Spontaneous rupture of a congenital diaphragmatic eventration in an infant

Abstract

Rupture of the diaphragm may be traumatic or spontaneous. A spontaneous rupture occurring in a congenital eventration of the diaphragm is extremely rare. Only one such case has been reported previously. We report a case of a 5-month-old male infant who presented with acute life-threatening respiratory distress secondary to spontaneous rupture of a congenital diaphragmatic eventration.

Spontaneous Rupture of a Congenital Diaphragmatic Eventration in an Infant

“…Spontaneous diaphragmatic rupture in association with eventration is extremely rare with only 3 reported cases in English literature. [3][4][5] In contrast, perforation of diaphragm is a known postoperative complication following suture plication of the eventration of diaphragm. [6] Spontaneous diaphragmatic rupture presents with acute onset respiratory distress without any history of preceding trauma.…”

“…[1,2] Spontaneous rupture of eventration of diaphragm is rarely reported in English literature. [3,4] We present an infant with spontaneous diaphragmatic eventration rupture resulting in gastrothorax and gastric volvulus.…”

Diaphragmatic Eventration : Review of Current Knowledge, Diagnostic, and Management Options

“…Newborns may be with a syndrome of potentially fatal acute respiratory difficulty, which can complicate with mediastinal deviation and pulmonary hypoplasia. Older children and adults may complain of digestive symptoms, such as abdominal pain, vomiting and flatulence [2]. The presence of associated factors, such as pulmonary hypoplasia in the affected side, mediastinal deviation and contralateral hypoplasia; compression of pulmonary atelectasis base and poor drainage; promote the development of bronchopneumonia and increase respiratory distress [8] The diaphragmatic eventration be predominantly asymptomatic, it is usually discovered accidentally by a chest x-ray [9].…”

“…In suspected cases, must be requested a chest x-ray in the posterior-anterior and lateral impact and assess the presence of elevation and narrowing of the dome of the hemidiaphragm affected, but not interrupted on abdominal viscera, being higher than the contralateral hemidiaphragm, in at least one intercostal space when located on the left and in at least two intercostal spaces when located on the right [8]. The lifting area corresponds to the weakened area or fibrotic of hemidiaphragm, moving to the thorax and justifying this respiratory distress [2]. The confirmation must be done through a chest x-ray, ultrasonography showing diaphragmatic movement minimal or paradoxical (the diaphragm muscle rises on inspiration and lower at expiration in relation to the abdominal cavity).…”

“…This elevation of the diaphragmatic dome to the chest also allows the protrusion of abdominal contents to the thoracic cavity. These changes justify the prejudice in the vents and the main clinical manifestations [2]. ED affects less than 0.05% of the population, both children as adults, is more common in males.…”