Laparoscopic Sleeve Gastrectomy as a Good Surgical Alternative in Gastric Volvulus Caused by Diaphragmatic Eventration

Left hemidiaphragmatic eventration in adult patients is rare; the diagnosis is usually made when a chest radiograph is performed to diagnose another condition. It can be detected in routine chest x-rays with a frequency that varies from 1/1400 to 1/32000 in asymptomatic cases [1]. Diaphragmatic eventration is characterized by a considerably thinning hemidiaphragm. During laparoscopic surgery, one can observe how hemidiaphragmatic thickness is reduced to two thin serous layers (pleural and peritoneal) [1-3]. In large event rations, the left hemi diaphragm usually involves an intrathoracic stomach, leading to a gastric volvulus. The left colic flexure and spleen also ascend to the chest by constant traction of the gastrocolic ligament and omentum. With the thoracic abdominal organs so occupied, the mediastinum and lungs suffer compression. The heart also undergoes a dextrorotation and a shift to the right. Lung retraction is proportional to the severity of the eventration and particularly affects the basal pyramid. Large diaphragmatic eventrations carry a reduction or inversion of diaphragmatic kinetics, impacting ventilatory mechanics.