PMC7876739_01
Preoperative CT scan.
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As result we found a volumetric reduction of the left pulmonary parenchyma with an ipsilateral subtotal atelectasia; the right lung was regular (Fig. 1).
a) Laparoscopic exploration with anomalous position of the diaphragmatic dome and transposition in the cranial sense of the hypochondriac abdominal organs; b) dissection of tenacious congenital adhesions and section of the spleenic-colic ligaments; c) laparoscopic plication of the left hemidiaphragm.
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These intraoperative findings confirmed the absence of a significant jatal hernia and the presence of a left diaphragmatic relaxation (Fig. 2a). With careful maneuvers we proceeded to section the tenacious congenital adhesions between the visceral organs (stomach, colon, spleen, pancreatic tail) and the diaphragmatic dome in order to obtain their repositioning in the normal anatomical place (Fig. 2b). Then we continued with an adequate laparoscopic plication of the left hemidiaphragm with nonresorbable sutures (Fig. 2c).
a) X-ray image of pneumothorax on POD 1; b) follow-up on POD 7.
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In postoperative course we registered a left basal pneumothorax with maximum size of 5 cm medially, with no clinical signs and compatible with the surgical procedure (Fig. 3a). We choised a conservative management and on POD 7 the patient was discharged after completed resolution of the pneumothorax (Fig. 3b).