Diaphragmatic eventration unusual presentation: a novel thoracoabdominal compartment syndrome case

Abstract

Diaphragmatic eventration is a rare entity in the adult population, and usually asymptomatic 1 ; our case is a young man with severe right-sided diaphragmatic eventration with huge dilated colon that has compromised the right hemithorax and caused complete lung collapse and mediastinal shift similar to tension pneumothorax picture with haemodynamic alteration. A single similar case report had been published but did not shed the light on the accurate description of the pathophysiological mechanism of the disease. We believe that such a high abdominal pressure that has transmitted to the thoracic cavity due to the pliable diaphragm causing such a derangment in both the anatomy and the physiology deserves reporting and we think that the term ‘thoracoabdominal compartment syndrome’ describes it accurately, so we discuss some learning points from our case and things that could have been done better.

Thoracoabdominal compartment syndrome complicating right-sided diaphragmatic eventration with co-existent unilateral renal agenesis

“…Complete lung collapse with mediastinal shift has been described as one of the complications of DE. 9 This was found in this index case; the total collapse of the right lung with the left mediastinal shift. The right hemithorax was filled with the liver, part of the gut, and the compressed remnants of the right lung.…”

“…2,5,8 Protrusion of colon into the thorax resulting in unilateral lung collapse, mediastinal shift, and features similar to tension pneumothorax have also been described and referred to as the thoraco-abdominal compartment syndrome. 9 This syndrome is believed to be a result of the transmission of the high abdominal pressure into the thoracic cavity ending up in physiologic and anatomic disruption. 9 Most adult patients with DE complain of respiratory symptoms, while others with associated mal-rotation of the gut also present subtle gastrointestinal symptoms.…”

“…9 This syndrome is believed to be a result of the transmission of the high abdominal pressure into the thoracic cavity ending up in physiologic and anatomic disruption. 9 Most adult patients with DE complain of respiratory symptoms, while others with associated mal-rotation of the gut also present subtle gastrointestinal symptoms. Renal agenesis and renal ectopia are sporadic findings in association with DE.…”

Thoracoabdominal Compartment Syndrome

“…Thoracoabdominal Syndrome is a rare complication of diaphragmatic eventration, usually present with hemodynamic compromise as a result of transmitted pressure from the abdominal cavity to the pleural space. Moreover, it is usually Thoracoabdominal Compartment syndrome chest radiograph [11].…”

“…These authors described the reason as tension pneumothorax despite the lack of air in the pleural cavity. Therefore, the exact pathophysiological association of the hemodynamic compromise, as a result of transmitted pressure from the abdominal cavity to the pleural cavity through the intact (but pliable) diaphragm, was not coined as a syndrome until Shaher et al described it [11].…”