CONGENITAL EVENTRATION OF D IRAGM RESEMBLING DIAPHRAGMATIC HERNIA: A CASE REPORT Jagadish Chandra Das*, Syeda Humaida Hasan2*, Nita Chowdhury3, Md. Akbar Husain Bhuiyan’, Newton Ghosh3, Debashish Kumar Roy? Professor & Head, Department of Neonatology, Chittagong Medical College Hospital (CMCH), Junior Consultant, Department of Neonatology, CMCH, *Assistant Registrar, Department of Pediatrics, CCH, #Professor, Department of Pediatric Surgery, CCH. Introduction Eventration of diaphragm isa rare anomaly where continuity of diaphragm remain intact with abnormal elevation of its musculature. The important aspect of the present case was that the neonate was clinically diagnosed as diaphragmatic hernia but eventually was confirmed as eventration of diaphragm during operative procedure, Objective The case is presented here with a view to aware pediatrician, neonatologist and pediatric surgeon regarding diagnostic dilemma and management of eventration. Case Report 7 days old full term female baby weighing 3000 ¢ was referred to a tertiary care hospital with the complaints of respiratory distress, cyanosis and feeding difficulties since her 1st day of age. Mother's antenatal period was Uneventful except polyhydramnios. On examination, she was ddyspneic, cyanosed with poor tone and activities. Recorded ‘oxygen saturation (Sp02) was 78%. Her chest was bulged on left side with mediastinal shifting to the right. Percussion note was dull with decreased air entry on the left side, There was no other congenital anomaly. Chest and abdominal radiograph did not define left hemidiaphragm. The neonate was initially diagnosed as left sided diaphragmatic hernia, Supportive management was given Fig: Patient ion artical ventilation Fg 2: After weaning rom venlator and CPAP Fig: Healing scar at nesion site She underwent operative procedure on her 13th postnatal day. Thin, intact left hemidiaphragm was found at the level of 2nd intercostal space. Abdominal viscera were herniated in the left thoracic cavity with compressed left lung. Plication of the diaphragm was done with 1/0 prolene after returning back the viscera. After operation, the patient was fon intermittent positive pressure ventilation (IPPV) and continuous positive airway pressure (CPAP) in neonatal intensive care unit. Follow up xrays showed high up diaphragm and gradual expansion of left lung field. Preoperative and postoperative echocardiography was normal. She was on oxygen support till 1 month of her age with gradual weaning. rr a Incision site was healthy but she had suffered from sepsis with, Staphylococcus aureas which was treated accordingly. The infant was discharged from hospital on 42th postnatal day. Figs Srl rertgenegrams rom ef tort Svreoperatve Chest and abdominal xy fesemBlog hernia B)ln immediate soxtopertve peri with hgh up daphrogm ] At the geo a day (ot 32th 200) wth expansion of Te ung Discussion Eventration occurs almost exclusively on the left side as seen in this case though sex predilection does not match with previous data. This patient presented with dyspnea in neonatal period which is the principal symptom of both diaphragmatic hernia and eventration. Imaging of the ciaphragm, fluoroscopy, prenatal ultrasound may be used to confirm the diagnosis. But in this case, only chest X-ray was done. It showed loss of demarcation of left hemidiaphragm ‘and bowel loops in the let thoracie cavity mimicking hernia, Even with the aid of MRi, sometimes it is difficult to distinguish hernia from eventration. The management of feventration depends upon the extent of cespiratory distress. Surgical intervention was required inthis newborn as she had severe respiratory distress with central cyanosis demanding mechanical ventiation. Pst operative chest imaging showed gradual expansion of ieft ung but long term outcome will ‘sepend on further pulmonary development. Conclusion Overall mortality of eventration of diaphragm is high even after plication in neonatal period. The neonate is saved probably due to absence of associated congenital anomaly, timely referral, prompt operative decision and good postoperative supportive care. Eventration of diaphragm should be kept in mind as 2 differential diagnosis of respiratory distress and cyanosis in neonate beside diaphragmatic hernia, Reference 1h rath, Andrade RS, Diaphragm Paton for Evetaon oF Pare A Revi tithe terse Am ore SunSOIOSBSTIEE 50 tripe Coen ihnprate fries Th val of chet eager Exkeeie ogron. pron Jounal of ao & Cnc Scenes 1% 2 SS Sah Sg Sind eatin Dupe Elta 4 babe |, Buonapg 5, Pads M,alaby €. Diaphragmatic Cention ‘ietaanaeease apg area ins Pern fart epee [XCar apo and Revew of Dagon tne Management Peenehs Pet Ter os sh coon