A Study on 114 cases of Congenital Diaphragmatic Eventration.

Aravindan, C (2007) A Study on 114 cases of Congenital Diaphragmatic Eventration. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Diaphragmatic eventration is an abnormal elevation of the intact diaphragm. .It may be congenital or acquired. It accounts for 5% of all diaphragmatic anomalies. Congenital diaphragmatic eventration(CDE) by definition present at birth. As with Bochhdalek’s congenital diaphragmatic hernia (CDH), congenital diaphragmatic eventration is thought to result from a congenital anomaly of pleuroperitoneal membrane but occurring at a slightly later stage. The condition remains important from the time it was recognized because of its close clinical similarity with CDH which has been a subject of great interest to pediatric surgeons throughout the world. CDH has seen over the years tremendous improvement in its survival and constant addition of diagnostic and therapeutic armamentarium in its management has made this possible though the cases with severe pulmonary hypoplasia and persistent pulmonary hypertension have very poor survival rates even in this modern era. 15- 20% of all CDH cases have a sac covering the herniated contents and this makes the differentiation between a complete eventration and CDH very difficult. And many authors say such a differentiation is not essential especially in massive herniation because the prognosis in these cases is similar because of associated pulmonary hypoplasia and such a differentiation is only arbitrary. The current study concentrates on clinical features, diagnosis, management and prognosis of this relatively rare clinical entity called congenital diaphragmatic eventration and comparison of prognosis of newborn cases of CDH and CDE in Indian scenario, in an institute like ours where we deal with a large volume of cases from all over South India which we thought could be of immense help for anyone who wants to know the clinical behavior of these cases and its management. There are only limited available studies in the literature worldwide with a large series as with this study which includes 114 cases of CDE. This study also aims at reviewing the complication rates of the two commonly performed surgical procedures for CDE individually which is all the more very difficult find in the literature. AIM : 1. To review the various clinical presentations of cases of diaphragmatic eventration and to know the common modes of presentation in various age groups. 2. To study the surgeries performed for diaphragmatic eventration and their results and to have a literature review in the subject. 3. To evaluate the prognosis following surgery and to study the prognosis of congenital diaphragmatic eventration in comparison with congenital diaphragmatic hernia in the newborn period. MATERIALS AND METHODS : All cases of diaphragmatic eventration diagnosed and treated at our hospital during the period from March 2001 to March 2006 (6 year period) were studied by reviewing the case records retrospectively. There were totally 114 cases. Age of presentation, sex, chief complaints and clinical features were noted. Chest X ray findings based on which the preoperative diagnosis was made were recorded. Note was made on other investigations done. Operative procedures done and the intra operative findings were noted. Complications and follow up of the cases were also recorded. CONCLUSIONS : 35% of all CDE cases present in newborn period and 79% present before 3 years of life. Left to right ratio is 3:1 and male to female ratio is 1.5:1. Bilateral cases are very rare. Segmental eventration was found in 23.7% cases and it usually affects right hemidiaphragm. Diaphragmatic elevation secondary to a primary lesion or due to birth injury is very rare. Cardiac anomalies are the commonest association – 11.5% in this series. CXR is the most important investigation required for diagnosis and is sufficient in most of the cases. A confident diagnosis of CDE was made in 74.4% of the cases according to this series with a combination of CXR and clinical features. Simple plication of diaphragm(71.5%) was the commonest surgery for CDE followed by excisional repair (28.5%) in our hospital. Major complications rate is 21.5 %. Wound complications are the commonest. Adhesive intestinal obstruction is commoner in excisional repair cases and recurrence of eventration appears to be common with placation. It needs further evaluation before calling it as a significant association. Mortality rate according to this series is 10.5% and the rate is almost double in the newborn period. Prognosis of newborn CDE cases as compared to CDH cases is much better probably due to less commoner association of lung hypoplasia with CDE cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Congenital Diaphragmatic Eventration ; case Study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:57
Last Modified: 28 Jul 2017 02:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/2284

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