Plastic surgery of an extensive diaphragm defect after subtotal removal in a teenager with diagnosed tuberculous empyema

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The presented case study demonstrates an example of successful treatment for a teenage patient who underwent subtotal resection of the diaphragm due to pleural empyema, resulting in the eventration of abdominal organs into the left hemithorax, the innovative technique used involved diaphragm plastic surgery using parietal pleural leaves and mesh implant, leading to positive outcomes.

Full Text

Restricted Access

About the authors

M. A. Bagirov

Central Tuberculosis Research Institute; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Author for correspondence.
Email: etavnai@yandex.ru
ORCID iD: 0000-0001-9788-1024
SPIN-code: 8820-5448

MD

Russian Federation, Moscow; Moscow

R. V. Tarasov

Central Tuberculosis Research Institute; Moscow Medical University "Reaviz"; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Email: etavnai@yandex.ru
ORCID iD: 0000-0001-9498-1142
SPIN-code: 4245-1560

Candidate of Medical Science

Russian Federation, Moscow; Moscow; Moscow

E. V. Krasnikova

Central Tuberculosis Research Institute

Email: etavnai@yandex.ru
ORCID iD: 0000-0002-5879-7062
SPIN-code: 4252-8340

MD

Russian Federation, Moscow

G. A. Asoyan

Central Tuberculosis Research Institute

Email: etavnai@yandex.ru
ORCID iD: 0000-0003-2927-7495
SPIN-code: 6213-7691
Russian Federation, Moscow

S. S. Sadovnikova

Central Tuberculosis Research Institute

Email: etavnai@yandex.ru
ORCID iD: 0000-0002-6589-2834

MD

Russian Federation, Moscow

A. S. Khozikov

Central Tuberculosis Research Institute

Email: etavnai@yandex.ru
ORCID iD: 0000-0003-0308-9592
SPIN-code: 2969-5800
Russian Federation, Moscow

References

  1. Алиев С.А., Рафиев С.Ф., Зейналов Б.М. Диагностика и хирургическое лечение разрывов диафрагмы. Хирургия. Журнал им. Н.И. Пирогова. 2010; 10: 22–8 [Aliev SA, Rafiev SF, Zeinalov BM. Diagnostics and surgical treatment of diaphragm ruptures. Pirogov Russian Journal of Surgery. 2010; 10: 22–8 (in Russ.)].
  2. Борисов А.Е., Кубачев К.Г., Кукушкин А.В. и др. Диафрагмальные грыжи, диагностика и хирургическое лечение. Вестник хирургии имени И.И. Грекова. 2012; 171 (6): 038–042 [Borisov A.Ye., Kubachev K.G., Kukushkin A.V., et al. Diaphragmatic hernias. Diagnosis and surgical treatment. Grekov's Bulletin of Surgery. 2012; 171 (6): 038–042 (in Russ.)]. doi: 10.24884/0042-4625-2012-171-6-038-042
  3. Кубачев К.Г., Кукушкин А.В. Повреждения диафрагмы при открытой и закрытой торакоабдоминальной травме. Сибирский медицинский журнал (Иркутск). 2009; 91 (8): 145–9 [Kubachev K.G., Kukushkin A.V. The lesions of diaphragm in open and closed thoracoabdominal trauma. Siberian Medical Journal (Irkutsk). 2009; 91 (8): 145–9 (in Russ.)].
  4. Паршин В.Д., Паршин В.В., Мирзоян О.С. и др. Операции на диафрагме в плановой торакальной хирургии. Хирургия. Журнал им. Н.И. Пирогова. 2013; 8: 7–14 [Parshin V.D., Parshin V.V., Mirzoyan O.S. et al. Surgery of the diaphragm in the planned thoracic surgery. Pirogov Russian Journal of Surgery. 2013; 8: 7–14 (in Russ.)].
  5. Черкасов В.А., Копытов Л.Ф., Брунс В.А. Хирургия поздних осложнений и последствий повреждений грудной клетки – новый этап в изучении травмы груди. Грудная и сердечно-сосудистая хирургия. 2005; 6: 34–42 [Cherkasov V.A., Kopytov L.F., Bruns V.A. Surgery for late complications and sequels of chest injuries is a new stage in the study of chest injury. Chest and cardiovascular surgery. 2005; 6: 34–42 (in Russ.)].
  6. Черноусов Ф.А., Лишов Д.Е. Хирургическое лечение скользящих гигантских грыж пищеводного отверстия диафрагмы. Грудная и сердечно-сосудистая хирургия. 2007; 5: 48–51 [Chernousov F.A., Lishov D.Ye. Surgical treatment of sliding giant hiatal hernias. Russian Journal of Thoracic and Cardiovascular Surgery. 2007; 5: 48–51 (in Russ.)].
  7. Сотниченко Б.А., Салиенко С.В., Сотниченко А.Б. и др. Диагностика и лечение травматических ущемленных диафрагмальных грыж. Грудная и сердечно-сосудистая хирургия. 2006; 4: 67–71 [Sotnichenko B.A., Saliyenko S.V., Sotnichenko А.В. et al. Stangulated diaphragmatic hernias: diagnosis and treatment. Russian Journal of Thoracic and Cardiovascular Surgery. 2006; 4: 67–71 (in Russ.)].
  8. Loring S.H., De Troyer A. Actions of the respiratory muscles. In: Roussos C., Macklem P.T., ed. The Thorax. New York: Marcel Dekker, 1985; 327.
  9. Mead J., Loring S.H. Analysis of volume displacement and length changes of the diaphragm during breathing. J Appl Physiol Respir Environ Exerc Physiol. 1982; 53 (3): 750–5. doi: 10.1152/jappl.1982.53.3.750
  10. Mead J., Yoshino K., Kikuchi Y. et al. Abdominal pressure transmission in humans during slow breathing maneuvers. J Appl Physiol (1985). 1990; 68 (5): 1850–3. doi: 10.1152/jappl.1990.68.5.1850
  11. Mead J. Functional significance of the area of apposition of diaphragm to ribcage. Am Rev Respir Dis. 1979; 119 (2 Pt 2): 31–2. doi: 10.1164/arrd.1979.119.2P2.31
  12. Morrison N.J., Richardson J., Dunn L. et al. Respiratory muscle performance in elderly subjects and patients with COPD. Chest. 1989; 95 (1): 90–4. doi: 10.1378/chest.95.1.90
  13. Sicular A. Direct septum transversum incision to replace circumferential diaphragmatic incision in operations on the cardia. Am J Surg. 1992; 164 (2): 167–70. doi: 10.1016/s0002-9610(05)80377-0
  14. Witzmann F.A., Kim D.H., Fitts R.H. Hindlimb immobilization: Length-tension and contractile properties of skeletal muscle. J Appl Physiol Respir Environ Exerc Physiol. 1982; 53 (2): 335–45. doi: 10.1152/jappl.1982.53.2.335
  15. Бисенков Л.Н. Торакальная хирургия. М., 2002; с. 883–9 [Bisenkov L.N. Thoracic surgery. Moscow, 2002; pp. 883–9 (in Russ.)].
  16. Татьянченко В.К., Черкасов М.Ф., Потемкин Е.И. и др. Способ лечения грыж диафрагмы. Патент РФ № 2251983 / № 200133027; заявлено 11.11.2003; опубликовано 20.05.2005 [Tatyanchenko V.K., Cherkasov M.F., Potemkin E.I. et al. Method of treatment of diaphragmatic hernia. Russian Federation patent No. 2251983 / No. 200133027; filed 11.11.2003; published 20.05.2005 (in Russ.)].
  17. Давыдов М.И. Способ формирования левой грудобрюшной преграды по М.И.Давыдову. Патент РФ № 93029424; заявлено 06.10.1993; опубликовано 20.07.1996 [Davydov M.I. Method of formation of the left thoracic abdominal obstruction according to M.I.Davydov. Russian Federation patent No. 93029424; applied for on 06.10.1993; published on 20.07.1996 (in Russ.)].
  18. Оперативная хирургия. Под ред. И. Литтманна. Будапешт, 1985; с. 285–93 [Operative surgery. Ed. by I. Littmann. Budapest, 1985; pp. 285-93 (in Russ.)].
  19. Bedini A., Andreani S., Muscolino G. Latissimus dorsi reverse flap to substitute the diaphragm after extrapleural pneumonectomy. Ann Thorac Surg. 2000; 69 (4): 986–8. doi: 10.1016/s0003-4975(99)01555-6
  20. Suzuki К., Takahashi К., Itou Y. et al. Reconstruction of diaphragm using autologous fascia lata an experimental study in dogs. Ann Thorac Surg. 2002; 74 (1): 209–12. doi: 10.1016/s0003-4975(02)03635-4
  21. Дамбаев Г.Ц., Топольницкий Е.Б., Гюнтер В.Э. и др. Способ пластики обширных дефектов диафрагмы. Патент РФ № 2400153, заявлено: 29.06.2009; опубликовано 27.09.2010 [Dambaev G.Ts., Topolnitsky E.B., Gunter V.E. et al. Method of plasty of extensive defects of the diaphragm. Russian Federation patent № 2400153, applied: 29.06.2009; published 27.09.2010 (in Russ.)].
  22. Хирургия далеко зашедших и осложненных форм рака легкого. Под ред. Л.Н. Бисенкова. СПб: ДЕАН, 2006; с. 270–1 [Surgery of far advanced and complicated forms of lung cancer. Ed. by L.N. Bisenkov. St. Petersburg: DEAN, 2006; pp. 270–1 (in Russ.)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Computed tomography (CT) of the chest on admission (25.01.21): diaphragmatic hernia on the left side; part of the stomach and loops of the colon are located in the left pleural cavity, cirrhotic changes in the lower lobe of the left lung

Download (193KB)
Indexing metadata
3. Fig. 2. Abdominal organs localized in the pleural cavity: a – loops of intestine; б – stomach floor

Download (62KB)
Indexing metadata
4. Fig. 3. Stages of surgery: а – mobilization of parietal pleural sheets in the extrapleural layer to form a new diaphragm dome; б – Parietal pleura sheets sutured with separate П-shaped capron sutures to the remnants of the resected diaphragm edges; в – reinforcement of the diaphragm with a mesh implant and its fixation with separate prolene sutures

Download (118KB)
Indexing metadata
5. Fig. 4. Stages of diaphragm plasty: a – return of the dislocated organs of the digestive system into the abdominal cavity, release of the parietal pleura and creation of the diaphragm dome; б – placement of single non-absorbable sutures on the formed diaphragm dome; в – fixation of the polymer mesh implant over the formed diaphragm dome

Download (340KB)
Indexing metadata
6. Fig. 5. Histological picture of the surgical material: a – fibrotic focus in the lung, hematoxylin and eosin staining, magnification ×100; б – encapsulated focus of loose eosinophilic necrosis of the pleura with a focus of calcification, hematoxylin and eosin staining, magnification ×40

Download (169KB)
Indexing metadata
7. Fig. 6. Chest CT scan 3 months after surgery (25.02.22): clear diaphragm line, the stomach is located in the subdiaphragmatic region; there are no signs of abdominal cavity organs dislocation; mediastinal organs are moderately displaced to the left

Download (323KB)
Indexing metadata

Copyright (c) 2025 Russkiy Vrach Publishing House