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Peritoneal-pericardial diaphragmatic hernia (PPDH)

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Synonym(s): Pericardiodiaphragmatic hernia


Introduction

  • Very rare condition in dogs.
  • Peritoneal-pericardial diaphragmatic hernia (PPDH) is a congenital communication remaining between the pericardial and peritoneal spaces, through the diaphragm.
  • Other congenital defects may be present, eg umbilical hernia, sternal deformity or ventricular septal defect.
  • Signs: usually referable to herniated abdominal contents, or may be due to compliance failure if a concurrent effusion is present (herniated liver lobe).
  • Frequently the patient is asymptomatic and PPDH is found as an incidental finding.
  • Diagnosis: radiography, ultrasonography.
  • Treatment: surgical correction is indicated if the patient is symptomatic. Surgical repair should be performed as early as possible in young animals.
  • Prognosis: good following surgical correction.
Print off Hernias in dogs (diaphragmatic) Owner Factsheet to give to your client.

Pathogenesis

Etiology

  • Embryological failure of diaphragm development - failure of closure of septum transversum or lateral pleuro-peritoneal folds.

Predisposing factors

General

  • Breed, eg Weimaraner.
  • Other family members affected.

Specific

  • Occasionally trauma can precipitate development of clinical signs - presumably by causing further herniation of abdominal organs.

Pathophysiology

  • Embryological failure of normal development of the diaphragm.
  • May affect septum transversum or lateral pleuro-peritoneal folds.
  • Communication between pericardial and peritoneal cavities.
  • If large enough defect, herniation of abdominal contents may occur into pericardial sac.
  • Herniation of the liver or gall-bladder may not result in symptoms or signs; occasionally vague malaise, vomiting, inappetence, weight loss.
  • Herniation of gastrointestinal tract usually results in symptoms, with vomiting, inappetence and weight loss to variable severity.
  • Rarely, an entrapped liver lobe may cause a transudate, and pericardial effusion results in signs of compliance failure.

Timecourse

  • Many patients may be asymptomatic for life.
  • Once clinical signs develop, tend to be slowly progressive if defect not corrected.

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.
  • Martin M (1999) Pericardial disease in the dog. In Practice 21 (7), 378-385 VetMedResource.
  • Berry C R, Koblik P D & Ticer J W (1990) Dorsal peritoneopericardial mesothelial remnant as an aid to diagnosis of feline congenital peritoneopericardial diaphragmatic hernia. Vet Radiol Ultrasound 31 (5), 239-245 VetMedResource.
  • Bellah J R et al (1989) Congenital cranioventral abdominal wall, caudal sternal, diaphragmatic, pericardial and intracardiac defects in Cocker Spaniel littermates. JAVMA 194 (12), 1741-1746 PubMed.
  • Hay W H et al (1989) Clinical, echocardiographic and radiographic findings of peritoneopericardial diaphragmatic hernia in two dogs and a cat. JAVMA 195 (9), 1245-1248 PubMed.

Other sources of information

  • Miller M W & Sisson D D (1995) Pericardial disorders. In:Textbook of Veterinary Internal Medicine. Eds: S J Ettinger & E C Feldman. Philadelphia: W B Saunders. pp 1032-1045.

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