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Lung India : Official Organ of Indian... Jan 2024
PubMed: 38160467
DOI: 10.4103/lungindia.lungindia_459_23 -
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 -
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 -
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 -
International Journal of Surgery Case... Nov 2023Chilaiditi's syndrome, characterized by the abnormal positioning of the intestine between the diaphragm and liver, and diaphragmatic eventration, a condition marked by...
INTRODUCTION AND IMPORTANCE
Chilaiditi's syndrome, characterized by the abnormal positioning of the intestine between the diaphragm and liver, and diaphragmatic eventration, a condition marked by the permanent elevation of one side of the diaphragm, are both exceedingly uncommon medical conditions. Their co-occurrence is even rarer, with only a handful of documented cases in medical literature.
CASE PRESENTATION
A 71-year-old male patient initially presented with shortness of breath and was subsequently diagnosed with both Chilaiditi's syndrome and diaphragmatic eventration. His medical history included episodes of abdominal pain, constipation, and a prior colonoscopy that revealed no abnormal findings. Thorough physical examinations and imaging studies confirmed these diagnoses, and the patient's treatment was conservatively managed with intravenous fluids and laxatives, resulting in a significant improvement in his symptoms. Subsequent regular follow-up assessments showed no recurrence of symptoms.
CLINICAL DISCUSSION
Chilaiditi's sign/syndrome is a rare condition involving colon interposition between the liver and diaphragm, often diagnosed incidentally during imaging. It mainly affects older men and can cause abdominal symptoms. Management is typically conservative, but surgery may be needed if symptoms persist or complications arise, especially in cases of colonic volvulus or ischemia. When encountering diaphragmatic air, consider a differential diagnosis to avoid unnecessary surgery. Simultaneous hepatodiaphragmatic colonic interposition and diaphragmatic eventration is extremely rare, with uncertain causation.
CONCLUSION
This case highlights the rarity of the combination of Chilaiditi's syndrome and diaphragmatic eventration. Conservative management led to a significant improvement in symptoms, underscoring the importance of early recognition to prevent complications.
PubMed: 37931502
DOI: 10.1016/j.ijscr.2023.109008 -
Updates in Surgery Apr 2024The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the...
The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).
Topics: Humans; Diaphragmatic Eventration; Retrospective Studies; Quality of Life; Diaphragm; Laparoscopy
PubMed: 37847484
DOI: 10.1007/s13304-023-01665-7 -
International Journal of Surgery Case... Jan 2024Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute...
INTRODUCTION AND IMPORTANCE
Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute or chronic presentation and its symptoms will vary according to the degree of obstruction and rapidity of onset.
CASE PRESENTATION
We report a case of a 84-year-old male with history of frequent periods of constipation and lack of appetite who presented to the emergency room with left-sided abdominal pain and distension and persistent nausea, without the ability to vomit. Abdominal radiograph, computed tomography scan of the abdomen, contrast-enhanced examination and upper endoscopy were consistent with a gastric volvulus secondary to diaphragmatic eventration. The patient's symptoms resolved after nasogastric tube placement and fluid resuscitation. However, he was proposed to a laparoscopic anterior gastropexy to prevent symptom recurrence. He remains asymptomatic after 3 years of follow-up.
CLINICAL DISCUSSION
The diagnosis of gastric volvulus is based mainly on clinical presentation and abdominal imaging. The main principles of surgical intervention include stomach decompression with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors.
CONCLUSION
Definitive treatment of both acute and chronic gastric volvulus includes a surgical approach. Laparoscopic anterior gastropexy has been found to be a viable alternative in these patients.
PubMed: 38035865
DOI: 10.1016/j.ijscr.2023.109095 -
Journal of Veterinary Science Mar 2024A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic,...
A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.
Topics: Female; Cats; Animals; Diaphragmatic Eventration; Diaphragm; Hernia, Diaphragmatic; Cat Diseases
PubMed: 38568821
DOI: 10.4142/jvs.23277 -
Journal of Surgical Case Reports Mar 2024The aim of this report is to describe the management of an iatrogenic diaphragmatic eventration following surgery to relieve neurogenic symptoms of thoracic outlet...
The aim of this report is to describe the management of an iatrogenic diaphragmatic eventration following surgery to relieve neurogenic symptoms of thoracic outlet syndrome in a patient with a prior history of sleeve gastrectomy. We discuss the case of a 46-year-old woman with a 6-month history of gastro-oesophageal reflux and dyspnoea. Imaging demonstrated a left hemidiaphragm eventration and hiatus hernia. The patient underwent laparoscopic plication of the left hemidiaphragm, repair of the hiatus hernia, and an omega loop gastric bypass, with satisfactory resolution of her symptoms. This demonstrates that surgical diaphragmatic plication has good outcomes in cases where the abdominal anatomy is already altered as a result of previous bariatric surgery, and that concurrent hiatus hernia repair, plication of iatrogenic diaphragm eventration, and sleeve to gastric bypass conversion satisfactorily relieve reflux and dyspnoea in a morbidly obese patient.
PubMed: 38487395
DOI: 10.1093/jscr/rjae117