Cimmino, M

Fei, L

Moccia, F

Romano, G

Trapani, V

BMC Geriatrics

English

PubMed

M Cimmino

F Moccia

V Trapani

G Romano

L Fei

Crossref

Prosthetic repair of left diaphragmatic defect in an elderly patient: a rare case report

Cimmino M

Moccia, TrapaniV

Romano G

FEI, Landino

Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"

Springer - Publisher Connector

MEETING ABSTRACT Open Access
Prosthetic repair of left diaphragmatic defect in
an elderly patient: a rare case report
M Cimmino*, F Moccia, V Trapani, G Romano, L Fei
From de Senectute: Age and Health Forum
Catanzaro, Italy. 5-7 December 2009
Background
Partial or complete agenesis of the hemidiaphragm is a
rare congenital malformation whose embryological basis
is unknown. Late presentation is extremely rare and
older patients are asymptomatic for a long time without
developing ventilator insufficiency, because of the asso-
ciated lung hypoplasia. Thus, only 7 cases of hemidia-
phragmatic agenesis have been reported in adult
patients.
Materials and methods
A 71-year-old man came to our Surgical Unit with fea-
tures of dyspepsia, severe constipation and occasional
but increasing episodes of incomplete bowel obstruction
accompanied by abdominal distension and pain. Stan-
dard chest X-rays showed intestinal gas associated with
a reduced diminished pulmonary volume in the left
hemithorax (Figure1A). Contrast medium X-ray of the
upper gastrointestinal tract and enema documented the
herniation of the stomach and the colon into the thor-
acic cavity (Figure 1B).
Results
Surgical treatment was carried out through a left sub-
costal laparotomy extended on the right side. The sto-
mach, transverse colon, splenic flexure, spleen and part
of the small bowel were found in the left thoracic cavity.
Repair was performed with a 2-mm-tick expanded poly-
tetrafluoroethylene soft tissue patch (Gore-tex®) that was
circumferencially anchored tension free to the ribs,
intercostals muscles and endothoracic fascia (Figure 1C).
Postoperative chest X-rays showed good placement of
the new diaphragmatic dome and the fundic air bubble
in its correct position (Figure 1D). No early major or
late complications were observed, and no recurrence
was found at 34 months’ follow-up.
Conclusions
The main questions relating to the management of a
large diaphragmatic defect, such as agenesis, concern
when and how to operate. We employed an e- PTFE
patch, which is currently used for repairing other types
of wall defect. This microporous mesh possessed good
biocompatibility and produces a low inflammatory and
fibrous reaction with a peripheral and interstitial
arrangement of collagen fibers that allows the formation
of a smooth surface. This surface is able to support a
Department of Clinical and Experimental Medicine and Surgery “F.Magrassi-
A. Lanzara”. Unit of General Surgery and Digestive Physiopathology, Second
University of Naples, 80131 Naples, Italy
Figure 1 Features of the left diaphragmatic agenesis and
positioning of the prosthesis. A) detail of chest x-ray showing the
bowel herniation into the left hemithorax; B) contrast medium x-ray
enema showing herniation of the colon into the left thoracic cavity;
C) intraoperative picture showing left diaphragmatic agenesis and
the e-PTFE Gore-Tex“ patch in place; D) postoperative standard
chest x-ray showing correct position of the new
prostheticdiaphragmatic dome.
Cimmino et al. BMC Geriatrics 2010, 10(Suppl 1):A4
http://www.biomedcentral.com/1471-2318/10/S1/A4
© 2010 Cimmino et al; licensee BioMed Central Ltd.
continuous layer of mesothelial cells on the peritoneal
surface. This mesh seems to be an adequate and satis-
factory diaphragmatic substitute, which can easily be
used to repair large diaphragmatic defects, ensuring the
best anatomical and physiological conditions possible
with only a low risk of recurrence.
Published: 19 May 2010
doi:10.1186/1471-2318-10-S1-A4
Cite this article as: Cimmino et al.: Prosthetic repair of left
diaphragmatic defect in an elderly patient: a rare case report. BMC
Geriatrics 2010 10(Suppl 1):A4.
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Cimmino et al. BMC Geriatrics 2010, 10(Suppl 1):A4
http://www.biomedcentral.com/1471-2318/10/S1/A4
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Prosthetic repair of left diaphragmatic defect in an elderly patient: a rare case report

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Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"

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