imaging diagnosis of right diaphragmatic eventration and dilated cardiomyopathy. He died on the second day after the hospital admission and had a post mortem examination that confirmed complete right diaphragmatic eventration, intestinal malrotation, left renal agenesis, dilated cardiomyopathy, and anteriorly rotated right kidney and had findings suggestive of a thoracoabdominal compartment syndrome. Thoracoabdominal compartment syndrome is described as transmission of abdominal pressure through a defective diaphragm causing compression of the hemithorax viscera and mediastinal shift with a hemodynamic alteration. The association of these anomalies is rare, and the possibility of this finding in a patient with eventration should always be considered.

Congenital diaphragmatic eventration with absent left phrenic nerve in the fetal pig.

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.

Minimally invasive surgery for diaphragmatic diseases in neonates and infants.

Owing to recent advances in minimally invasive surgery (MIS), laparoscopic and thoracoscopic surgery have been gradually introduced for use in neonates and infants. This review focuses on two popular MIS procedures for diaphragmatic diseases in neonates and infants: congenital diaphragmatic hernia (CHD) repair and plication for diaphragmatic eventration. While several advantages of MIS are proposed for CDH repair in neonates, there are also some concerns, namely intraoperative hypercapnia and acidosis and a higher recurrence rate than open techniques. Thus, neonates with severe CDH, along with an unstable circulatory and respiratory status, may be unsuitable for MIS repair, and the use of selection criteria is, therefore, important in these patients. It is generally believed that a learning curve is associated with the higher recurrence rate. Contrary to CDH repair, no major disadvantages associated with the use of MIS for diaphragmatic eventration have been reported in the literature, other than technical difficulty. Thus, if technically feasible, all pediatric patients with diaphragmatic eventration requiring surgical treatment are potential candidates for MIS. Due to a shortage of studies on this procedure, the potential advantages of MIS compared to open techniques for diaphragmatic eventration, such as early recovery and more rapid extubation, need to be confirmed by further studies.

[EXPERIENCE OF RELAPAROTOMY APPLICATION IN SURGICAL TREATMENT OF THE ABDOMINAL CAVITY ORGANS DISEASES].

During 2011 - 2014 yrs in Surgical Clinic of The First City Clinic (Poltava) a relaparotomy was performed in 127 patients. There was established, that relaparotomy constitutes the only one procedure for such life threatening states, as intraabdominal bleeding, ileus in a decompensation stage, eventration, progressing peritonitis, abdominal compartment syndrome stages III - IV. The rate of relaparotomy application after performance of urgent operative interventions is bigger than after planned operations (ratio 4:1). Individual estimation of a state and choice of optimal surgical tactics during primary and secondary operative interventions are needed to improve the results of treatment.

Imaging of the diaphragm: anatomy and function.

The diaphragm is the primary muscle of ventilation. Dysfunction of the diaphragm is an underappreciated cause of respiratory difficulties and may be due to a wide variety of entities, including surgery, trauma, tumor, and infection. Diaphragmatic disease usually manifests as elevation at chest radiography. Functional imaging with fluoroscopy (or ultrasonography or magnetic resonance imaging) is a simple and effective method of diagnosing diaphragmatic dysfunction, which can be classified as paralysis, weakness, or eventration. Diaphragmatic paralysis is indicated by absence of orthograde excursion on quiet and deep breathing, with paradoxical motion on sniffing. Diaphragmatic weakness is indicated by reduced or delayed orthograde excursion on deep breathing, with or without paradoxical motion on sniffing. Eventration is congenital thinning of a segment of diaphragmatic muscle and manifests as focal weakness. Treatment of diaphragmatic paralysis depends on the cause of the dysfunction and the severity of the symptoms. Treatment options include plication and phrenic nerve stimulation. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115127/-/DC1.

Left diaphragmatic eventration associated with ipsilateral pulmonary sequestration and intrathoracic kidney in a fetus: reviewing the prenatal diagnosis and etiopathogenesis.

The prenatal diagnosis of congenital diaphragmatic eventration, pulmonary extralobar sequestration and intrathoracic ectopic kidney in a single fetus is not reported yet according to the pubmed. Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm. Differential diagnosis from hernia is essential for the perinatal management. Extralobar sequestrations are usually asymptomatic and detected incidentally. Intrathoracic kidney is an extremely rare congenital anomaly. Genitourinary and cardiac anomalies should be searched as common co-existing malformations. Besides prenatal ultrasound, fetal magnetic resonance imaging has a substantial support in counselling the family, planning the follow-up of the pregnancy and decision-making for the perinatal management.

Congenital diaphragmatic eventration in two closely related British Shorthair cats.

Two closely related British Shorthair cats, which died after surgery performed in the dorsal position, were presented for dissection. In both, a thin, flaccid, enlarged transparent tendinous diaphragmatic portion protruded cranially into the thoracic cavity, forming a cupola in which left, right medial and quadrate hepatic lobes were encased in both cats and the stomach in one cat. Microscopically, no muscle fibres were observed in the membrane, but numerous hepatocytes and bile ducts were incorporated in its central part. The anomaly was diagnosed as a congenital diaphragmatic eventration.

Mediastinal lipoblastoma causing diaphragmatic eventration: a case report and review of the literature.

Lipoblastomatous tumors are quite rare neoplasms derived from embryonic white fatty tissues. The majority is seen in infancy and early childhood. Generally they arise in extremities. Here, we present a 12-month-old female infant presenting with a mediastinal and cervical mass, showing left diaphragmatic eventration. We reviewed these cases and discussed clinical manifestations, radiologic, and histopathologic findings and treatment of these tumors.

Compression of the right atrium due to coexistence of diaphragmatic eventration and Chilaiditi's syndrome.

We report on a 70-year-old male who was admitted to hospital due to progressive onset of dyspnea and fever. Diagnostic work-up revealed a high diaphragmatic position, compression of the right heart and supraventricular tachycardia. A simultaneous incidental finding was hepatodiaphragmatic colonic interposition (Chilaiditi's syndrome). Diaphragmatic plication through a right thoracotomy with bowel reduction was effective to treat the patient.This is the second reported case in the literature of a simultaneous occurrence of diaphragmatic eventration and Chilaiditi's syndrome.

Congenital diaphragmatic eventration in a stillborn foal.

A stillborn full term foal was presented at necropsy. The dilated duodenum and the dorsal and ventral left colon and cecum extended into the thoracic cavity and were encased by a thin transparent membrane originating from the diaphragm. The congenital condition was diagnosed as a developmental anomaly with diaphragmatic eventration. To the authors' knowledge, this is the first report of diaphragmatic eventration in a Thoroughbred stillborn foal.

Técnica de las eventroplastias con malla protésica / Surgical technique for eventroplasty with prosthetic mesh

La mayor parte de los estudios prospectivos mostraron clara superioridad de la reparación con malla protésica sobre los procedimientos anatómicos en el tratamiento de las eventraciones, y apoyaron el concepto del uso de material protésico aun en los defectos eventrógenos de menor tamaño. En este trabajo se va a describir la técnica de la eventroplastía con malla en las eventraciones más frecuentes (AU)

Técnica de las eventroplastias con malla protésica / Surgical technique for eventroplasty with prosthetic mesh

La mayor parte de los estudios prospectivos mostraron clara superioridad de la reparación con malla protésica sobre los procedimientos anatómicos en el tratamiento de las eventraciones, y apoyaron el concepto del uso de material protésico aun en los defectos eventrógenos de menor tamaño. En este trabajo se va a describir la técnica de la eventroplastía con malla en las eventraciones más frecuentes

Prediction of outcome in infants with congenital diaphragmatic hernia or severe diaphragmatic eventration.

Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) still have high mortality. Our aims were to identify clinical prognostic factors for CDH and SDE, and to determine whether the size or area of the proximal bilateral pulmonary arteries (PA) correlate with the clinical outcome. We retrospectively analyzed medical charts of 26 patients--20 with CDH and 6 with SDE, but no obvious other associated anomalies--admitted over a 12-year period. We compared prenatal history, clinical manifestations, blood gas, and echocardiography before surgery in the survivors and the non-survivors. Ten patients (8 CDH, 2 SDE) died 2 to 16 days after birth, including 2 patients without surgery due to progressive hypoxemia. The survivors had significantly higher 1- and 5-min Apgar scores, higher the worst preductal arterial blood gas pH levels, lower oxygen indices, and lower PaCO2 (P < 0.05). The McGoon index of PA size measured by echocardiography was higher in survivors, but not statistically significant. Nakada PA index results, however, were statistically significant (93.07 +/- 32.02 vs. 121.07 +/- 27.08, P < 0.05) In conclusion, Apgar scores, preductal PaCO2, oxygen index, and pH level can predict prognosis in infants with CDH and SDE. The Nakada PA index, however, might be a useful prognostic marker for patients with CDH and SDE.

Congenital eventration of the diaphragm in children: 25 years' experience in three pediatric surgery centers.

Eventration of the diaphragm is generally defined as an abnormal elevation of all or a portion of an attenuated but otherwise intact diaphragmatic leaf. Previous studies have indicated that eventration is a relatively rare condition, which can be symptomatic and requires surgery. We aimed to evaluate our patients with diaphragmatic eventration, and to discuss their characteristics in the light of the relevant literature. We retrospectively analyzed age, sex, incidence, location of the eventration, symptoms, associated anomalies, surgical technique, complications and survival in our patients. Between 1974 and 1999, 33 patients were treated in the Pediatric Surgery Departments of Ege University, SSK Children's Hospital and Behçet Uz Children's Hospital, 18 of them boys and 15 girls. The ages of our patients ranged from three days to 12 years. All of the patients had at least one of the respiratory symptoms such as cough, respiratory distress and fever; 3 newborns were admitted with severe respiratory distress while children belonging to higher age groups had symptoms of acute or recurrent pulmonary infections and failure to thrive. The eventration was right-sided in 22, 11 eventrations were left-sided. Diagnosis was performed with the help of a number of radiological studies such as fluoroscopic investigation, contrast study of the upper gastrointestinal system, direct X-ray graphies of the thorax, CT scan and ultrasonography, as necessary. Surgery was performed via thoracotomy in 20 patients and the 12 other patients underwent laparotomy for plication. One patient underwent thoracoabdominal plication. Two patients died because of cardio-respiratory complications in the early postoperative period and the rest of them survived to annual follow-ups. In conclusion, diaphragmatic eventration is an important condition which can eventually be mortal. Early diagnosis is necessary and plication is the treatment of choice.

Eventración diafragmática traumática derecha: Reporte de un caso y revisión / de la literatura / S. T

La eventración diafragmática constituye una rara forma de afección diafragmática. Aunque no existen datos concluyentes, las eventraciones adquiridas del lado izquierdo parecen ser las más frecuentes. Por ser poco común, se presenta un paciente que luego de intervención neuroquirúrgica por accidente automovilístico muestra disnea y se le realiza radiografía de tórax, donde se observa elevación importante del hemidiafragma derecho. Se efectúan estudios contrastados del tractus digestivo superior e inferior, ultrasonografía y tomografía axial computadorizada abdominal con pruebas funcionales ventilatorias. Se interviene quirúrgicamente, y se comprueba una eventración diafragmática con laceraciones musculares. Se le realiza plicatura, en 3 planos, con puntos de Halsted y sutura no absorbible. Evolución satisfactoria. Se discute la difícil diferenciación entre eventración y hernia diafragmática, y en la mayoría de los casos la confirmación definitiva se efectúa durante el acto operatorio. No obstante, por el compromiso respiratorio que produce, la conducta quirúrgica será la correcta en estos pacientes. La reparación multilaminar es esencial para evitar la recidiva(AU)

Combination of diaphragmatic eventration and microphthalmia/anophthalmia is probably nonrandom.

Two sporadic cases of eventration of the diaphragm are reported; one had bilateral colobomatous microphthalmia and the other had anophthalmia. Absence of polydactyly and presence of eventration rather than diaphragmatic hernia helped to exclude Fryns syndrome. These cases together with published cases with overlapping features support the thesis that this combination of defects is nonrandom and of heterogeneous cause. Some cases are due to a pleiotropic gene defect. In other cases, a polytypic developmental field involving an unknown developmental cascade common to the eye and diaphragm may provide a basis for the combination.

Left diaphragmatic eventration with a suprapubic spleen: report of a case.

Diaphragmatic defects such as eventration and hernia are known to be associated with a high-sited, sometimes intrathoracic spleen. We report here a unique case of an 8-year-old boy found to have a left congenital diaphragmatic eventration and a suprapubic wandering spleen after presenting with symptoms of an "acute abdomen" due to torsion of the splenic pedicle. To our knowledge only one other case of a similar paradoxical association of these anomalies has been reported before; interestingly, in this patient splenic infarction had also resulted secondary to splenic torsion. We recommend careful evaluation of the location and vascular status of the spleen in all patients with congenital diaphragmatic defects due to the common occurrence of splenic vascular insult.

Surgical embryology and anatomy of the diaphragm with surgical applications.

This article reviews the development, surgical anatomy, and teratology of the diaphragm, and discusses the diagnostic procedures, surgical therapy, and prognosis of congenital disturbances. Special attention is paid to the traumatic rupture of the diaphragm, concerning incidence, cause, diagnosis, prognosis, and surgical repair.