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Pediatric Reports Jul 2023The term congenital diaphragmatic eventration (CDE) refers to an anatomical abnormality of the diaphragm. It is a very rare condition; however, early and prompt...
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.
PubMed: 37606445
DOI: 10.3390/pediatric15030041 -
ANZ Journal of Surgery Apr 2023
Topics: Humans; Diaphragmatic Eventration; Stomach Volvulus
PubMed: 36196995
DOI: 10.1111/ans.18103 -
Journal of Laparoendoscopic & Advanced... Oct 2015To report our technique and experiences in the laparoscopic diaphragmatic hemiplication (LDHP) in children with acquired diaphragmatic eventration after congenital heart...
PURPOSE
To report our technique and experiences in the laparoscopic diaphragmatic hemiplication (LDHP) in children with acquired diaphragmatic eventration after congenital heart surgery.
SUBJECTS AND METHODS
Between October 2007 to December 2013, 3498 children with congenital heart disease underwent cardiac surgery in our hospital, and 40 (1.14%) of them had unilateral diaphragmatic elevation on postoperative chest X-ray (mean elevation, 2.5 ± 0.26 intercostal spaces [ICS]) and were diagnosed as having diaphragmatic eventration due to diaphragmatic hemiparesis as a result of phrenic nerve injury. These 40 patients were followed up, and 22 of them recovered after conservative treatment; the other 18 needed surgical intervention. We conducted a retrospective study relating to surgical indications, surgical technique, complications, and outcomes.
RESULTS
There were 24 boys and 16 girls with a mean age of 10.0 ± 4.5 months old (range, 2 months-4 years). Twenty-two patients did not require surgical intervention. Eighteen patients underwent LDHP (12 cases left-sided and 6 cases right-sided); 2 of them had emergency LDHP with a history of ventilator dependency after cardiac surgery, and 16 of them had planned LDHP with a history of recurrent pneumonia and dyspnea. The operative time was 60 ± 7.9 minutes (range, 45-105 minutes), with minimal blood loss (3 ± 1.5 mL [range, 1-9 mL]), no intra- or postoperative complications, and postoperative hospital stay of 7 ± 1.3 days (range, 5-10 days). The diaphragmatic drop was 2.4 ± 0.2 (range, 2-4 ICS) without recurrence, and the follow-up time for all 40 patients was 14.8 ± 1.6 months (range, 11-36 months).
CONCLUSIONS
Our study further shows that LDHP is feasible and effective in selected patients after congenital heart surgery. Our technique is convenient and provides excellent clinical and radiological results.
Topics: Blood Loss, Surgical; Child, Preschool; Diaphragm; Diaphragmatic Eventration; Female; Heart Defects, Congenital; Humans; Infant; Laparoscopy; Length of Stay; Male; Operative Time; Peripheral Nerve Injuries; Phrenic Nerve; Postoperative Complications; Respiratory Paralysis; Retrospective Studies
PubMed: 26312945
DOI: 10.1089/lap.2014.0675 -
Journal of Laparoendoscopic & Advanced... Jun 2020To present a case series of children with eventration of diaphragm who underwent thoracoscopic repair highlighting the technical points and surgical modifications to... (Observational Study)
Observational Study
To present a case series of children with eventration of diaphragm who underwent thoracoscopic repair highlighting the technical points and surgical modifications to prevent a recurrence. This is an observational study of patients with diaphragmatic eventration admitted to a tertiary care institute. The study was designed following CARE guidelines endorsed by EQUATOR Network. Pediatric patients who had undergone thoracoscopic repair between January 2010 and March 2019 were included in the study. Age at surgery, gender, weight, site of the lesion, operating time, need for postoperative drain, and complications were assessed. Twenty-six patients had thoracoscopic repair of the eventration of diaphragm. The male-female ratio was 12:1 and mean weight at the time of surgery was 6.3 kg (2.2-22 kg) with most patients having left side congenital diaphragmatic eventration ( = 21) as compared with the right side ( = 5). The average operating time was 66 minutes (37-144 minutes). Diaphragm plication by a thoracoscopic approach is safe and feasible in neonates and pediatric patients.
Topics: Child; Child, Preschool; Diaphragm; Diaphragmatic Eventration; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Operative Time; Recurrence; Thoracoscopy
PubMed: 32155102
DOI: 10.1089/lap.2019.0805 -
Prague Medical Report 2022Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring,...
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.
Topics: Cesarean Section; Diaphragm; Diaphragmatic Eventration; Erythema Infectiosum; Female; Humans; Infant, Newborn; Male; Parvovirus B19, Human; Pregnancy
PubMed: 35248165
DOI: 10.14712/23362936.2022.6 -
Journal of Clinical Medicine Aug 2023Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of...
Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of diaphragmatic plication (DP) is still underestimated. The aim of the present study is to evaluate the efficacy of minimally-invasive surgical diaphragmatic plication for the management of unilateral diaphragmatic eventration, to the best of our knowledge, this is the largest series reported in the literature using a non-resectional technique. All patients with unilateral diaphragmatic paralysis admitted for diaphragmatic plication (DP) between January 2008 and December 2022 formed the cohort of this retrospective analysis. DP procedure was done to plicate the diaphragm without resection or replacement with synthetic materials. Patients were divided into two groups: Group I included patients who underwent DP through an open thoracotomy, and Group II included patients who underwent DP through video-assisted thoracoscopic surgery (VATS). Data from all patients were collected prospectively and subsequently analyzed retrospectively. Patients' characteristics, lung function tests, radiological findings, type of surgical procedures, complications, and postoperative follow-up were compared. The primary outcome measure was the postoperative result (deeper position of the paralyzed diaphragm) and improvement of dyspnea. The secondary outcome was lung function values over a long-term follow-up. The study included a total of 134 patients who underwent diaphragmatic plication during the study period. 94 (71.7%) were males, mean age of 64 (SD ± 14.0). Group I (thoracotomy group) consisted of 46 patients (35 male). Group II (VATS-group) consisted of 88 patients (69 male). The majority of patients demonstrated impaired lung functions ( = 126). The mean length of diaphragmatic displacement was 8 cm (SD ± 113.8 cm). The mean duration of the entire procedure, including placement of the epidural catheter (EDC), was longer in group I than in group II ( = 0.016). This was also observed for the mean length of the surgical procedure itself ( = 0.031). Most patients in group I had EDC ( = 38) ( = 0.001). Patients in group I required more medication for pain control ( = 0.022). A lower position of the diaphragm was achieved in all patients ( < 0.001). The length of hospital stay was 7 (SD ± 4.5) days in group I vs. 4.5 (SD ± 3.2) days in group II ( = 0.036). Minor complications occurred in 3% ( = 4) in group I vs. 2% ( = 3) in group II. No mortality was observed in any of the groups. Postoperative follow-up of patients at 6, 12, and 24 months showed a significant increase in forced vital capacity (FVC) up to 25% (SD ± 10%-35%) ( = 0.019), in forced expiratory volume in 1 s (FEV1) up to 20% (SD ± 12%-38%) in both groups ( = 0.026), also in the diffusion capacity of carbon monoxide (DLCO) up to 15% (SD ± 10%-20%) was noticed in both groups. Chronic pain symptoms were noted in 13% ( = 6) in group I vs. 2% ( = 2) in group II ( = 0.014). Except for one patient in group II, no recurrence of DE was observed. Diaphragm plication is an effective procedure to reduce debilitating dyspnea and improve lung function in patients suffering from diaphragm eventration. Minimally invasive diaphragmatic plication using VATS procedures is a safe and feasible procedure for the management of unilateral diaphragmatic paralysis. VATS-DP is superior to open procedure in terms of pain management and length of hospital stay, hence, accelerated recovery is more likely. Careful patient selection is crucial to achieving optimal outcomes. Prospective studies are needed to validate these results.
PubMed: 37629343
DOI: 10.3390/jcm12165301 -
Journal of Clinical Medicine May 2023A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration,... (Review)
Review
INTRODUCTION
A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association.
CASE PRESENTATION
A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful.
CONCLUSIONS
CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
PubMed: 37297803
DOI: 10.3390/jcm12113608 -
Lung India : Official Organ of Indian... 2023Diaphragm eventration is a rare permanent abnormal elevation of diaphragmatic muscles. They are rare entities with right-sided eventration occurring rarer still. We...
Diaphragm eventration is a rare permanent abnormal elevation of diaphragmatic muscles. They are rare entities with right-sided eventration occurring rarer still. We present a case of a 69-year-old male with right-sided hemidiaphragmatic eventration and post-COVID 19 pulmonary fibrotic changes.
PubMed: 37787362
DOI: 10.4103/lungindia.lungindia_92_23 -
Journal of Pediatric Surgery Jun 2020Thoracoscopic plication has gained popularity in the management of diaphragmatic eventration, and several suturing techniques have been described. However, the... (Comparative Study)
Comparative Study
BACKGROUND
Thoracoscopic plication has gained popularity in the management of diaphragmatic eventration, and several suturing techniques have been described. However, the superiority of one technique over the other has not been demonstrated. The purpose of this study is to report our experience with diaphragmatic plication and to compare the thoracoscopic interrupted and pleated suture techniques in pediatric patients with diaphragmatic eventration.
METHODS
This is a retrospective cohort study (level of evidence: 3) performed on 14 patients with diaphragmatic eventration. All patients were symptomatic and had diaphragmatic plication via thoracoscopy. The patients were further divided into two groups according to the repair technique; interrupted repair (n = 9) and pleated repair (n = 5). Preoperative, operative and postoperative data were compared between the two groups.
RESULTS
The median age was 9.5 months (25th- 75th percentiles: 6 to 15 months), and 8 (57%) were males. Twelve patients (85.71%) had right side eventration, and nine patients (64.29%) had congenital diaphragmatic eventration. One case was converted to open thoracotomy because of adhesions. There was no difference in the preoperative characteristics between both groups. Median operative time was 117 min (25th- 75th percentiles: 101-129 min) and 77 min (25th- 75th percentiles: 73-83 min) in the interrupted and pleated groups, respectively (p = 0.004). One patient had a postoperative elevation of the diaphragm (incomplete repair) in the pleated group (p = 0.357). No recurrence was reported during the follow-up.
CONCLUSION
Thoracoscopic plication is an effective technique for management of diaphragmatic eventration in children. Pleating technique is easy, fast, and associated with a marked reduction in operative time.
TYPE OF THE STUDY
Retrospective cohort study.
LEVELS OF EVIDENCE
Level of evidence: 3.
Topics: Child, Preschool; Diaphragmatic Eventration; Female; Follow-Up Studies; Humans; Infant; Male; Operative Time; Recurrence; Retrospective Studies; Suture Techniques; Thoracoscopy; Treatment Outcome
PubMed: 31937447
DOI: 10.1016/j.jpedsurg.2019.11.019 -
Pediatric Emergency Care Nov 2021We present a rare case of a 10-year-old boy with a right diaphragmatic eventration (DE), an uncommon pathology in children. The case highlights the importance of making...
We present a rare case of a 10-year-old boy with a right diaphragmatic eventration (DE), an uncommon pathology in children. The case highlights the importance of making a correct differential diagnosis between an acquired diaphragmatic hernia and a DE, two uncommon diaphragmatic pathologies. Differential diagnosis of these two entities can usually be made based on radiological findings, by identifying the continuity or the lack of continuity of the diaphragm, but sometimes, especially when on the right side, like in our case, they can be very difficult to differentiate by imaging. Diaphragmatic eventration is an abnormal elevation of an intact diaphragm that maintains its continuity and its attachments to the costal wall. Diaphragmatic hernia occurs when abdominal organs move into the chest through a defect in the diaphragm. Diaphragmatic hernia is generally symptomatic and always a medical emergency and requires urgent surgery, whereas DE is generally asymptomatic, has a better prognosis, and can be treated conservatively.As the treatment, the surgical approach, and the prognosis of these two entities are very different, a correct differential diagnosis is very important.
Topics: Child; Diagnosis, Differential; Diaphragm; Diaphragmatic Eventration; Hernias, Diaphragmatic, Congenital; Humans; Male; Prognosis
PubMed: 30829839
DOI: 10.1097/PEC.0000000000001765