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Thoracoscopic plication for idiopathic eventration of the bilateral diaphragm: Report of a case.

Ichiki Y, Korehisa S, Kawasaki J, Hamatsu T, Suehiro T, Koike M, Tanaka F, Sugimachi K - Int J Surg Case Rep (2015)

Bottom Line: Trauma, neoplasms, infection, and degenerative disease are the most common causes of this condition, whereas idiopathic eventration of the diaphragm is relatively infrequent.She subsequently withdrew from home oxygen therapy, which had introduced preoperatively, and exhibited a significant improvement in her pulmonary function for one year after the operation.We consider thoracoscopic plication to be an effective minimally invasive method, although single-lung ventilation is required.

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Surgery, Onga Nakama Medical Association Onga Hospital, 1725-2 Oaza-Ozaki Ongacho, Onga-gun, Fukuoka 811-4342, Japan. Electronic address: y-ichiki@med.uoeh-u.ac.jp.

No MeSH data available.


Related in: MedlinePlus

(A) The operative findings show the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs. (B) We performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue.
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fig0010: (A) The operative findings show the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs. (B) We performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue.

Mentions: An 85-year-old female with right diaphragmatic eventration newly detected on a chest roentgenogram (Fig. 1A) visited our hospital. She had no symptoms, and was therefore, followed closely without treatment. Two months later, she presented with dyspnea, and bilateral diaphragmatic eventration was detected on chest X-rays (Fig. 1B), without any underlying causes, such as neoplasms, trauma, infection or neuromuscular disorders. Computed tomography scans showed neither intrathoracic tumors nor a subphrenic process causing the diaphragmatic eventration. An arterial blood gas analysis performed under room air revealed the following data: pH 7.389; carbon dioxide tension 47.2 mm Hg; oxygen tension 62.3 mm Hg; base excess 2.3. Spirometry showed a forced volume capacity (FVC) of 800 ml (40.6% of predicted) and forced expiratory volume in 1 s (FEV1.0) of 550 ml (38.1% of predicted). She required home oxygen therapy (HOT) and surgical treatment was considered to be essential due to her progressive dyspnea. Plication of the right diaphragm using video-assisted thoracoscopic surgery (VATS) was performed in order to avoid injury to the intestines. A 10-mm port was placed in the ninth intercostal space along the postaxillary line, followed by 4-cm mini thoracotomy in the eighth intercostal space in the left decubitus position. The lung was deflated to reveal the right diaphragm, and the operative findings showed the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs (Fig. 2A). We subsequently performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue (Fig. 2B). The patient’s symptoms disappeared immediately after the podedure, and postoperative chest X-rays showed the right diaphragm to be fixed in the normal location (Fig. 3). The patient was then withdrawn from HOT, and thereafter, exhibited an uneventful postoperative course for one year after the operation.


Thoracoscopic plication for idiopathic eventration of the bilateral diaphragm: Report of a case.

Ichiki Y, Korehisa S, Kawasaki J, Hamatsu T, Suehiro T, Koike M, Tanaka F, Sugimachi K - Int J Surg Case Rep (2015)

(A) The operative findings show the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs. (B) We performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430177&req=5

fig0010: (A) The operative findings show the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs. (B) We performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue.
Mentions: An 85-year-old female with right diaphragmatic eventration newly detected on a chest roentgenogram (Fig. 1A) visited our hospital. She had no symptoms, and was therefore, followed closely without treatment. Two months later, she presented with dyspnea, and bilateral diaphragmatic eventration was detected on chest X-rays (Fig. 1B), without any underlying causes, such as neoplasms, trauma, infection or neuromuscular disorders. Computed tomography scans showed neither intrathoracic tumors nor a subphrenic process causing the diaphragmatic eventration. An arterial blood gas analysis performed under room air revealed the following data: pH 7.389; carbon dioxide tension 47.2 mm Hg; oxygen tension 62.3 mm Hg; base excess 2.3. Spirometry showed a forced volume capacity (FVC) of 800 ml (40.6% of predicted) and forced expiratory volume in 1 s (FEV1.0) of 550 ml (38.1% of predicted). She required home oxygen therapy (HOT) and surgical treatment was considered to be essential due to her progressive dyspnea. Plication of the right diaphragm using video-assisted thoracoscopic surgery (VATS) was performed in order to avoid injury to the intestines. A 10-mm port was placed in the ninth intercostal space along the postaxillary line, followed by 4-cm mini thoracotomy in the eighth intercostal space in the left decubitus position. The lung was deflated to reveal the right diaphragm, and the operative findings showed the right diaphragm to be pushed up toward the thoracic cavity by the celiac organs (Fig. 2A). We subsequently performed plication using interrupted horizontal mattress sutures with polypropylene and absorbable pledgets to prevent the device cutting through the tissue (Fig. 2B). The patient’s symptoms disappeared immediately after the podedure, and postoperative chest X-rays showed the right diaphragm to be fixed in the normal location (Fig. 3). The patient was then withdrawn from HOT, and thereafter, exhibited an uneventful postoperative course for one year after the operation.

Bottom Line: Trauma, neoplasms, infection, and degenerative disease are the most common causes of this condition, whereas idiopathic eventration of the diaphragm is relatively infrequent.She subsequently withdrew from home oxygen therapy, which had introduced preoperatively, and exhibited a significant improvement in her pulmonary function for one year after the operation.We consider thoracoscopic plication to be an effective minimally invasive method, although single-lung ventilation is required.

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Surgery, Onga Nakama Medical Association Onga Hospital, 1725-2 Oaza-Ozaki Ongacho, Onga-gun, Fukuoka 811-4342, Japan. Electronic address: y-ichiki@med.uoeh-u.ac.jp.

No MeSH data available.


Related in: MedlinePlus