Hérnia diafragmática peritôniopericárdica congênita em uma gata / Congenital peritoniopericardial diaphragmatic hernia in a female kitten

Background: Peritoneopericardial diaphragmatic hernia is a rare pathogenesis of congenital origin, which occurs due to a failure in the communication between the diaphragm and the pericardium during embryogenesis. Symptoms may be non-existent or non-specific, depending on the herniated organ involved and, in most cases, the diagnosis is incidental. Regarding the most indicated treatment, there are still divergences in the literature concerning the indication of conservative or surgical treatment. This study reports the case of a feline peritoneopericardial hernia, for which surgical correction was the treatment of choice. Case: A 3-month-old female kitten, no defined racial pattern, was referred to the Veterinary Hospital of the Federal Rural University of Pernambuco for treatment of a peritoneopericardial diaphragmatic hernia. This condition was diagnosed through radiographic examination after the patient having been submitted to pediatric castration and presented anesthetic complications in the transsurgery. Blood count, biochemical profile and Doppler echocardiogram were performed, which showed no significant changes. To obtain a better study and surgical planning, computed tomography was performed to observe the heart located cranially in the pericardial cavity. Caudally to the heart, hepatic parenchyma located in the pericardial cavity was observed; and hepatic vessels presenting slightly enlarged dimensions. These tomographic findings suggested peritoneopericardial diaphragmatic hernia; being the liver present in the pericardial cavity and signs of congestion in the hepatic parenchyma. Due to the likelihood of future worsening of the hernia, surgical correction was performed, with an abdominal midline incision in the preumbilical region to reposition the liver to its normal anatomy, followed by diaphragm reconstitution through a herniorrhaphy. After the surgical procedure, the patient was referred for observation in internment and, after 15 days, the skin sutures were removed. Complete correction of the hernial defect was observed on radiography performed 30 days after the surgical procedure. However, the examination showed the presence of deviation/ deformity in the topography of the sternum and costal cartilages, with slight cardiac displacement to the right hemithorax, suggesting the presence of pectus excavatum. Discussion: Peritoneopericardial diaphragmatic hernia is considered rare and, despite being one of the most common causes of congenital pericardial anomaly in felines, it has a low prevalence ranging from 0.06% to 1.45%. They are usually diagnosed from two years of age, with prevalence for older animals. However, due to having presented anesthetic changes, the patient of this case report could be diagnosed early. Among the most common organs that migrate to the thoracic cavity, the liver is the most commonly observed, which is also the hernia content of the present report. Peritoneopericardial hernia is often diagnosed through radiography and ultrasound, and these imaging tests proved to be sufficient for the diagnosis in this report. However, computed tomography was important for providing a better study of case and for the adoption of median celiotomy as a treatment. Associations with other malformations are described in the literature, with pectus excavatum being the most common and also observed in this report. Peritoneopericardial diaphragmatic hernia is a rare anomaly, rarely reported in the literature and with divergences regarding its treatment. The adoption of early surgical treatment performed in this report showed satisfactory evolution and the possibility of a favorable prognosis.

Hérnia diafragmática peritoneopericárdica em um felino da raça Persa / Peritoneopericardial diaphragmatic hernia in a Persian cat

Background: Peritoneopericardial diaphragmatic hernia is a congenital defect characterized by an anomalous communication between the abdominal cavity and pericardial sac, which can lead to displacement of the abdominal viscera into the thoracic cavity. The occurrence in felines is higher among long-haired breeds, mainly the Persian breed, possibly based onan autosomal recessive inheritance. The diagnosis of PPDH is performed by means of chest radiography with or without contrast, in association with other imaging tests such as ultrasonography and echocardiography. Our objective in this study was to report the occurrence and macroscopic changes in a case of peritoneopericardial diaphragmatic hernia in a Persian feline. Case: A 9-year-old male Persian cat weighing 3.4 kg was referred to the HPET-Private Veterinary Clinic, Salvador, Bahia, with an history of weight loss and chronic intermittent vomiting during the preceding 6 months, with lateral decubitus and breathing difficulties. Ultrasonography revealed findings suggestive of an infiltrative process in the stomach and duodenum, enlarged gastric lymph nodes, and some nodular images indicating slight displacement of the liver. Chest radiography revealed a cardiac silhouette with markedly enlarged dimensions associated with a dorsal deviation of the terminal trachea, and echocardiography revealed a small amount of pericardial effusion. The patient showed initial clinical improvement after blood transfusion; however, after 2 days, he exhibited significant clinical worsening and was therefore euthanized with the owner's consent. Post mortem evaluation revealed partial herniation of the liver and gallbladder into the chest cavity through a diaphragmatic hernia ring. The heart was partially surrounded by the left medial lobe of the liver, which was displaced into the pericardial sac. Herniated hepatic lobes had an irregular capsular surface with evident lobulation and tension lipidosis. In the abdominal cavity, the remainder of the liver (right lateral and medial lobes) was observed to be slightly enlarged, with an irregular surface, diffusely reddish with intense evidence of the lobular pattern and white and firm multifocal areas (fibrosis). In the duodenum, close to the pylorus, there was a nodule measuring 2.8 x 2.5 x 1.0 cm, with a whitish and ulcerated surface. When cut, it was soft and exhibited a homogeneous, whitish compact surface. Histopathological examinationshowed marked proliferation of fibrous connective tissue, which for the most part separated the lobes by septa and surrounded the portal space (fibrosis), a marked diffuse chronic inflammatory infiltrate composed of lymphocytes and plasma cells. In addition, marked bile duct hyperplasia and multifocal areas of fatty degeneration (steatosis). Discussion: The diagnosis was based on the association of clinical and pathological findings. Considering the age and clinical signs presented by the patient in this report, as well as the presence of few radiographic signs that were indicative of PPDH, the first differential diagnosis thought was pericardial neoplasia. Peritoneopericardial diaphragmatic hernia in felines is always of congenital origin and may occur asymptomatically depending on the number and involvement of herniated viscera. In this case, the patient's diagnosis of peritoneopericardial hernia was a necropsy finding; the fact that in agreement with previous reports of high rates of incidental diagnoses reinforces the importance of performing necropsy for confirmation or diagnosis of unexpected pathologies. In the present case, peritoneopericardial diaphragmatic hernia in isolation may not have led to severe anemia that culminated in the patient's death. The anatomopathological findings were compatible with biliary cirrhosis and multifocal liver fibrosis, accompanied by the presence of anemia and consequent hypovolemia.

Diagnosis and treatment of a peritoneopericardial hernia in an adult dog: a case report / Diagnóstico e tratamento de hérnia peritoniopericárdica em cão adulto: relato de caso

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.

A hérnia diafragmática peritoniopericárdica é uma anomalia congênita pericárdica comum em cães e gatos, sendo caracterizada pela comunicação entre abdômen e saco pericárdico. Os animais podem ser assintomáticos ou apresentar sinais clínicos inespecíficos relacionados aos sistemas gastrointestinal e cardiorrespiratório. Expõe-se um caso de um cão Schnauzer, fêmea, 3 anos de idade, pesando 7,7 kg, com histórico de cansaço fácil e cianose em momentos de estresse. O diagnóstico de hérnia peritoniopericárdica foi confirmado por meio de ecocardiografia e exame radiográfico simples e contrastado que evidenciaram a presença de lobos hepáticos no saco pericárdico. O animal foi submetido a celiotomia pré-umbilical para correção do defeito, apresentando melhora imediata dos sinais clínicos após a correção cirúrgica.

Diagnosis and treatment of a peritoneopericardial hernia in an adult dog: a case report / Diagnóstico e tratamento de hérnia peritoniopericárdica em cão adulto: relato de caso

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.(AU)

A hérnia diafragmática peritoniopericárdica é uma anomalia congênita pericárdica comum em cães e gatos, sendo caracterizada pela comunicação entre abdômen e saco pericárdico. Os animais podem ser assintomáticos ou apresentar sinais clínicos inespecíficos relacionados aos sistemas gastrointestinal e cardiorrespiratório. Expõe-se um caso de um cão Schnauzer, fêmea, 3 anos de idade, pesando 7,7 kg, com histórico de cansaço fácil e cianose em momentos de estresse. O diagnóstico de hérnia peritoniopericárdica foi confirmado por meio de ecocardiografia e exame radiográfico simples e contrastado que evidenciaram a presença de lobos hepáticos no saco pericárdico. O animal foi submetido a celiotomia pré-umbilical para correção do defeito, apresentando melhora imediata dos sinais clínicos após a correção cirúrgica.(AU)

Herniorrafia diafragmática videoassistida em gato: relato de caso / Videoassisted diaphragmatic hernia repair in a cat: case report

Relata-se um caso de um felino com sinais de dificuldade respiratória havia cerca de 30 dias e emagrecimento progressivo. Ao exame radiográfico torácico e de abdômen, ficou evidenciada perda de definição da linha diafragmática, sendo compatível com hérnia diafragmática. Na laparoscopia, foi observado grande defeito diafragmático, além de estruturas herniadas. Em razão de as vísceras abdominais direcionarem-se ao tórax, dificultando a oclusão do defeito com suturas intracorpóreas, optou-se pela realização de incisão paracostal, procedendo-se à herniorrafia por celiotomia reduzida. A videolaparoscopia permitiu localizar o local herniado e promover a redução dos órgãos envolvidos com mínimo trauma operatório. Logo, mostrou-se como eficaz ferramenta diagnóstica e auxiliar no tratamento de hérnias diafragmáticas crônicas de grande dimensão em gato.(AU)

This is a case report of a cat with signs of respiratory distress for about 30 days and progressive weight loss. The thoracic radiograph and abdomen examination evidencing loss of definition of the diaphragmatic line is compatible with diaphragmatic hernia. In laparoscopy, a large diaphragmatic defect and herniated structures were observed. Since abdominal viscera point towards the chest making occlusion of defective intracorporeal sutures difficult, paracostal incision proceeding to hernia repair by short celiotomy was chosen. Laparoscopy allows for location of herniated place and promotes the reduction of organs involved with minimal surgical trauma. Therefore, it was shown to be an effective diagnostic tool and an aid in the treatment of chronic diaphragmatic hernias of large size in a cat.(AU)

Herniorrafia diafragmática videoassistida em gato: relato de caso / Videoassisted diaphragmatic hernia repair in a cat: case report

Relata-se um caso de um felino com sinais de dificuldade respiratória havia cerca de 30 dias e emagrecimento progressivo. Ao exame radiográfico torácico e de abdômen, ficou evidenciada perda de definição da linha diafragmática, sendo compatível com hérnia diafragmática. Na laparoscopia, foi observado grande defeito diafragmático, além de estruturas herniadas. Em razão de as vísceras abdominais direcionarem-se ao tórax, dificultando a oclusão do defeito com suturas intracorpóreas, optou-se pela realização de incisão paracostal, procedendo-se à herniorrafia por celiotomia reduzida. A videolaparoscopia permitiu localizar o local herniado e promover a redução dos órgãos envolvidos com mínimo trauma operatório. Logo, mostrou-se como eficaz ferramenta diagnóstica e auxiliar no tratamento de hérnias diafragmáticas crônicas de grande dimensão em gato.(AU)

This is a case report of a cat with signs of respiratory distress for about 30 days and progressive weight loss. The thoracic radiograph and abdomen examination evidencing loss of definition of the diaphragmatic line is compatible with diaphragmatic hernia. In laparoscopy, a large diaphragmatic defect and herniated structures were observed. Since abdominal viscera point towards the chest making occlusion of defective intracorporeal sutures difficult, paracostal incision proceeding to hernia repair by short celiotomy was chosen. Laparoscopy allows for location of herniated place and promotes the reduction of organs involved with minimal surgical trauma. Therefore, it was shown to be an effective diagnostic tool and an aid in the treatment of chronic diaphragmatic hernias of large size in a cat.(AU)

Co-ocurrence of an osteogenesis imperfecta-like phenotype and congenital diaphragmatic hernia in a kitten

A rare case of the co-occurrence of an osteogenesis imperfecta-like phenotype and congenital diaphragmatic hernia is reported in a male, mixed-breed kitten with a clinical history of dyspnea, dehydration, sternal recumbency and stupor. The animal presented moderate bone deformity of the fore and hind limbs, muscle atrophy, and cervical and thoracic lordosis. The radiological examination and necropsy revealed diffuse and intense radiolucency throughout the skeleton, curved or fractured bones, very thin cortical long bones, an intensely extended medullary canal and left diaphragmatic hernia with an aperture without bleeding or scarring. Microscopically, some long bones and vertebral bodies had less-differentiated cartilaginous epiphysis, predominantly attached to the epiphyseal plate and with absence of secondary ossification centers or incipient formation. The trabeculae were thin, few, surrounded by abundant cartilaginous tissue and coated with a layer of bulky cuboidal osteoblasts. The cortical long bones, vertebrae, skull and ribs were thin and discontinuous. Based on the clinical, radiological, macroscopic and microscopic findings, a diagnosis of osteogenesis imperfecta and congenital diaphragmatic hernia was confirmed. To the best of our knowledge, this report is the first case of OI associated with congenital diaphragmatic hernia in an animal.

Co-ocurrence of an osteogenesis imperfecta-like phenotype and congenital diaphragmatic hernia in a kitten

A rare case of the co-occurrence of an osteogenesis imperfecta-like phenotype and congenital diaphragmatic hernia is reported in a male, mixed-breed kitten with a clinical history of dyspnea, dehydration, sternal recumbency and stupor. The animal presented moderate bone deformity of the fore and hind limbs, muscle atrophy, and cervical and thoracic lordosis. The radiological examination and necropsy revealed diffuse and intense radiolucency throughout the skeleton, curved or fractured bones, very thin cortical long bones, an intensely extended medullary canal and left diaphragmatic hernia with an aperture without bleeding or scarring. Microscopically, some long bones and vertebral bodies had less-differentiated cartilaginous epiphysis, predominantly attached to the epiphyseal plate and with absence of secondary ossification centers or incipient formation. The trabeculae were thin, few, surrounded by abundant cartilaginous tissue and coated with a layer of bulky cuboidal osteoblasts. The cortical long bones, vertebrae, skull and ribs were thin and discontinuous. Based on the clinical, radiological, macroscopic and microscopic findings, a diagnosis of osteogenesis imperfecta and congenital diaphragmatic hernia was confirmed. To the best of our knowledge, this report is the first case of OI associated with congenital diaphragmatic hernia in an animal.(AU)

Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog / Correção laparoscópica de hérnia pleuroperitoneal utilizando malha de polipropileno em cão

Pleuroperitoneal hernias are the most uncommon type of diaphragmatic hernias in dogs and cats. The treatment of choice is surgery and may involve the use of prosthetic implant through celiotomy. In the current report, laparoscopic repair of a congenital pleuroperitoneal hernia using polypropylene mesh in a dog is described. The surgery was feasible. Appropriate reduction of the hernia was carried out and no complications were noted(AU)

Hérnias pleuroperitoneais são o tipo mais incomum de hérnias diafragmáticas em cães e gatos. O tratamento de escolha é cirúrgico e pode envolver o uso de implantes protéticos na abordagem via laparotomia. No presente relato, é descrito o reparo de uma hérnia pleuroperitoneal congênita através de laparoscopia com utilização de malha de polipropileno. A cirurgia foi viável. Houve redução apropriada da hérnia sem observação de complicações(AU)

Hérnia diafragmática traumática em felino / Diaphragmatic traumatic hernia in feline

As hérnias diafragmáticas caracterizam-se pela passagem das vísceras abdominais para a cavidade torácica após ruptura do diafragma (FOSSUM et al., 2007). Normalmente as hérnias diafragmáticas tem origem traumática (DALECK et al., 2008), podendo também ser de caráter congênito (MAZZANTI et al., 2003). Os sintomas relacionam-se com alterações gastrointestinais e respiratórias, sendo a dispneia o distúrbio mais mencionado (DRUMOND et al., 2007). O diagnóstico fundamenta-se, especialmente, na história do paciente que geralmente coincide com trauma, decorrente de acidentes automobilísticos, quedas, chutes e brigas (FOSSUM et al., 2007), e sinais clínicos apresentados, porém o exame radiográfico é primordial para o diagnóstico conclusivo (ARAGÃO et al., 2010). Com esse trabalho objetivou-se relatar um caso de hérnia diafragmática adquirida em felino após traumatismo, submetido ao tratamento cirúrgico, o qual desencadeou parada cardiorrespiratória com necessidade de atendimento emergencial.

Hérnia diafragmática traumática em felino / Diaphragmatic traumatic hernia in feline

As hérnias diafragmáticas caracterizam-se pela passagem das vísceras abdominais para a cavidade torácica após ruptura do diafragma (FOSSUM et al., 2007). Normalmente as hérnias diafragmáticas tem origem traumática (DALECK et al., 2008), podendo também ser de caráter congênito (MAZZANTI et al., 2003). Os sintomas relacionam-se com alterações gastrointestinais e respiratórias, sendo a dispneia o distúrbio mais mencionado (DRUMOND et al., 2007). O diagnóstico fundamenta-se, especialmente, na história do paciente que geralmente coincide com trauma, decorrente de acidentes automobilísticos, quedas, chutes e brigas (FOSSUM et al., 2007), e sinais clínicos apresentados, porém o exame radiográfico é primordial para o diagnóstico conclusivo (ARAGÃO et al., 2010). Com esse trabalho objetivou-se relatar um caso de hérnia diafragmática adquirida em felino após traumatismo, submetido ao tratamento cirúrgico, o qual desencadeou parada cardiorrespiratória com necessidade de atendimento emergencial.(AU)

Ultrassonografia de colestase extra-hepática em gata com hérniadiafragmática: relato de caso / Ultrasound of extrahepatic cholestasis in a female cat with diaphragmatic hernia: case report

A obstrução biliar extra-hepática é rara em gatos. Entre as várias causas verificam-se as compressivas deorigem traumática; dentre elas encontra-se a hérnia diafragmática. A ultrassonografia é um importantemeio de diagnóstico da obstrução biliar, uma vez que possibilita a visibilização da dilatação do sistemabiliar, principalmente em casos crônicos. Este artigo relata o caso de uma gata sem raça definida de oitomeses de idade que apresentou obstrução biliar extra-hepática em consequência de uma hérnia diafragmáticacrônica, onde houve deslocamento do duodeno para o tórax levando consigo o ducto colédoco,causando compressão deste e dilatação do sistema biliar. A hérnia diafragmática foi diagnosticada pelaradiografia simples. A ultrassonografia permitiu o diagnóstico da obstrução biliar bem como determinara cronicidade do caso devido a dilatação dos ductos biliares intra-hepáticos. O animal foi encaminhadopara laparotomia para correção da hérnia, porém foi à óbito no final do procedimento. Foi realizadanecropsia para avaliação macroscópica do parênquima hepático e do sistema biliar e as característicasvistas estavam de acordo com as observadas no momento da ultrassonografia, mostrando o quão útil éeste exame para o diagnóstico da obstrução biliar e para determinar o grau de dilatação biliar.(AU)

The extrahepatic biliary obstruction is rare in cats. The compressive traumatic obstruction, specifically thediaphragmatic hernia, is amongst the various causes. The sonography is an important to biliary obstructiondiagnosis, since it allows the visualization of the biliary system dilatation, in particular the chronic cases.This study reports a extrahepatic biliary obstruction, result of a chronic diaphragmatic hernia, in a femalemongrel cat, eight months old. At the radiography exam of the torax was observed the displacement of theduodenum and the common bile duct to the chest. The sonography confirmed the diagnosis of biliary obstruction and enabled to determine the chronicity of the case due to dilatation of the intrahepatic bile ducts.The surgery for hernia reduction was realized, but the animal died after the surgical procedure. Necropsywas performed for macroscopic evaluation of the hepatic parenchyma and biliary system. The finds wereseen according to the sonographic examination, demonstrating how useful is the sonography for biliaryobstruction diagnosis and to determine biliary dilatation degree.(AU)

Ultrassonografia de colestase extra-hepática em gata com hérniadiafragmática: relato de caso / Ultrasound of extrahepatic cholestasis in a female cat with diaphragmatic hernia: case report

A obstrução biliar extra-hepática é rara em gatos. Entre as várias causas verificam-se as compressivas deorigem traumática; dentre elas encontra-se a hérnia diafragmática. A ultrassonografia é um importantemeio de diagnóstico da obstrução biliar, uma vez que possibilita a visibilização da dilatação do sistemabiliar, principalmente em casos crônicos. Este artigo relata o caso de uma gata sem raça definida de oitomeses de idade que apresentou obstrução biliar extra-hepática em consequência de uma hérnia diafragmáticacrônica, onde houve deslocamento do duodeno para o tórax levando consigo o ducto colédoco,causando compressão deste e dilatação do sistema biliar. A hérnia diafragmática foi diagnosticada pelaradiografia simples. A ultrassonografia permitiu o diagnóstico da obstrução biliar bem como determinara cronicidade do caso devido a dilatação dos ductos biliares intra-hepáticos. O animal foi encaminhadopara laparotomia para correção da hérnia, porém foi à óbito no final do procedimento. Foi realizadanecropsia para avaliação macroscópica do parênquima hepático e do sistema biliar e as característicasvistas estavam de acordo com as observadas no momento da ultrassonografia, mostrando o quão útil éeste exame para o diagnóstico da obstrução biliar e para determinar o grau de dilatação biliar.

The extrahepatic biliary obstruction is rare in cats. The compressive traumatic obstruction, specifically thediaphragmatic hernia, is amongst the various causes. The sonography is an important to biliary obstructiondiagnosis, since it allows the visualization of the biliary system dilatation, in particular the chronic cases.This study reports a extrahepatic biliary obstruction, result of a chronic diaphragmatic hernia, in a femalemongrel cat, eight months old. At the radiography exam of the torax was observed the displacement of theduodenum and the common bile duct to the chest. The sonography confirmed the diagnosis of biliary obstruction and enabled to determine the chronicity of the case due to dilatation of the intrahepatic bile ducts.The surgery for hernia reduction was realized, but the animal died after the surgical procedure. Necropsywas performed for macroscopic evaluation of the hepatic parenchyma and biliary system. The finds wereseen according to the sonographic examination, demonstrating how useful is the sonography for biliaryobstruction diagnosis and to determine biliary dilatation degree.

Toracoscopia nas hérnias diafragmáticas: estudo experimental em cães

The most common type of diaphragmatic hernia in dogs and cats is the traumatic one.As an anatomic alteration surgery is the elected treatment. The purpose of this study was to evaluate videothoracoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in eight dogs. In the first phase of the study diaphragmatic hernias were performed in the dogs through laparoscopic access. One week later the dogs were summited to a thoracoscopic surgery to make diagnostic and surgical correction. Thoracoscopic access showed to be efficient for identification of the defects and visceral displacements and for the surgical treatment.

Na classificação das hérnias diafragmáticas, a traumática é a forma mais prevalente em cães e gatos. A alteração, que se caracteriza por uma alteração anatômica, tem na correção cirúrgica, o tratamento recomendado. O presente estudo se propôs a avaliar a cirurgia videotoracoscópica no diagnóstico e tratamento de hérnias diafragmáticas em cães. Na primeira etapa do experimento, oito animais foram submetidos à produção de um modelo de hérnia diafragmática por meio do acesso laparoscópico. Após o período de uma semana, os cães foram submetidos à segunda etapa experimental através do acesso toracoscópico, tendo como finalidade o diagnóstico e a terapêutica cirúrgica. O acesso toracoscópico mostrou-se eficaz tanto no caráter diagnóstico das rupturas e dos deslocamentos, como na correção cirúrgica de reposição visceral e rafia diafragmática.

Toracoscopia nas hérnias diafragmáticas: estudo experimental em cães

The most common type of diaphragmatic hernia in dogs and cats is the traumatic one.As an anatomic alteration surgery is the elected treatment. The purpose of this study was to evaluate videothoracoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in eight dogs. In the first phase of the study diaphragmatic hernias were performed in the dogs through laparoscopic access. One week later the dogs were summited to a thoracoscopic surgery to make diagnostic and surgical correction. Thoracoscopic access showed to be efficient for identification of the defects and visceral displacements and for the surgical treatment.

Na classificação das hérnias diafragmáticas, a traumática é a forma mais prevalente em cães e gatos. A alteração, que se caracteriza por uma alteração anatômica, tem na correção cirúrgica, o tratamento recomendado. O presente estudo se propôs a avaliar a cirurgia videotoracoscópica no diagnóstico e tratamento de hérnias diafragmáticas em cães. Na primeira etapa do experimento, oito animais foram submetidos à produção de um modelo de hérnia diafragmática por meio do acesso laparoscópico. Após o período de uma semana, os cães foram submetidos à segunda etapa experimental através do acesso toracoscópico, tendo como finalidade o diagnóstico e a terapêutica cirúrgica. O acesso toracoscópico mostrou-se eficaz tanto no caráter diagnóstico das rupturas e dos deslocamentos, como na correção cirúrgica de reposição visceral e rafia diafragmática.

Diaphragmatic hernia in horse: case report / Hérnia diafragmática em equino: relato de caso

The diaphragmatic hernia is a rare cause of colic in equine and may be congenital or acquired. The intestine is commonly involved in cases of diaphragmatic hernia, and clinical signs are related to the intestinal segment involved and the extension, obstruction may occur from a simple process to a strangulating. Often, clinical signs are characterized by acute abdominal whit severe pain, dyspnea and tachypnea. The diagnosis of diaphragmatic hernia can be difficult, and in most cases only is established during surgery or at necropsy. This paper reports a diaphragmatic hernia case in a quarter horse stallion, with 14 years of age showing acute abdominal signs. The clinical examination showed tachycardia, tachypnea and absence of intestinal motility. Turbidity, increase of leukocytes and protein was observed in the analysis of peritoneal fluid. Exploratory laparotomy was performed, but due to the presence of hemorrhagic mesentery, intestinal ischemia, and irreducible incarceration of the jejunum in epiploic foramen, euthanasia was decided. Furthermore, at necropsy, was observed a diaphragmatic hernia with presence of the small intestine in the thorax.

A hérnia diafragmática é uma causa rara de cólica em equinos, podendo ser de origem congênita ou adquirida. Comumente, o intestino encontra-se envolvido nos casos de hérnia diafragmática, sendo que quadro clínico está relacionado ao segmento intestinal envolvido e a extensão da obstrução intestinal, podendo ocorrer desde uma obstrução simples até um processo estrangulante. Frequentemente, os sinais clínicos se caracterizam por desconforto abdominal agudo de intensidade grave, dispneia e/ ou taquipneia. O diagnóstico de hérnia diafragmática pode ser difícil, e na maioria das vezes só é estabelecido durante o procedimento cirúrgico ou na necropsia. O presente trabalho relata a ocorrência de uma hérnia diafragmática em um garanhão, quarto de milha de 14 anos de idade apresentando sinais de desconforto abdominal agudo. O exame físico revelou taquicardia, taquipneia e ausência de motilidade intestinal. A análise do líquido peritoneal mostrou turbidez, aumento de leucócitos e aumento de proteína. O equino foi submetido à laparotomia exploratória, mas devido à presença de mesentério hemorrágico, isquemia intestinal e encarceramento irredutível do jejuno em forâmen epiplóico, decidiuse pela eutanásia. Além destes achados, na necropsia, foi observada uma hérnia diafragmática com presença de intestino delgado no tórax. 

Retalho pediculado do músculo grande dorsal para reparo de defeito diafragmático experimental em cães

In this study, the Latissimus dorsi muscular flap was experimentally used for the repair of iatrogenic diaphragmatic defects in 18 adult dogs. The flap was elevated maintaining its dorso-caudal attachment. The diaphragm was accessed through a right thoracotomy in the tenth intercostal space, a defect in the diaphragm was created and the flap was sutured in the margins of the defect. The flap was capable of covering one third of the right hemidiaphragm. All the animals had good post-surgery recoveries. Respiratory function was not compromised. Necropsies were taken at 15, 30 and 60 days post-surgery. Macro and microscopically, the muscle showed few adhesions with adjacent viscera and excellent healing. The Latissimus dorsi muscular flap can be useful for reconstruction of large diaphragmatic defects in dogs.

Neste experimento, foi utilizado um retalho do músculo grande dorsal, com pedículo dorso-caudal, para o reparo de defeitos diafragmáticos iatrogênicos em 18 cães adultos. O acesso ao diafragma foi através de toracotomia no décimo espaço intercostal, sendo criado um defeito diafragmático, onde o retalho foi suturado. O retalho muscular pediculado cobriu um terço do hemidiafragma direito. Os animais tiveram boa recuperação pós-cirúrgica, sem sinais de comprometimento respiratório. Foram feitas necropsias aos 15, 30 e 60 dias do pós -operatório. O local submetido ao implante apresentou algumas aderências com vísceras adjacentes e consolidação da sutura macro e microscopicamente. Conclui-se que o retalho pediculado do grande dorsal pode ser útil para o reparo de grandes defeitos diafragmáticos em cães.

Retalho pediculado do músculo grande dorsal para reparo de defeito diafragmático experimental em cães

In this study, the Latissimus dorsi muscular flap was experimentally used for the repair of iatrogenic diaphragmatic defects in 18 adult dogs. The flap was elevated maintaining its dorso-caudal attachment. The diaphragm was accessed through a right thoracotomy in the tenth intercostal space, a defect in the diaphragm was created and the flap was sutured in the margins of the defect. The flap was capable of covering one third of the right hemidiaphragm. All the animals had good post-surgery recoveries. Respiratory function was not compromised. Necropsies were taken at 15, 30 and 60 days post-surgery. Macro and microscopically, the muscle showed few adhesions with adjacent viscera and excellent healing. The Latissimus dorsi muscular flap can be useful for reconstruction of large diaphragmatic defects in dogs.

Neste experimento, foi utilizado um retalho do músculo grande dorsal, com pedículo dorso-caudal, para o reparo de defeitos diafragmáticos iatrogênicos em 18 cães adultos. O acesso ao diafragma foi através de toracotomia no décimo espaço intercostal, sendo criado um defeito diafragmático, onde o retalho foi suturado. O retalho muscular pediculado cobriu um terço do hemidiafragma direito. Os animais tiveram boa recuperação pós-cirúrgica, sem sinais de comprometimento respiratório. Foram feitas necropsias aos 15, 30 e 60 dias do pós -operatório. O local submetido ao implante apresentou algumas aderências com vísceras adjacentes e consolidação da sutura macro e microscopicamente. Conclui-se que o retalho pediculado do grande dorsal pode ser útil para o reparo de grandes defeitos diafragmáticos em cães.

Diaphragmatic hernia in horse: case report / Hérnia diafragmática em equino: relato de caso

The diaphragmatic hernia is a rare cause of colic in equine and may be congenital or acquired. The intestine is commonly involved in cases of diaphragmatic hernia, and clinical signs are related to the intestinal segment involved and the extension, obstruction may occur from a simple process to a strangulating. Often, clinical signs are characterized by acute abdominal whit severe pain, dyspnea and tachypnea. The diagnosis of diaphragmatic hernia can be difficult, and in most cases only is established during surgery or at necropsy. This paper reports a diaphragmatic hernia case in a quarter horse stallion, with 14 years of age showing acute abdominal signs. The clinical examination showed tachycardia, tachypnea and absence of intestinal motility. Turbidity, increase of leukocytes and protein was observed in the analysis of peritoneal fluid. Exploratory laparotomy was performed, but due to the presence of hemorrhagic mesentery, intestinal ischemia, and irreducible incarceration of the jejunum in epiploic foramen, euthanasia was decided. Furthermore, at necropsy, was observed a diaphragmatic hernia with presence of the small intestine in the thorax.

A hérnia diafragmática é uma causa rara de cólica em equinos, podendo ser de origem congênita ou adquirida. Comumente, o intestino encontra-se envolvido nos casos de hérnia diafragmática, sendo que quadro clínico está relacionado ao segmento intestinal envolvido e a extensão da obstrução intestinal, podendo ocorrer desde uma obstrução simples até um processo estrangulante. Frequentemente, os sinais clínicos se caracterizam por desconforto abdominal agudo de intensidade grave, dispneia e/ ou taquipneia. O diagnóstico de hérnia diafragmática pode ser difícil, e na maioria das vezes só é estabelecido durante o procedimento cirúrgico ou na necropsia. O presente trabalho relata a ocorrência de uma hérnia diafragmática em um garanhão, quarto de milha de 14 anos de idade apresentando sinais de desconforto abdominal agudo. O exame físico revelou taquicardia, taquipneia e ausência de motilidade intestinal. A análise do líquido peritoneal mostrou turbidez, aumento de leucócitos e aumento de proteína. O equino foi submetido à laparotomia exploratória, mas devido à presença de mesentério hemorrágico, isquemia intestinal e encarceramento irredutível do jejuno em forâmen epiplóico, decidiuse pela eutanásia. Além destes achados, na necropsia, foi observada uma hérnia diafragmática com presença de intestino delgado no tórax.