Cases reported "Diaphragmatic Eventration"

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1/15. Diaphragmatic rupture after epidural anaesthesia in a patient with diaphragmatic eventration.

    An 85-year-old man with undiagnosed eventration of the left hemidiaphragm had an above-knee amputation under epidural anaesthesia. His post-operative course was stormy with two episodes of cardiovascular collapse. On the third post-operative day, rupture of the left hemidiaphragm was diagnosed, the bowel had herniated into the left hemithorax. It is proposed that the left hemidiaphragm ruptured spontaneously because of muscular weakness secondary to the thoracic segmental blockade associated with lumber epidural anaesthesia.
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2/15. Split cord malformation with partial eventration of the diaphragm. Case report.

    The authors describe the case of a 3-year-old girl who presented with a dorsal split cord malformation (SCM) and was found to have eventration of the diaphragm. Although the child did not undergo surgery for eventration, its presence suggests a need for careful preoperative planning and clinical evaluation to rule out or confirm the anomalies associated with spinal dysraphism or SCM.
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3/15. diaphragmatic eventration : an uncommon presentation of a phrenic nerve schwannoma.

    We describe a patient who presented with a left lower lobe lung lesion suspicious for cancer with possible hilar involvement. Intraoperatively, we found a primary left phrenic nerve tumor, diaphragmatic eventration, and left lower lobe atelectasis. He was successfully treated with total excision of the tumor and plication of the diaphragm. Histopathology was consistent with schwannoma of the phrenic nerve. diaphragmatic eventration is an uncommon presentation of a phrenic nerve schwannoma, which is itself a rarely occurring tumor. Surgical resection of the tumor and diaphragmatic plication is the primary modality of management in these patients.
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4/15. Radiographic appearances following the Thal procedure.

    The Thal procedure for repair of distal esophageal stricture is described briefly and the radiographic appearance is ilustrated. The radiologist should be aware of the procedure to avoid confusing the post-operative appearance with a para-esophageal hiatus hernia or diaphragmatic eventration.
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5/15. Gastric rupture associated with pregnancy.

    BACKGROUND: Spontaneous gastric rupture during pregnancy is rare. CASE: A young primigravida delivered a 34-week stillborn infant. Shortly after delivery, she developed signs of hypovolemic shock. Ultrasound examination showed a large amount of free intra-abdominal fluid. At laparotomy, gastric rupture was encountered and repaired. Congenital eventration of the left hemidiaphragm was also noted. After a complicated postoperative course, the patient recovered and has done well. CONCLUSION: Rapid surgical intervention for gastric rupture associated with pregnancy is necessary for maternal survival.
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6/15. Congenital bilateral diaphragmatic eventration with membranous chest wall hamartoma.

    The case of a 2-month-old girl with congenital bilateral eventration of the diaphragm is reported. After normal delivery from cephalic position, the patient developed respiratory distress. Mechanical ventilation started immediately but extubation was difficult. A membranous lesion was found on computed tomography of the chest. Resection of the membrane between the right middle and lower lobes and bilateral diaphragmatic plication was performed. Histologically the membrane was a chest wall hamartoma. The patient was extubated on 6 day postoperatively and is alive and well 4 months after surgery.
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7/15. Thoracoscopic repair of diaphragmatic eventration.

    We report a 6-month-old child who presented with recurrent chest infections associated with a right diaphragmatic eventration. Failure in conservative management lead to thoracoscopic plication at 17 months of age and discharge on the third postoperative day. At one year followup he is completely free from all symptoms, and his chest x-ray demonstrates a marked improvement in the position of the diaphragm. We recommend thoracoscopy as a viable approach in treating this condition in children.
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8/15. Congenital diaphragmatic eventration associated with massive hiatal hernia.

    Congenital eventration of the diaphragm is uncommon. Its association with a hiatal hernia has not been reported earlier. We report a case of such an association in a 2-month-old boy who presented with tachypnea aggravated by feeding and recurrent vomiting. Diagnostic uncertainty and a unique course of postoperative recovery complicated by gastric volvulus are described. The patient underwent surgical plication of the right diaphragm, followed by an emergency hiatal repair on the first postoperative day. Timely recognition, and repair of the hiatal hernia averted a fatal complication.
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9/15. Thoracoscopic diaphragmatic eventration repair in children: about 10 cases.

    BACKGROUND AND AIM: Recent reports in literature have emphasized the clinical perception of reduced pain, postoperative morbidity, and dysfunction associated with thoracoscopic approach compared with standard thoracotomy. The authors describe a thoracoscopic approach and technical details for diaphragmatic eventration repair in children. patients AND methods: Ten patients, 4 girls and 6 boys, 1 teenager (14 years old) and 9 children (age range, 6-41 months; average, 17 months), were operated for a diaphragmatic eventration in 3 different pediatric surgery teams, according to the same technique. Symptoms were recurrent infection (7 cases), dyspnea on exertion (2 cases), and a rib deformity (1 case). An elective thoracoscopy was performed, patient in a lateral decubitus. A low carbon dioxide insufflation allowed a lung collapse. Reduction of the eventration was made progressively when folding and plicating the diaphragm. Plication of the diaphragm was done with an interrupted suture (6 cases) or a running suture (4 cases). The procedure finished either with an exsufflation (4 cases) or a drain (6 cases). RESULTS: A conversion was necessary in 2 cases: 1 insufflation was not tolerated and 1 diaphragm, higher than the fifth space, reduced too much the operative field. patients recovered between 2 and 4 days. dyspnea disappeared immediately. Mean follow-up of 16 months could assess the clinical improvement in every patient. DISCUSSION: Thoracoscopic conditions are quite different between a diaphragmatic hernia repair previously reported and an eventration. Concerning diaphragmatic hernias, reduction is easy, giving a large operative space for suturing the diaphragm. Concerning diaphragmatic eventrations, the lack of space remains important at the beginning of the procedure despite the insufflation into the pleural cavity. The operative ports must be high enough in the chest to allow a good mobility of the instruments. Chest drainage seems to be unnecessary. CONCLUSION: diaphragmatic eventration repair by thoracoscopy is feasible, safe, and efficient in children. Above all, it avoids a thoracotomy. It improves the immediate postoperative results with a good respiratory function.
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ranking = 2.5
keywords = operative
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10/15. Diaphragmatic paralysis and eventration in infants.

    Twenty-six children with eventration (congenital in 10, resulting from birth trauma in four, and resulting from operative phrenic nerve injury in 12) under 15 months of age were evaluated at a single institution in a 5 year period. There was a high incidence of significant associated anomalies and prematurity. All operative phrenic nerve injuries occurred in patients under 3 months of age, and they were most common in patients undergoing Blalock-Taussig shunt. Plication (12 thoracic, nine abdominal) was performed in 21 patients, 19 of whom had respiratory distress or were ventilator dependent. Repeat plication was required in four patients. All long-term survivors were extubated within 1 week of plication. Of 21 patients undergoing plication, 14 (67%) died. death was attributed directly to complications of eventration in three patients and was a contributing factor in nine patients. We reached the following conclusions: The incidence of operative phrenic nerve injury in infants undergoing lateral thoracotomy, particularly for Blalock-Taussig shunt, is higher than generally appreciated; plication is a safe procedure as performed by either an abdominal or thoracic approach; failure to achieve extubation within a week of plication is an ominous prognostic sign; mortality in patients with eventration in the presence of major associated conditions may be high despite plication.
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