Diaphragmatic eventration associated with megacolon: a narrative review

Diaphragmatic eventration is a rare condition classified as acquired or congenital. Diaphragmatic eventration associated with megacolon is a clinical finding that does not fit the existing principles of treatment. This study aimed to review this association in order to update the knowledge available on diaphragmatic eventration.

We included articles about diaphragmatic eventration associated with megacolon. The search databases included PubMed, Google Scholar, and African Journal Online, which were added to other articles obtained by manual search.

We included 21 case reports in the study. From these, we identified four common points: the left side was involved in 95.2% (except one case where the liver was displaced), all patients were adults, the clinical presentations were respiratory symptoms in (90.4%, n = 19), and abdominal emergency syndrome in (38%, n = 8). The condition is easily detected on standard X-rays, and no cause has been identified for the acquired eventration. The surgical approaches were laparotomy (61.9%), thoracotomy (19%), and laparotomy and thoracotomy (4.8%). This treatment consists of management of eventration and megacolon. Treatment was surgical in 86.7% ( n = 18) of patients. It consisted of diaphragm plication in 23.8% ( n = 5), colonic resection in 19% ( n = 4), diaphragmatic plication, and colonic resection in 42.9% ( n = 9).

Megacolon can reveal diaphragmatic eventration in adults, especially on the left side. The diagnosis is easily detected on radiography. This can present as a major surgical abdominal emergency and therefore must be managed using an open abdominal approach. Other cases can be managed through the abdominal or thoracic route; however, treatment of colonic distension must be considered.