Praneetha Narahari, MD, James Svoboda, MD. Saint Agnes Medical Providers/Saint Agnes Medical Center
Diaphragmatic Eventration may occur as a congenital anomaly with loss of muscle fibers in the central tendon, that looks membranous, or from paralysis, where there is muscle, but no contractility. It Usually presents as respiratory distress due to reduced pulmonary volume from the abdominal pressure. I report a rare case presenting as gastric outlet obstruction.
The thinned out membranous diaphragm was housing the stomach in the LUQ concavity as shown on the UGI. The displaced stomach was causing dysphagia and vomiting, with inability to eat. The colon and small bowel was also seen on CT to be present in the LUQ.
64 year old gentlemen presented with inability to eat with vomiting and dysphagia and dyspnea. The severe dysphagia, bloating, vomiting was associated with LUQ pain. He claimed to be standing upright and massaging his LUQ for relief of symptoms. CT scan and UGI revealed eventration of diaphragm with high riding stomach in the chest. Patient also had severe mitral regurgitation, with exertional dyspnea in addition to dyspnea with bloating.
Laparoscopic repair was proceeded with plication of the diaphragm with multiple interrupted #0 Ethibond sutures. This was reinforced with composite mesh- which was sutured and partly tacked with staples.
Patient recovered well and was able to eat well and obtained symptomatic relief. He did not have any further vomiting or bloating. He did develop CHF from MR and had Mitral valve replacement and is currently doing well.
Thoracoscopic approach has been described, but it is feasible to perform plication with laparoscopy and also use a compsite mesh to reinforce the repair site.
Technological advances have extended the applications of laparoscopic procedures. The morbidity of surgery is lessened if laparoscopy is feasible. The duration of stay is reduced in this cost conscious environment. The durability of the repair is prolonged with addition of composite mesh.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77721
Program Number: P601
Presentation Session: Poster (Non CME)
Presentation Type: Poster