Diaphragm: hernia
Introduction
- Cause: acute abdominal compressive injuries. In all cases of trauma discuss with owner the potential complications at the time of injury.
- Herniated organs include intestine, liver, spleen and stomach. Associated injuries include paracostal abdominal ruptures, pulmonary and cardiac contusions.
- Duration of condition may be from several hours to several years.
- Signs:
- (Acute): shock, respiratory distress due to pulmonary atelectasis or contusion causing hypoxia, cardiac dysrhythmias caused by myocardial injury.
- (Chronic): exercise intolerance, abnormal respiratory pattern, reluctance to lie down, empty abdomen on palpation, displacement of auscultated heart sounds, intermittent regurgitation, jaundice, hydrothorax, gastric herniation and tympany.
- Onset of signs may be insidious.
- Diagnosis: clinical signs, radiography and ultrasonography.
- Treatment: stabilization then surgical repair Diaphragm: repair of diaphragmatic defects.
- Prognosis: reasonable; poor, if premature surgery.
Presenting signs
Acute
- Shock.
- Respiratory distress.
- Cardiac dysrhythmias (myocardial bruising).
Chronic
- Reluctance to lie prone or stand.
- Respiratory abnormalities/dyspnea.
- Intermittent regurgitation.
- Jaundice.
- Hydrothorax (liver entrapment).
- Gastric herniation and tympany.
- Exercise intolerance.
Acute presentation
- Sudden death.
Age predisposition
- <2 years (related to incidence of HBCs).
Cost considerations
- Surgical repair.
Special risks
- General anesthesia: respiratory complications Anesthesia: for ruptured diaphragm.
Pathogenesis
Etiology
- Trauma; acute abdominal compressive injuries against a closed glottis.
Pathophysiology
- Acute abdominal compressive injuries → diaphragmatic tears (circumferential, radial or a combination of the two) → organ herniation, eg intestine, liver, spleen, stomach → pulmonary compression → dyspnea.
- Associated injuries (paracostal abdominal rupture, pulmonary atelectasis contusion) → hypoxia, cardiac contusion → myocardial injury → dysrhythmias.
- Chronic herniation of abdominal organs (may) → intermittent regurgitation, jaundice, hydrothorax, gastric herniation and tympany.
Timecourse
- Acute or chronic (hours to years).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Liptak J M, Bissett S A, Allan G S et al (2002) Hepatic cysts incarcerated in a peritoneopericardial diaphragmatic hernia. J Feline Med Surg 4 (2), 123-125 PubMed.
- Hardie E M, Ramirez O 3rd, Clary E M et al (1998) Abnormalities of the thoracic bellows - stress fractures of the ribs and hiatal hernia. JVIM 12 (4), 279-287 PubMed.
- Williams J, Léveille R, Myer C W (1998) Imaging modalities used to confirm diaphragmatic hernia in small animals. Compend Contin Educ 20 (11), 1199-1211 VetMedResource.
- Voges A K, Bertrand S, Hill R C et al (1997) True diaphragmatic hernia in a cat. Vet Radiol & Ultras 38 (2), 116-119 PubMed.
- Mann F A, Aronson E, Keller G (1991) Surgical correction of a true congenital pleuroperitoneal diaphragmatic hernia in a cat. JAAHA 27 (5), 501-507 VetMedResource.
- Wilson G P 3rd, Hayes H M Jr. et al (1986) Diaphragmatic hernia in the dog and cat - a 25-year overview. Semin Vet Med Surg Small Anim 1 (4), 318-326 PubMed.
- Hammons J R (1980) Ventral hernia and diaphragmatic anomaly in a cat. Mod Vet Pract 61 (4), 347, 350 PubMed.
- Frye F L, Taylor D O (1968) Pericardial and diaphragmatic defects in a cat. JAVMA 152 (10), 1507-1510 PubMed.