RESUMEN
INTRODUCTION AND IMPORTANCE: Managing refractory pancreatic effusion due to porous diaphragm syndrome (PDS) is a challenge. Various surgical interventions such as repairing the defect, sealing with fibrin glue, performing parietal pleurectomy, and talc pleurodesis have been reported however, the use of composite mesh placement in treating PDS has not been described in the literature. CASE PRESENTATION: All three male patients with a low body mass index were diagnosed with pancreatic disease as described in cases 1-3 and associated pancreatic effusion. These patients required medical treatment as an initial approach and surgical intervention in the form of decortication, sterilization of the thoracic cavity with 20 % betadine and normal saline in the ratio 1:4, followed by warm normal saline washes and composite mesh placement for PDS followed by endoscopic retrograde cholangiopancreatography (ERCP) as a pancreatic intervention after 3 weeks. Only one patient underwent sphincterotomy, while the other two patients had no abnormality on ERCP. Post-operative follow-ups at 3, 6, and 12 months were uneventful with no recurrence. CLINICAL DISCUSSION: The mechanism for pancreatic effusion is explained by pancreatic duct disruption followed by enzyme leak leading to pancreatic-pleural communication mediated by PDS. Various studies have described their role in treating PDS, even thoracoscopic pleurodesis requiring prolong chest tube and repeated talc slurry for better outcome. However, to address this, we performed the above procedure as a bridge approach followed by a pancreatic intervention. CONCLUSION: Thoracic intervention with composite mesh can serve as a bridge procedure before future pancreatic intervention or surgery.
RESUMEN
We present the case of a patient who developed a massive right pleural effusion after pelvic surgery, not thoracic surgery. Lymphatic leakage into the abdominal cavity after pelvic surgery can cause massive pleural effusion when complicated with porous diaphragm syndrome.
RESUMEN
INTRODUCTION: Emphysematous pyelonephritis (EP) is a life-threatening renal disease requiring early and immediate therapy. EP resulting in tubercular empyema is unusual, with no reports to date. PRESENTATION OF CASE: A 50-year-old female in sepsis diagnosed with diabetes mellitus on insulin presented with recurrent abdominal pain radiating to the left side of her back for one month and recurrent episodes of vomiting and fever for one week. Her contrast-enhanced computed tomography showed emphysematous pyelonephritis (EP), ruptured splenic abscess, disrupted and eventrated left diaphragmatic lining, pleuroperitoneal communication, and a left empyema. Genexpert studies for pleural pus revealed Mycobacterium tuberculosis. Her deteriorating condition required surgical intervention in the form of decortication, sterilization of the thoracic cavity, and composite mesh placement for the diaphragmatic porous syndrome. CONCLUSION: This case report demonstrates the rare and aggressive presentation of EP, its sequelae, and successful management with composite mesh to prevent recurrent intrathoracic infection secondary to porous diaphragm syndrome.
RESUMEN
Porous diaphragm syndrome describes a defect in the diaphragm in which substances pass from the peritoneal cavity to the pleural space. Defects may be congenital or acquired. Acquired defects are caused by the thinning and eventual splitting of collagen fibres in the tendinous part of the diaphragm. We report a case of porous diaphragm syndrome with recurrent thymoma that presented with massive ascites. Increasing intra-abdominal pressure by ascites and diaphragmatic thinning due to malnutrition by malignancies resulted in the formation of an artificial hole. Thoracentesis changed the balance of hydrostatic pressure, which initiated the influx of a large volume of ascites to the pleural cavity through a hole in the diaphragm.
RESUMEN
Porous diaphragm syndromes are characterized by the passages of substances such as fluids, blood and gases through diaphragmatic defect from the peritoneal cavity into the pleural space. Clinically, they usually present with pleural effusions, hemothorax, pneumothorax and even empyema, secondary to the abdominal pathology. This condition may give rise to respiratory and cardiovascular problems in peri-anesthetic period. We report a case of progressive hemothorax induced by postoperative abdominal bleeding leading to cardiac arrest in gynecologic patient with undiagnosed porous diaphragmatic syndrome.