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ABSTRACT: The triad of gastric volvulus (GV), wandering spleen (WS), and diaphragmatic eventration (DE) is extremely uncommon and only two cases have been reported in the current pediatric literature. In this paper, we aim to describe the diagnostic and surgical management of a 5-month-old baby with this pathological triad and to present the other cases reported in pediatric literature. A 5-month-old baby was referred to our hospital because of vomiting and inconsolable crying from 12 h. The X-ray study demonstrated a severely distended stomach and a left diaphragmatic elevation. Swallow fluoroscopy revealed no passing contrast in duodenum and abdomen ultrasound showed splenic malposition. Computed tomography scan confirmed GV and WS. The patient underwent an urgent laparoscopy that revealed ischemia of the gastric antrum, thrombosis of the right gastroepiploic vein, and eventration of the left hemidiaphragm. After laparotomic conversion due to hemodynamic instability, derotation of the stomach allowed appreciation of splenic 360° twisting within the diaphragmatic defect. The spleen was untwisted, placed in a fashioned retroperitoneal pocket, and covered with the splenocolic ligament. The stomach was anchored to the large omentum and the diaphragm was plicated. Our case is the first one describing this pathological triad in such a little infant. This association is probably the result of a developmental defect of left upper abdomen ligaments and must be considered a cause of upper gastrointestinal obstruction. In case of diaphragmatic defects, if gastric malposition or ectopic spleen are identified, we suggest early diaphragmatic plication, prophylactic gastropexy, and splenopexy to prevent GV and WS torsion, which can lead to gastric necrosis with perforation and splenic infarction. Although laparoscopy may be useful, operative laparotomy is necessary in case of hemodynamic instability. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic malformations include congenital diaphragmatic hernia (CDH) and eventration of the diaphragm. The clinical presentation is variable, and the prognosis depends on multiple factors. The coexistence of CDH and diaphragmatic eventration in the same patient is extremely unusual and has not been reported previously in the literature. We report this rare association in a 3-month-old male infant who was managed successfully by minimally invasive approach.

Hiatal hernia, para-hiatal hernia, diaphragmatic hernia, diaphragmatic agenesis and diaphragmatic eventration are the main types of the diseases with diaphragmatic anatomic abnormalities. Benign and malignant tumors of the diaphragm are not discussed in this paper. Caused by the lack of knowledge about these diseases, improper imaging, clinical diagnosis is often confusing. Based on the literatures and our own experience, this paper proposes the concept of “diseases with diaphragmatic anatomic abnormalities”. The purpose is to summarize these diseases, and briefly describe the treatment methods, and to help strengthen the understanding and treatment of such diseases.

Diaphragm eventration is the permanent elevation of a hemidiaphragm and can be due to congenital or acquired causes. It is a rather uncommon condition in adults and causes a spectrum of symptoms, ranging from asymptomatic incidental findings on imaging to life-threatening respiratory distress. Asymptomatic patients do not require any treatment, but plication is the conventional, well-known method for treating symptomatic patients. Management varies depending on the symptoms. In this article, we discuss two rare cases of diaphragmatic eventration that were treated with minimal access surgery.

ABSTRACT: Congenital diaphragmatic malformations include congenital diaphragmatic hernia (CDH) and eventration of the diaphragm. The clinical presentation is variable, and the prognosis depends on multiple factors. The coexistence of CDH and diaphragmatic eventration in the same patient is extremely unusual and has not been reported previously in the literature. We report this rare association in a 3-month-old male infant who was managed successfully by minimally invasive approach. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

Diaphragmatic eventration is commonly seen following high-energy traumas, particularly due to traffic accidents and falls from significant heights. This pathology has the potential to influence both the gastrointestinal and cardiorespiratory systems, presenting with a variety of symptoms. A 45-year-old male patient, with a history of trauma from falling off a tree, sought medical attention at our clinic with dyspeptic complaints and symptoms of shortness of breath. During the physical examination, diminished sounds were detected in the right lung field, along with epigastric tenderness. For diagnostic purposes, a posteroanterior chest radiograph (CXRs) and thoracic computed tomography (CT) scan were obtained. A subsequent bronchoscopy, performed with a pulmonology consultation, revealed decreased diaphragmatic movements. Taking into account the findings, a thoracic surgery treatment plan was devised for the patient. This case report underscores the significance of considering the seldom-encountered pathology of diaphragmatic eventration in patients presenting with dyspeptic and respiratory complaints. Keeping in mind that patients with such symptoms frequently turn to family physicians, it highlights the pivotal role of a multidisciplinary primary care approach in initiating the diagnostic trajectory. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive surgery has been widely used for diaphragmatic eventration (DE). We aimed to compare the mid-term outcomes of robot-assisted thoracoscopic (RTP) and conventional thoracoscopic plication (CTP) for DE and to discuss the technical advantages of RTP. Methods: From January 2015 to July 2022, the clinical outcomes of 30 RTP patients and 35 CTP patients were retrospectively analyzed. The baseline data, surgical outcomes and surgical technique will be compared in detail. Results: The baseline data of two groups were comparable. No intraoperative conversion or complications occurred. The total operation time and intraoperative blood loss were similar between two groups, but RTP group had a significantly shorter diaphragmatic plication time compared to CTP group (25.77±3.55 min vs 44.49±4.43 min, p < 0.001). The total surgical cost of RTP group was higher than that of CTP group (48,593.06±2752.33 RMB vs 25,181.23±5681.51 RMB, p < 0.001). No significant differences were found in postoperative hospital stay, diclofenac suppository dosage, unplanned readmission rate within 30 days postoperatively, recurrence rate, or postoperative complications within 1 year postoperatively between RTP and CTP groups. Sixty patients had preoperative symptoms resolved or significantly improved with normal diaphragmatic position. However, two patients in CTP group encountered recurrence, and one patient in CTP group and two patients in RTP group had a diaphragm descent in only one intercostal space. Conclusion: RTP is a feasible and effective minimally invasive option for the treatment of DE, with mid-term outcomes comparable to CTP, which has a great advantage in terms of easier suturing and free knotting. DE can serve as an ideal disease type to train robots for thoracoscopic surgery by young doctors. Level of evidence: Level III.

Introduction: Pediatric gastric volvulus (GV) with diaphragmatic eventration is a rare but lethal condition. Case presentation: A 1-year-old girl complained of progressive vomiting, abdominal pain, and distension. On examination, plain abdominal radiograph demonstrated an air bubble sign in the left upper abdomen with elevation of the hemidiaphragm, while water-soluble contrast follow-through imaging showed partial gastric rotation. During exploratory laparotomy, gastric volvulus (GV) with left diaphragmatic eventration was identified. This abnormality was reduced by performing diaphragmatic plication and gastropexy. Postoperatively, the patient recovered without complications and was discharged on the tenth day of treatment. Conclusion: Pediatric gastric volvulus (GV) with diaphragmatic eventration is a surgical emergency. This case underscores the importance of considering GV in pediatric patients presenting with vomiting and abdominal symptoms, specifically when radiographic evidence suggests gastric distension and diaphragmatic abnormalities.

Intractable hiccups are a rare yet debilitating pathology with a broad differential and often indicate a more serious underlying pathology, which can range from neoplasms to structural abnormalities. In this case report, we present a 64-year-old male with seven months of intractable hiccups determined to be caused by eventration of the right hemidiaphragm. The patient was treated with baclofen to treat the hiccups pharmacologically. He was also prescribed voice therapy to establish rescue breathing techniques and reduce laryngospasm. Finally, he was referred to thoracic surgery for further evaluation and potential surgical intervention should his diaphragmatic eventration worsen or cause hypoxemia. To our knowledge, this is the first reported case of an association between diaphragmatic eventration and intractable hiccups. It is important to highlight this addition to the broad differential of intractable hiccups and to emphasize an interdisciplinary approach to workup and treatment of intractable hiccups.

Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10—stapled resection, 9—suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other. [ABSTRACT FROM AUTHOR]

Poland syndrome is a rare malformation characterized by agenesis of the pectoralis major muscle and breast agenesis associated or not with anomalies of the homolateral upper limb. We described a unique case of complete Poland syndrome with hepatic evisceration and diaphragmatic eventration in a female newborn, confirmed by a thoracic computed tomography scan. The patient underwent a thoracotomy with the repair of the chest wall. The follow-up was uneventful. Poland syndrome is a rare congenital malformation with varying degrees of thoracic and homolateral upper limb malformations. It is the first case of complete Poland syndrome reported in the literature. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. Case presentation We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient’s history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. Conclusion Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis.

Abstract Background Thoracic kidney (TK) presenting with symptomatic urolithiasis is a rare case scenario. Retrograde intrarenal surgery (RIRS) for calculus in TK is not reported in the literature. We report a case of partial staghorn calculus in TK managed by RIRS. Case presentation A young adult male presented with back pain and was found to have right TK and bilateral partial staghorn calculus. He also had right cryptorchidism with intraabdominally located testis. He underwent staged bilateral RIRS and laparoscopic right orchiectomy. Follow-up ultrasound imaging showed complete stone clearance in both kidneys. Conclusions RIRS is safe and effective treatment option, in the management of urolithiasis in TK. The anatomical abnormalities in TK did not play any hindrance role in the ureteral access, renal maneuverability of the flexible ureterorenoscope and subsequent drainage of the stone dust after RIRS.

Objective: Unusual clinical course Background: Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie's syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal distension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie's syndrome 1 day after diaphragmatic plication surgery. Case Report: We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient's condition. Conclusions: In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie's syndrome to prevent large-bowel perforation. [ABSTRACT FROM AUTHOR]

Diaphragmatic eventration is an abnormal elevation of part or the entire hemidiaphragm. It can be congenital or acquired. It occurs in 2 to 7 in 100000 live births and it is more common among boys. Symptomatic eventration is presented with different respiratory or gastrointestinal symptoms. The diagnosis is based on radiological images. Surgical treatment is indicated for all symptomatic patients. The goal is to strengthen the thin and weak diaphragm by plicating the diaphragm itself. Surgical approaches may differ. We present an eight month old boy with eventration who was diagnosed during prolonged respiratory infection. Our treatment approach was thoracoscopic plication of the diaphragm with good long-term outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article was to present the results of thoracotomy performed in three symptomatic adult patients with congenital diaphragm eventration in the light of current literature data. Methods: Along with representation of the surgical management of each case, a brief review of literature was performed. Results and Conclusion: Diaphragmatic eventration is a rare clinical entity that may be congenital or acquired. Surgery, which may be open or endoscopic, is the primary treatment modality for symptomatic patients.

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.

Background: Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. Case presentation: We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient's history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. Conclusion: Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Though their etiology and pathology are distinct, the treatment of symptomatic diaphragm eventration and paralysis is the same – diaphragm plication. Though there is little data to objectively compare plication techniques, all offer significant improvement in symptoms, pulmonary function, and respiratory quality-of-life scores. Nonetheless, potential advantages of a robot assisted laparoscopic approach to plication include lower morbidity than thoracotomy and laparotomy techniques; avoidance of single lung ventilation, less intercostal nerve pain, and greater working domain compared with thoracotomy and thoracoscopic approaches; and enhanced dexterity as compared with standard laparoscopic instrumentation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article was to present the results of thoracotomy performed in three symptomatic adult patients with congenital diaphragm eventration in the light of current literature data. Methods: Along with representation of the surgical management of each case, a brief review of literature was performed. Results and Conclusion: Diaphragmatic eventration is a rare clinical entity that may be congenital or acquired. Surgery, which may be open or endoscopic, is the primary treatment modality for symptomatic patients. [ABSTRACT FROM AUTHOR]

Abstract Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P

Diaphragmatic hernia and eventration of the diaphragm as congenital defects have similar clinical and radiological presentations. The umbilical venous catheter is successfully used for venous access in a neonatal age group with minimal complications. We present a case of a two-day-old neonate, initially scheduled for thoracoscopic repair of right diaphragmatic hernia. But, the intraoperative evaluation revealed the right diaphragmatic eventration. After initial ventilation and optimization in the neonatal intensive care unit, the baby was taken up for thoracoscopic repair under general anesthesia. The postoperative abdominal radiograph showed migration of umbilical vein catheter into the portal vein cephalad. The possible explanation is liver reposition to standard anatomical localization upon surgical correction. The catheter was uneventfully pulled back to its optimal position.

We encountered a case of high insertion of the right diaphragm complicated with congenital diaphragmatic hernia that was diagnosed based on thoracoscopic findings. A full‐term male baby was suspected of having right congenital diaphragmatic hernia or diaphragmatic eventration on postnatal imaging. He only had episodes of mild but prolonged symptoms following upper respiratory tract infection and his course was otherwise uneventful during outpatient monitoring. At 1 year old, the elevated liver volume remained large, which might eventually interfere with his lung growth, so thoracoscopic exploration was planned. Thoracoscopy revealed liver prolapse from a diaphragmatic defect. In addition, the anterior to lateral inserted part of the diaphragm was high, with the anterior part reaching the fourth rib. We repaired only the diaphragmatic defect without repositioning the diaphragm, and the postoperative course was uneventful. High insertion of the diaphragm should be considered as a differential diagnosis of congenital diaphragmatic eventration. [ABSTRACT FROM AUTHOR]

Abstract Background Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a high rate of new mutation and variable expression. Diffuse neurofibroma of the epidermis invading deeper organs is rare.We report a case of diffuse subcutaneous neurofibroma in the thoracoabdominal wall which had invaded the diaphragm and caused diaphragmatic eventration. Case presentation We describe a patient with diffuse neurofibroma of the chest and abdomen who was admitted to the hospital due to sudden abdominal pain and a possible diaphragmatic hernia. We performed thoracotomy and found that the neurofibroma had invaded the diaphragm and caused diaphragmatic eventration. Conclusions This occurrence has not been reported, and it shows that although neurofibromatosis is a benign disease, it still has the biological behavior of a malignant tumor and may cause a serious impact on and damage to other organs.

Symptomatic unilateral diaphragmatic eventration require surgical intervention. A 56-year-old woman complained of dyspnoea on exertion and was noted to have left diaphragm elevation on chest radiographs. Dynamic magnetic resonance imaging showed paradoxical movement of the left diaphragm. We performed diaphragmatic plication by uniportal thoracoscopy with knifeless endostaplers and a loop needle device. Her symptoms significantly improved immediately after the operation, and this condition had been maintained for 6 months. We thus suggest this minimally invasive technique as an easy and safe method for diaphragmatic plication., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Abstract Congenital Diaphragmatic Eventration (DE) requires a prompt diagnosis to avert the potentially life‐threatening complications. Herein, a 5‐month‐old male presented with recurrent respiratory infections due to a right‐sided diaphragmatic eventration. Misdiagnosed from previous medical visits, timely surgical intervention by thoracoscopic plication of the diaphragm was crucial for our patient's survival.

Aarskog Scott syndrome is a rare genetic disorder characterised by facial, limb and genital abnormalities first described in 1970. Its evolving nature in terms of associated features and increased surgical interventions necessitates anaesthesiologists to have a thorough knowledge about this syndrome for a better preparedness. Although multiple case reports have been published in literature since its discovery, no case report regarding its anaesthetic considerations and challenges have been described in literature till now. We report challenges encountered and successful anaesthetic management of a seven-year-old girl with Aarskog Scott Syndrome posted for a corneal repair in view of traumatic corneal perforation.

Congenital Diaphragmatic Eventration (DE) requires a prompt diagnosis to avert the potentially life‐threatening complications. Herein, a 5‐month‐old male presented with recurrent respiratory infections due to a right‐sided diaphragmatic eventration. Misdiagnosed from previous medical visits, timely surgical intervention by thoracoscopic plication of the diaphragm was crucial for our patient's survival. [ABSTRACT FROM AUTHOR]

Purpose: The diaphragmatic plication procedure by thoracoscopy has gradually become standard treatment for diaphragmatic eventration (DE). However, thoracoscopic diaphragmatic plication is difficult to manipulate and the surgical learning curve is long. This study aimed to demonstrate the feasibility and safety of same-day surgery for DE by minithoracotomy in children. Methods: From December 2017 to December 2019, we included 22 patients who underwent diaphragmatic plication of DE in the Department of Pediatric Thoracic Surgery at the Guangzhou Women and Children's Medical Center. A total of 10 patients underwent diaphragmatic plication by minithoracotomy and 12 patients underwent thoracoscopic plication. The perioperative condition and postoperative follow-up were evaluated, respectively. Results: The age, sex, and weight were no different in the minithoracotomy group versus the thoracoscopy group (P > 0.05). The intraoperative time, blood loss volume, and postoperative hospital stay of the minithoracotomy group were significantly less than that of the thoracoscopy group (31.10 ± 4.70 min vs. 72.08 ± 22.8 min; 1.20 ± 0.42 ml vs. 2.58 ± 1.67 ml; and 1.00 ± 0.00 days vs. 6.00 ± 2.95 days, respectively, all P < 0.05). The eventration levels in these two groups were significantly different in the perioperative and postoperative periods as detected by chest X-ray. No chest tubes were inserted and no recurrence of DE occurred in the thoracoscopy group through the postoperative follow-up of at least 6 months. Conclusion: Same-day surgery by minithoracotomy as a treatment for DE was feasible and safe with less operative time, less blood loss, and low recurrence. Same-day surgery for DE was attributed to a quick recovery. More prospective studies are necessary to further explore the consequences of same-day surgery for DE by minithoracotomy. [ABSTRACT FROM AUTHOR]

Diaphragmatic eventration (DE) associated with gastrointestinal anomalies is rarely reported, and its treatment is not well defined. We present a 24-years-old male admitted for cough, dyspnea, and chest pain, all of gradual onset. Chest computerized tomography (CT) and chest x-ray diagnosed diaphragmatic eventration and colonic distension. He underwent surgery via a posterolateral thoracotomy. We found colonic distension which pushed the left hemidiaphragm under intense pressure further into the chest, making immediate diaphragmatic plication via the chest difficult. We managed this by colonic needle decompression followed by resection and plication of the diaphragm. The patient had a satisfactory postoperative recovery with a good respiratory profile and no constipation. At a follow up visit, barium enema showed megacolon with no apparent etiology. He is to have a long-term outpatient follow up. Diaphragmatic eventration coexisting with megacolon is rare. Data available suggests supplementary abdominal workup is necessary to better plan the surgery. Surgical correction via an abdominal route tends to be more appropriate in these scenarios. In cases of gastrointestinal anomaly associated with diaphragmatic eventration, more careful abdominal consideration is needed to better plan the surgery. • Diaphragmatic eventration coexisting with megacolon is rare. • In case of diaphragmatic eventration associated with gastrointestinal anomalies, a special look on the abdomen allows a better planning of the surgery. • The abdominal approach for surgery seems more appropriate in these cases. [ABSTRACT FROM AUTHOR]

Pediatric gastric volvulus (GV) with diaphragmatic eventration is a rare but lethal condition. A 1-year-old girl complained of progressive vomiting, abdominal pain, and distension. On examination, plain abdominal radiograph demonstrated an air bubble sign in the left upper abdomen with elevation of the hemidiaphragm, while water-soluble contrast follow-through imaging showed partial gastric rotation. During exploratory laparotomy, gastric volvulus (GV) with left diaphragmatic eventration was identified. This abnormality was reduced by performing diaphragmatic plication and gastropexy. Postoperatively, the patient recovered without complications and was discharged on the tenth day of treatment. Pediatric gastric volvulus (GV) with diaphragmatic eventration is a surgical emergency. This case underscores the importance of considering GV in pediatric patients presenting with vomiting and abdominal symptoms, specifically when radiographic evidence suggests gastric distension and diaphragmatic abnormalities. [ABSTRACT FROM AUTHOR]

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.

Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a high rate of new mutation and variable expression. Diffuse neurofibroma of the epidermis invading deeper organs is rare.We report a case of diffuse subcutaneous neurofibroma in the thoracoabdominal wall which had invaded the diaphragm and caused diaphragmatic eventration.Case Presentation: We describe a patient with diffuse neurofibroma of the chest and abdomen who was admitted to the hospital due to sudden abdominal pain and a possible diaphragmatic hernia. We performed thoracotomy and found that the neurofibroma had invaded the diaphragm and caused diaphragmatic eventration.Conclusions: This occurrence has not been reported, and it shows that although neurofibromatosis is a benign disease, it still has the biological behavior of a malignant tumor and may cause a serious impact on and damage to other organs. [ABSTRACT FROM AUTHOR]