Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation

Abstract

We present a rare case of 32year old female with congenital diaphragmatic eventeration female presenting in an adult. She had symptoms of intermittent dyspnea and occasional epigastric discomfort. Patient had no previous history of trauma. Physical examination showed bowel sound involving the left hemithorax. Imaging modalities confirmed the diagnosis of a congenital left diaphragmatic eventeration. Patient underwent plication of the diaphragm using the abdominal approach. Intra-operatively, the left diaphragm was attenuated. Plication was done with 1st layer of imbricating silk heavy sutures buttressed by a second layer of interrupted absorbable sutures. She post-operatively had atelectasis on the left lung. Incentive spirometry and deep breathing exercises were started with resolution of the atelectasis after 1 week post-operatively. Patient had an unremarkable post-operative stay with resolution of symptoms. There are reports that diaphragmatic eventration diagnosed even as late 70 years old, highlighting the dogma that this is an asymptomatic disorder does not need all the time surgical therapy. But we still recommend surgical therapy as soon as diagnosis is confirmed. In this patient, there was no recurrence of symptoms after a follow-up of 2 years. Whether surgery indeed improved lung functions in these vastly asymptomatic patients, these questions could be an active area of research in the long term outcomes of these patients.

Keywords: Atelectasis; Diaphragmatic exenteration; Diaphragmatic plication.

Fig. 1

Chest Xray AP view showing shift of the cardiac shadow to the right with note of bowel loops in the left thorax.

Fig. 2

Coronal view of the Chest CT-scan IV and oral contrast showing gastric and bowel contents in the left hemithorax.

Fig. 3

Axial view of the Chest CT-scan IV and oral contrast showing gastric and bowel contents in the left hemithorax.

Fig. 4

Barium swallow outlining the gastric fundus, cardia and body which was located in the left hemithorax.

Fig. 5

Clear delineation of the left diaphragm outline with no defects noted.

Fig. 6

Diaphragm appears to be thinned out and attenuated intra-operatively.

Fig. 7

1st layer of imbricating sutures to the diaphragm.

Fig. 8

2nd layer of buttress sutures to reinforce the 1st layer.

Fig. 9

Chest Xray taken on the first operative day showing atelectasis on the left lung.

Fig. 10

Chest Xray taken 1 week post-operatively showing left lung expansion and elevated left hemidiaphragm.