Author(s): Alvin B. Caballes, MD, FPCS and Johann Paulo S. Guzman, MD
Reported here is the first documented laparoscopic repair of a rare partial diaphragmatic eventration in a pediatric patient. The case involves a three-year-old female who had recurrent cough. While a Morgagni hernia was the initial impression, an eventration of the left anterior diaphragm was instead found on laparoscopy. Repair was aided by using transcutaneous traction, with plication achieved by intracorporeal sutures. The patient recovered uneventfully and follow-up x-ray after six months demonstrated an intact repair.
Analogous diaphragmatic anomalies may have divergent clinical manifestations. Bochdalek hernias, while often associated with severe respiratory distress in affected neonates, may also not manifest overtly in other patients. Likewise, different anomalies may have similar clinical presentations. Patients with Morgagni hernias or eventrations, while often asymptomatic, can also present with severe pulmonary and gastrointestinal impairments. The diagnostic uncertainty is highlighted in the present case, wherein a child preoperatively diagnosed to have a Morgagni hernia was found intra-operatively to have a rare left anterior diaphragmatic eventration. 5 The laparoscopic approach adopted not only facilitated diagnosis, but was adaptable enough to enable intracorporeal repair for an altered indication.
Key words: diaphragmatic eventration, diaphragmatic hernia, laparoscopy