Abstract Ref Number = APCP994
DIAPHRAGMATIC EVENTRATION MIMICKING CONGENITAL DIAPHRAGMATIC HERNIA
Aldora Jesslyn Oentari,Landelina Lany Tantiyo,Iman Martafani
pribadi Dr Kanujoso Djatiwibowo Hospital, Balikpapan, East Borneo, Indonesia
Background : Diaphragmatic Eventration (DE) is due to muscular portion maldevelopment of the hemidiaphragm where it is thin and hypoplastic, so the musculature is inadequate to restrain abdominal viscera, the diaphragm rises to a more cephalad position than normal, leading to upward displacement of the abdominal viscera. Its a rare condition between 0,001 to 0,003% incidence in live birth. In some cases, its difficult to distinguished from Congenital Diaphragmatic Hernia (CDH). Since the CDH had same symptoms as DE, the unbroken continuity (muscle fibre) is the difference between them.
Case Presentation Summary : An eight days old male full term infant, birth weight 3000 gr, born with APGAR score 5/6, reffered to emergency room from another hospital, diagnosed CDH. Presented with dyspnoea, grunting, asymmetric chest wall with intercostal retraction, decrease vesicular sound in right lung, RR 64x/minutes, acyanotic. In NICU, chest x-rays revealed heart was pushed to the left side, stomach and intestine loop on the right hemithorax. Laboratory and BGA examination showed normal count. Patient treated as DE. Laparotomy exploration postponed until 6-8weeks, because there was plexus edema, so the neuron impuls can not drained, then a plication procedure was not performed too.
Learning Points/Discussion : Differentiation between DE and CDH is very difficult, but important because eventration has a severe perinatal outcome in form of respiratory distress, cyanosis, and respiratory failure compared to hernia. Total eventration occurs almost exclusively on the left and usually seen in a male. In severe condition can simulate a CDH in a newborn complicated with pulmonary hypoplasia/ hypertension. In contrast with CDH, the diagnosis of DE is not suspected prenatally, but after birth, and in many cases the diagnosis may be delayed due to absence of symptoms. Chest radiography, ultrasound, CT-scan, or magnetic-resonance (MR) may be used to evaluate the anatomy of the diaphragm. While, the function of the diaphragm can be evaluated with fluoroscopy, ultrasound or MR fluoroscopy.
Keywords: Diaphragmatic eventration Congenital diaphragmatic hernia Infant