A case of successful treatment of a patient with diaphragm disinsertion

Abstract

A case of 59-year old patient has been described in the article. The patients has got multiple home trauma (multiple fragmental fractures of left ribs, left-sided pneumothorax and pneumomediastinum) in January, 2015. At admission, the left pleural cavity was drained and pharmacological treatment was initiated. After the pneumothorax was resolved, the patient refused further treatment and was discharged from the hospital. The further course of the disease was complicated by rib fractures non-union, development of rib valve and diaphragmic hernia. The patient’s condition gradually deteriorated including exacerbations of chronic obstructive pulmonary disease. In May, 2016, he was admitted in a hospital with severe life-threatening acute respiratory failure. Left-sided thoracotomy with reconstruction of a giant defect of the left diaphragmic dome using surgical mesh was performed. To restore the ribcage and to remove the hernia, open surgical reposition and osteosynthesis of the 10#th let rib with its reconstruction were performed. To resolve the spontaneous pneumothorax which had not resolved by the pleural cavity drainage, the bronchus was locked using an endobronchial valve. This technique was developed in this clinic.