EVENTRATION OF RIGHT HEMIDIAPHRAGMA IN A 47-YEAR-OLD ADULT. CLINICAL CASE PRESENTATION

Abstract

We present the case of a 47-year-old male patient with intellectual disability whose diagnosis was right diaphragmatic eventration. He has no history of abdominal trauma, however, he records an exploratory laparotomy for an unknown reason. He goes to the emergency room for an acute abdominal condition. During the surgical procedure, parietoenteric and enteroenteric adhesions are found; megacolon; fibrotic band in sigmoid colon; right lung completely collapsed; compliant right hemidiaphragm. Adherolysis + Brooke-style hemicolectomy + transverse ileus latero-terminal anastomosis + fiberoptic bronchoscopy + right diaphragmatic plication + right diaphragmatic plasty + pleural drainage + pleural lavage and drainage were performed.

Diaphragmatic eventration is defined as an abnormal elevation, which may be partial or total, of a hemidiaphragm, which may be related to both myoblast migration defects and phrenic nerve innervation disorders. The worldwide prevalence of this disease is less than 0.05%, there are few reports of its presentation in adult patients, highlighting its presentation as dyspneic syndrome. There is a dogma of conservative treatment in asymptomatic patients, however surgical treatment is recommended in all patients by different authors. Laparoscopic diaphragmatic plication is the most indicated option in the resolution of this pathology.