Introduction

• Loss of integrity of diaphragm following traumatic incident allows some of the abdominal viscera to enter the thorax.
• This results in compression of the lungs which may lead to ventilation/perfusion mismatch and hypoxia if severe.
• Respiratory compromise may also result from lung contusion, pleural effusion Pleural: effusion such as hemorrhage or chylothorax Chylothorax , restriction of chest wall movement due to rib fractures, or voluntary restriction of chest wall excursion because of pain.
• Myocardial contusion may cause cardiac dysrhythmias Heart: dysrhythmia resulting in decreased cardiac output and tissue hypoxia. This usually resolves within a few days.
• Shock Shock , defined as inadequate tissue perfusion and multiple organ dysfunction, frequently follows major trauma. Fluid therapy Fluid therapy , oxygen Nasal oxygen administration and time may be needed for the patient to recover.
  An intact diaphragm is not essential to sustain life
• It is more important to correct shock, circulatory and respiratory function than operate immediately to correct a ruptured diaphragm.
• Circumstances necessitating immediate surgery are:
  • Massive abdominal organ displacement into the thorax causing excessive lung compression.
  • Displaced, dilating stomach.
  • Continuing hemorrhage.
  • Ruptured bowel.

Pre-operative assessment

Pre-medication

Induction of anaesthesia

Maintenance of anesthesia

Recovery

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Wagner A E, Gaynor J S, Dunlop C I et al (1998) Monitoring adequacy of ventilation by capnometry during thoracotomy in dogs. JAVMA 212 (3), 377-379 PubMed.
• Boudrieau R J, Muir W W (1987) Pathophysiology of traumatic diaphragmatic hernia. Compendium on Continuing Education for the Practicing Veterinarian 9 (4), 379-385, 386 VetMedResource.