RESUMO
Eventration of the diaphragm is a cephalad displacement of the diaphragm because of congenital or acquired causes. The diaphragm maintains its anatomical continuity and normal attachments. It may be partial or complete and unilateral or bilateral. Most adult presentations are asymptomatic, but patients may present with respiratory, gastrointestinal, or cardiac symptoms. Surgical repair is indicated in the symptomatic patient with the most common being diaphragmatic plication. We present surgical repair of a symptomatic left diaphragmatic eventration in an octogenarian.
RESUMO
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.
RESUMO
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.
Assuntos
Humanos , Masculino , Idoso , Síndromes Compartimentais/patologia , Eventração Diafragmática/patologia , Rim/anormalidades , Autopsia , Cardiomiopatia Dilatada , Evolução FatalRESUMO
Introducción: las eventraciones y las hernias diafragmáticas crónicas son dos afecciones que en ocasiones se confunden; tienen una frecuencia relativamente baja y su estrategia quirúrgica varía. Objetivo: mostrar la experiencia del Hospital Universitario Clínico Quirúrgico Comandante Manuel Fajardo en la atención de enfermos con hernias y eventraciones diafragmáticas. Métodos: se presentan 11 pacientes atendidos desde 1998 hasta 2015 por afecciones del diafragma como eventraciones y hernias diafragmáticas crónicas. Del total, 7 fueron operadas con anillos de hasta 10 cm y dos con más de 10 cm. Resultados: se operaron 9 pacientes con hernias diafragmáticas y 2 con eventraciones. Ocho hernias fueron del lado izquierdo y una derecha. En 8 de las hernias el contenido era multivisceral. La hernia derecha tenía un anillo de más de 10 cm y con el hígado en su contenido. Cinco fueron reparadas mediante superposición de colgajos y en cuatro se necesitó una malla protésica. Las eventraciones se presentaron en dos mujeres, ambas parciales, una derecha y otra izquierda, tratadas con plicatura del hemidiafragma en dos planos. Conclusiones: las hernias y las eventraciones diafragmáticas son entidades parecidas con particularidades y terapéutica diferentes. En las eventraciones, la plicatura del diafragma es la técnica de elección, por vía abierta o de preferencia por toracoscopia. En las hernias diafragmáticas, la reparación depende del tamaño del anillo, hasta 10 cm se prefiere la reparación con superposición de colgajos y en defectos mayores el uso de mallas protésicas, preferentemente por una toracotomía(AU)
Introduction: Chronic diaphragmatic hernias and eventrations are two conditions sometimes mistaken for each other. They have a relatively low frequency and their surgical strategy varies. Objective: To show the experience at Comandante Manuel Fajardo Clinical Surgical University Hospital in the caring for patients with diaphragmatic eventrations and hernias. Methods: 11 patients attended from 1998 to 2015 were presented for diaphragmatic conditions, such as hernias and chronic diaphragmatic eventrations. Of the total, 7 were operated with rings of up to 10 cm. Two were operated for rings of more than 10 cm. Results: 9 patients with diaphragmatic hernias and 2 with incisional hernias were operated. Eight hernias were on the left side. One hernia was on the right side. In 8 of the hernias, the content was multivisceral. The right hernia had a ring of more than 10 cm, and had the liver in its content. Five hernias were repaired by flaps. Four hernias required a prosthetic mesh. The eventrations were presented in two women, both partial: one was on the right and the other was on the left, and both were treated with plication of the hemidiaphragm in two planes. Conclusions: Diaphragmatic hernias and eventrations are similar entities with different characteristics and therapeutics. In eventrations, the plication of the diaphragm is the technique of choice, either openly or preferably by thoracoscopy. In diaphragmatic hernias, repair depends on the size of the ring, up to 10 cm, flap repair is preferred, and in larger defects, it is the use of prosthetic meshes, preferably by thoracotomy(AU)
Assuntos
Humanos , Masculino , Feminino , Telas Cirúrgicas/estatística & dados numéricos , Toracoscopia/estatística & dados numéricos , Eventração Diafragmática/cirurgia , Hérnia Diafragmática Traumática/cirurgiaRESUMO
BACKGROUND: Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. CLINICAL CASE: Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. CONCLUSIONS: Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus.
Assuntos
Eventração Diafragmática/complicações , Gastrectomia/métodos , Laparoscopia , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
La eventración diafragmática constituye una rara anomalía congénita del diafragma que se presenta debido a una embriogénesis deficiente con atrofia de las fibras musculares del diafragma, transformación de conjuntiva y pérdida del tono muscular. Se presentó el caso de un paciente de 45 años de edad, mestizo, con antecedente de sufrir asma bronquial que acudió a Consulta de Cirugía del Centro Integral de Salud Salvador Allende, Caracas, en septiembre de 2011, refirió episodios de disnea y dolor torácico que se incrementaba con el ejercicio físico. Al examen clínico se detectaron ruidos hidroaéreos en hemitórax izquierdo lo que motivó la indicación de estudios radiográficos que evidenciaron la presencia de una eventración diafragmática de grandes proporciones; fue sometido a intervención quirúrgica con plicatura diafragmática con excelentes resultados.
The diaphragmatic eventration is a rare congenital anomaly of the diaphragm due to a deficient embryogenesis of the diaphragm, with atrophy of muscular fibers, conjunctive transformation and loss of the muscular tone. A 45- year-old male patient with history of asthma who came to Surgery Consultation of Salvador Allende Health Center, Caracas, in September 2011, with episodes of dyspnea and thoracic pain that was increasing with physical exercise. The examination revealed hydroaerial noises to the left hemithorax and radiographic exams were done, the diaphragmatic eventration diagnosis of big proportions was revealed. The surgical treatment was determined by diaphragmatic plication with excellent results.
RESUMO
Introducción: la distocia de hombros es un evento impredecible que puede ser leve o grave. En el período neonatal constituye el factor de riesgo más importante para lesión del plexo braquial y una causa excepcional de eventración diafragmática por injuria del nervio frénico. Presentación del caso: se presenta un recién nacido producto de parto distócico por distocia de hombros, que nace severamente deprimido y en su evolución requiere soporte ventilatorio prolongado. Conclusiones: el estudio fluoroscópico concluyó una eventración diafragmática derecha, permaneciendo con un síndrome de dificultad respiratoria de aproximadamente un mes de evolución y sin requerir tratamiento quirúrgico hasta el momento actual. Las complicaciones más frecuentes fueron la bronconeumonía y las atelectasias a repetición. Se realizó una revisión actualizada del tema destacándose diagnóstico etiológico. Se presentan fotos previo consentimiento familiar.
Introduction: shoulder dystocia is an unpredictable event that can be mild or severe. In the neonatal period is the most important risk factor for brachial plexus injury and an exceptional cause of diaphragmatic hernia by phrenic nerve injury. Case presentation: a newborn is presented after a shoulder dystocia delivery, born severely depressed and whose evolution requires prolonged ventilatory support. Conclusions: in the fluoroscopic study we concluded right diaphragmatic hernia, with respiratory distress syndrome approximately of one month of evolution and without requiring surgical treatment to date. The most frequent complications were repeated bronchopneumonia and atelectasis. An updated review of the literature highlighting etiologic diagnosis was made. Photos are presented prior parental consent.
RESUMO
Se reporta el caso de un neonato femenino de 26 días evaluado y diagnosticado con una patología diafragmática, observándose 7 días antes del ingreso manifestaciones clínicas como tos, obstrucción nasal, rechazo a la succión y signos variables de dificultad respiratoria. En la radiografía de tórax se evidencia vísceras en el tórax. La valoración cardiológica fue normal. Se interviene quirúrgicamente y se encuentra eventración diafragmática. En su estancia hospitalaria presenta otras complicaciones digestivas, por lo que es sometido a una nueva cirugía, encontrándose malformaciones a nivel de tubo digestivo. La evolución clínica es favorable hasta el alta.
A 26 days female neonate case is reported. Evaluation and diagnosis was made: diaphragmatic pathology. Seven days before admission were present some signs like cough, nasal blockage, rejection to suction, and changeable signs of respiratory discomfort. In the chest X-ray we can see abdominal viscera in the thorax. Cardiologic evaluation was normal. Surgical treatment was applied and a big diaphragmatic eventration was found. In her stay at the Hospital the patient presented other digestive complications, which caused another surgical intervention, this time we found malformations in the digestive tract. Clinical evolution was favorable until discharge.