Felis ISSN 2398-2950

Diaphragm: hernia

Synonym(s): Diaphragmatic rupture, Pleuroperitoneal hernia

Contributor(s): Andrew Gardiner

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.

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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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 (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 (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.


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