DIAPHRAGMATIC EVENTRATION MANAGEMENT

BY DR U L SANDEEP VARMA PG GENERAL SURGERY

MODERATOR DR V PRABHAKAR

PROF AND HOD DEPT OF PEDIATRIC SURGERY

• A 12 month old female child hailing from NALGONDA was referred to pediatric surgery department with

• History of recurrent respiratory tract infections since birth and more since 10 days

• Pyrexia since 9 days

• Respiratory distress since 1 day.

• On general examination child is mildly toxic ,

minimal Respiratory distress with appearance of failure to thrive with weight 6.8 kgs at 1year of age.

• Respiratory sounds were diminished in the left base with hyper resonance on percussion.

• Abdomen soft and scaphoid . No Visible peristalisis , mass or tenderness.

• A diagnosis of Left Diaphragmatic Eventration was made and child was planned for surgery after stabilisation of respiratory system and complete pre-operative assessment.

• Under strict aseptic precautions and general anaesthesia (endo-tracheal intubation)

• Abdomen opened by left subcostal incision

• Left upper abdominal contents are brought into the wound and left dome of diaphragm is visualized.

• Left lobe of liver is mobilized by dividing left triangular ligament.

• Lower lobe of left lung is clearly visible through diaphragm which is stretched out and transparent.

• Lower margin of left lung is seen moving with respiration.

• The thin layer is consisting of Peritoneum. Diaphragm which is thin and stretched out. Pleura.

• To avoid negative pressure in thoracic cavity during surgery a small rent is made in the diaphragm after it is pulled out.

• Through this rent we have introduced Inter costal drainage tube and fixed it.

• Posterior part of diaphragm is muscular while central and anterior portions were stretched out and membranous.

• Plication was done with 2’0 Mersilk in a direction Postero lateral to antero medial to avoid injury to phrenic nerve.

• Iv antibiotics were continued. • POD-1:- • Child is active . • No distress • One episode of fever present. • HR- 92/min • RR-28/min • SPO2- 99% at room air

• RS :- BAE +, EQUAL , No added sounds. • Apex beat – palpable in left 5th ICS medial to

mid clavicular line . • ICD column moving freely.

• POD-7:- • Icd column was moving minimally and Icd was

removed.

• POD-10:- • Suture removal was done on 10th post op day . • Wound healthy.

• She was advised to review monthly once for 3 months .

THANKYOU