Carrasco Anibal, Castro Ricardo
Department of General Surgery, Jorge Reategui Delgado Hospital, Av. Grau block 11 s/n, Piura, Peru.
Case Rep Surg. 2018 Dec 6;2018:2631391. doi: 10.1155/2018/2631391. eCollection 2018.
We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. The present case, though quite infrequent, shows the presence of an ectopic thoracic kidney on the right side. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. The right hemithorax presented invasion of the thin loops, right colon, and kidney. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. The intrathoracic kidney remained in place. The outcome was satisfactory. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. It represents a clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion in order to correlate symptoms and imaging findings and understand the etiopathogenesis. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used.
我们旨在回顾关于膈膨出症诊断的相关文献，并报告一名17岁女性患者的临床表现及手术治疗情况。本病例虽极为罕见，但显示右侧存在异位胸肾。临床特征包括4年来的干咳、胸痛、呼吸窘迫及支气管痉挛；此外，患者自幼患有支气管哮喘发作。右半胸可见细环、右结肠及肾脏受侵。治疗方法为腹腔镜手术，随后采用双层补片开胸手术。胸腔内的肾脏位置未变。结果令人满意。考虑到该病症的年龄、性别及右侧发病情况，与胸肾异位相关的膈膨出症是一种极为罕见的病症。它代表了一项临床和诊断挑战；临床医生、放射科医生和外科医生必须高度怀疑，以便将症状与影像学表现相关联，并了解其发病机制。此外，他们应尽可能利用目前使用的微创程序，规划充分且个体化的手术修复方案。
