Diaphragmatic Paralysis or palsy – “Plication of diaphragm”
Plication of diaphragm is specifically performed in case of paralysis or eventration of diaphragm. Paralysis of diaphragm, by and large, is due to damage to the phrenic nerve. And, eventration is an abnormal shape or elevation of the diaphragm which is primarily congenital. Both of them can result in breathing difficulties. A well functioning taut diaphragm is needed to prevent inflation of lungs outwards while breathing out (expiration).
The plication of diaphragm is performed either open or thoracoscopically. The weakened part/area of the diaphragm is grasped, generally with a clamp. It is then carefully elevated to determine the position of the suture line.
Layers of sutures, encircling the chest wall, are patiently sewn at the edge of the diaphragm.
Consequently, to help lungs inflate properly, the height of diaphragm is lowered by a few ribs (one or two). To ensure that the fluid or accumulated air drains, chest tubes are inserted.
Diaphragmatic Hernias occurs due to some defect (opening) in the diaphragm. It results in protrusion of abdominal organs upwards into the chest. It can be congenital or acquired. Significantly, it is a medical emergency and requires immediate treatment.
- Congenital Diaphragmatic Hernia (CDH) occurs due to abnormal development of diaphragm while the fetus is still being formed. This defect leads to movement of other abdominal organs to the place where the lungs ideally should be. Resultantly, the lungs may not develop properly.
- Acquired Diaphragmatic Hernia (ADH) is generally the result of blunt or penetrating injury. It can follow a surgical procedure where the diaphragm has been inadvertently injured. Both congenital and acquired diaphragmatichernias typically require urgent surgery. Surgery must be performed to remove the abdominal organs from the chest and place them back into the abdomen. The surgeon will then repair the diaphragm.
Rupture or tear of diaphragm
Diaphragmatic Rupture is essentially a tear of diaphragm. Most commonly, it results from blunt trauma. This happens in about 5% of the cases of severe blunt trauma to the trunk. Primarily, the signs and symptoms of a diaphragm rupture are-
- Respiratory distress
- Painful chest or abdomen
- Diminished breath sounds
- Many are detected on imaging alone
Once diagnosed, the only treatment for a diaphragmatic tear is surgery. The surgery may be approached via the abdomen or thorax.