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Volume 05 Neonatal and Pediatric Medicine
ISSN: 2572-4983 World Pediatrics 2019
December 04-05, 2019
December 04-05, 2019 | Barcelona, Spain
32nd World Pediatrics Conference
Latissimus dorsi muscle flap in treating recurrent eventration of diaphragm
Sujata Sai
Manipal Hospital, India
Background: Diaphragmatic eventration-Permanent elevation of a hemi-diaphragm without defects in continuity. It is a
rare anomaly, occurring in about 0.001-0.003% of live births (Urschel et al.,) It is associated with recurrent pneumonia,
severe respiratory distress, ventilator dependency.
Case report: 11 month old child with recurrent respiratory tract infections requiring hospitalization. Hostory of full term
normal vaginal delivery. Respiratory distress at birth, and was found to have left sided eventration of diaphragm. The child
underwent laparotomy and plication repair on 8th day of life and was discharged home on 22nd day of life. However, the
child developed recurrent episodes of cough and fever from one month post op.
Investigations: X Ray- elevated left dome of diaphragm Barium meal follow through- recurrence with stomach and
splenic flexure occupying the eventration.
Operative procedure: Left dorsolateral incision, Left latissimus dorsi identified, dissected and safeguarded, Thoracotomy
done in 5th ICS, Eventration of left lobe of diaphragm, Thin diaphragm/sac on the anteromedial aspect left dome of
diaphragm, Diaphragm repaired by plication and fixation to the anterior chest wall, Diaphragm repair reinforced with left
latissimus dorsi flap Incision closed in layers, wound dressed, Discharged on POD 22, with no complications.
Discussion: Neonates with large defects require prosthetic patch closure because of the paucity of native diaphragmatic
tissue. As the child grows, patch separation can occur necessitating reoperation. Because of reliable blood supply and the
innate strength, LD flap can support the diaphragmwell and can prevent its eventration.
Conclusion: Diaphragmatic plication is a standard, well-described technique to treat diaphragmatic eventration. LD flap
has been used in treating CDH, while its use in eventration is not well established. However, in our patient we performed
a latissimus dorsi muscle flap to treat recurrent eventration of the left hemi diaphragm successfully.
Neonat Pediatr Med 2019, Volume: 05