EVENTRATION OF THE DIAPHRAGM: A 10- YEAR EXPERIENCE

Eventration of the diaphragm is a condition characterized by an attenuated but otherwise intact diaphragm. Twenty patients (age range: 2 days to 11 years) were treated for eventration of the diaphragm during a ten year period (19 85-1995). There were 11 girls and 9 boys with a mean gestational age of 37 weeks. 14 patients were born with cephalic presentation, 3 patients with breech delivery and 3 patients by caesarean section. In 5 cases with difficult delivery, forceps were used. Mean birth weight of patients was 2510 gm (range 900 to 3500 g). The most common clinical manifestations of these patients were respiratory distress (16 cases) and failure to thrive (14 cases below 3rd percentile). 50% of patients (10 cases) had from 1 to 5 associated anomalies. Cardiac anomalies were the most common (n= 5), followed by respiratory system anomalies (n= 4), malrotation (n= 3), and hiatal hernia (n= 2). All patients had an elevated diaphragm in the chest radiograph (n= 20), but only some had paradoxical movement in fluoroscopic studies (n= 5). In 8 patients GI contrast studies were performed and three patients were found to have malrotation. 15 patients had right, 3 patients left, and two patients bilateral diaphragmatic eventration. 18 patients underwent operation (plication), while two patients with small and asymptomatic eventration were not operated. Operative repair was performed with no mortality. Hospital stay was 14.5 days. 12/20 patients had come for follow-up and they were evaluated from 5 months to 10 years. All showed good results from diaphragmatic plication without respiratory distress or infection and gained weight from below the 3rd percentile to above the 10th percentile. Surgical correction is strongly recommended in patients with eventration of the diaphragm and failure to thrive or other clinical manifestations.