Porcine small intestinal submucosa biomaterial graft for repair of a congenital pleuroperitoneal hernia in a kitten.

In this case, porcine small intestinal submucosa (pSIS) was used to repair a large congenital diaphragmatic hernia in a kitten. The pSIS was moistened in saline, folded in half, and sutured to the remnant of the right hemidiaphragm. The animal was determined to be doing well clinically and radiographically 12 wk after procedure. At 8.5 mo of age, the kitten was spayed, and the diaphragm was inspected, revealing a thin, semitransparent membrane at the central region of the previous pSIS graft. Serial thoracic radiographs may be an effective way to reach a diagnosis of a diaphragmatic hernia if not clearly identifiable on initial radiographs. Surgeons should be prepared to use alternative techniques to close large diaphragmatic defects. Porcine SIS was demonstrated to be a strong, easy-to-use, readily available, and effective technique to close a large defect in the diaphragm with excellent results in the short and medium terms. When hernia repair is employed in juvenile animals, reassessment of the diaphragmatic repair should be considered if future abdominal surgeries, such as ovariohysterectomies, are necessary. A functional 8-ply pSIS should be considered in cats and dogs as it has a lower complication and graft failure rate. Key clinical message: When serial radiographs fail to diagnose a diaphragmatic hernia when one is highly suspected, other modalities, such as ultrasonography or other contrast modalities, should be considered. A functional 8-ply pSIS should be considered to reconstruct the diaphragm, particularly in growing animals, as it is an effective graft with low complication and graft failure rates.

Greffe de biomatériau de sous-muqueuse intestinale porcine pour la réparation d'une hernie pleuropéritonéale congénitale chez un chatonDans ce cas, la sous-muqueuse intestinale porcine (pSIS) a été utilisée pour réparer une grande hernie diaphragmatique congénitale chez un chaton. La pSIS a été humidifiée dans une solution saline, pliée en deux et suturée au reste de l'hémidiaphragme droit. L'animal s'est avéré se porter bien cliniquement et radiographiquement 12 semaines après l'intervention. À l'âge de 8,5 mois, le chaton a été stérilisé et le diaphragme a été inspecté, révélant une fine membrane semi-transparente dans la région centrale de la greffe pSIS précédente. Des radiographies thoraciques en série peuvent être un moyen efficace de poser un diagnostic d'hernie diaphragmatique si elle n'est pas clairement identifiable sur les radiographies initiales. Les chirurgiens doivent être prêts à utiliser des techniques alternatives pour fermer les gros défauts diaphragmatiques. La SIS porcine s'est avérée être une technique solide, facile à utiliser, facilement disponible et efficace pour fermer un gros défaut du diaphragme avec d'excellents résultats à court et moyen terme. Lorsque la réparation d'une hernie est utilisée chez les animaux juvéniles, une réévaluation de la réparation diaphragmatique doit être envisagée si de futures chirurgies abdominales, telles que des ovariohystérectomies, sont nécessaires. Une pSIS fonctionnelle à 8 plis doit être envisagée chez les chats et les chiens car elle présente un taux de complications et d'échec de greffe plus faible.Message clinique clé :Lorsque les radiographies en série ne permettent pas de diagnostiquer une hernie diaphragmatique alors qu'elle est fortement suspectée, d'autres modalités, telles que l'échographie ou d'autres modalités de contraste, doivent être envisagées. Une pSIS fonctionnelle à 8 plis doit être envisagée pour reconstruire le diaphragme, en particulier chez les animaux en croissance, car il s'agit d'une greffe efficace avec un faible taux de complications et d'échec de greffe.(Traduit par Dr Serge Messier).

Concomitant Congenital Diaphagmatic Hernia (CDH) and bilateral bacterial glomerulonephritis in a pet chinchilla (Chinchilla lanigera).

BACKGROUND: The domestic chinchilla has been descended from Chinchilla lanigera (long-tailed Chinchilla) or Chinchilla chinchilla (short-tailed Chinchilla). Both species of chinchilla are currently listed as endangered by the IUCN Red List of Threatened Species. Over the past 20 years, they have spread as pets and overall knowledge about their care is improving. The present case report describes a congenital diaphragmatic hernia in a Chinchilla lanigera. CASE PRESENTATION: A 1-year-old, 420 g female chinchilla (Chinchilla lanigera) was presented for clinical examination due to 2 days haematuria episodes and anorexia. A complete haematological analysis was performed, showing a moderate neutrophilia and severe renal involvement. X-rays showed severe intestinal meteorism affecting mostly the cecum, and a soft tissue density mass with translucent areas located in the caudal thorax, making it hard to distinguish the cardiac silhouette. A barium swallow (barium sulfate) was performed and after 20 min, radiograms were performed again, showing part of the stomach dislocated in thorax. Ultrasound was also carried out, confirming the partial stomach herniation into the thoracic cavity and a severe nephropathy. The patient was euthanized according to the owner's wish and a complete necropsy was performed. The diagnosis was congenital diaphragmatic hernia concomitant to a severe bilateral bacterial glomerulonephritis. DISCUSSION AND CONCLUSIONS: Diaphragmatic hernias can be either congenital or acquired. About CDHs in pet chinchillas, literature is still lacking. In this patient there was no history of previous traumas. No scar tissue or thickening involved margins of the pathological diaphragm window at the necropsy, supporting the hypothesis of a congenital defect. Glomerulonephritis most often results from immune-mediated mechanisms, generally after the deposition of soluble immune complexes within the glomeruli. This mechanism is favoured by a prolonged antigenemia that could occur during specific viral infections, chronic bacterial infections, chronic parasitism, autoimmune diseases and neoplasia. Few cases of nephritis are described in chinchillas (Chinchilla lanigera), mostly related to bacterial sepsis or less commonly involving fungi. The evidence of bacterial aggregates in kidneys at the histopathology, confirmed the infective aetiology. No relationship between the diaphragmatic hernia and glomerulonephritis was found in this report.

Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus).

The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.

IMAGING DIAGNOSIS-THE COMPUTED TOMOGRAPHY FEATURES OF A PLEUROPERITONEAL HERNIA IN A CAT.

An 8-year-old female neutered domestic short hair cat presented for investigation of poorly controlled diabetes mellitus. Thoracic radiographs identified a soft tissue opacity in the caudoventral thorax adjacent to the diaphragm. Computed tomography (CT) then characterized a pleuroperitoneal hernia with cranial displacement of a portion of the liver within the hernia. A pleuroperitoneal hernia was confirmed and repaired via exploratory laparotomy. This is the first description of the CT features of a pleuroperitoneal hernia in a cat.

A ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog.

OBJECTIVE: To report a ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog. ANIMAL: A 5-month-old 15-kg entire male Labrador Retriever. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The dog presented with a history of diarrhea for a week and acute-onset lethargy and vomiting for 3 days. Clinical examination revealed borborygmi on auscultation of the chest, and subsequent imaging showed a congenital peritoneopericardial diaphragmatic hernia. TREATMENT AND OUTCOME: The ventro-central diaphragmatic defect was repaired with a pericardial flap, which subsequently failed 7 months later. The revision surgery was performed with a novel surgical technique. The defect was closed by means of incising the ventral attachments of the diaphragm either side of the defect and sliding it medially to allow a tension-free closure. The ventral aspect of the incised diaphragm was reattached with circumcostal sutures and the central defect closed. The dog recovered rapidly and without complication. An excellent outcome was reported after surgery. CLINICAL RELEVANCE: This novel technique was a simple method to repair a peritoneopericardial diaphragmatic hernia and had good clinical results in this case.

Oesophageal stricture in a cat with true pleuroperitoneal hernia.

A 2-year-old neutered male Bengal cat presented with solid food dysphagia and chronic regurgitation for >5 months. There were no clinical abnormalities on haematological or radiographic examinations. Thoracic radiography revealed a soft tissue opacity mass adjacent to the diaphragm in the caudoventral thorax. Ultrasonography revealed a protruding liver lobe surrounded by a hyperechoic lining from the diaphragm towards the thorax, and a pleuroperitoneal hernia was diagnosed. An endoscopy was performed to examine the cause of regurgitation, and an oesophageal stricture was observed. Endoscopic balloon dilation of the oesophageal stricture was performed, and the regurgitation was resolved immediately. However, regurgitation relapsed 2 months later, and computed tomography was performed to ascertain the cause. Computed tomography revealed oesophageal mural thickening and true pleuroperitoneal hernia with partial liver lobe herniation. A second endoscopy with balloon dilation was performed to treat the relapsing oesophageal stricture, and the clinical signs resolved without the need for herniorrhaphy. Nevertheless, oesophageal stricture could occur due to gastroesophageal reflux related to a pleuroperitoneal hernia; however, a definite link could not be elucidated in this case. This report describes a case of oesophageal stricture and concurrent true pleuroperitoneal hernia in a cat.

Equine Pulmonary Agenesis and Hypoplasia Associated With Diaphragmatic Herniation.

Pulmonary malformations are rare equine congenital anomalies. Over a 3-year timeframe, three cases of left sided pulmonary agenesis were diagnosed in perinatal foals. All three cases were associated with concurrent ipsilateral diaphragmatic herniation and hypoplasia of the right lung lobe. All three foals died immediately following parturition due to perinatal asphyxia associated with the congenital malformations. To the author's knowledge, this is the first report of pulmonary agenesis in the horse.

Relationships between congenital peritoneopericardial diaphragmatic hernia or congenital central diaphragmatic hernia and ductal plate malformations in dogs and cats.

OBJECTIVE: To characterize the association between peritoneopericardial diaphragmatic hernia (PPDH) or congenital central diaphragmatic hernia (CCDH) and ductal plate malformations (DPMs) in dogs and cats. ANIMALS: 18 dogs and 18 cats with PPDH or CCDH and 19 dogs and 18 cats without PPDH or CCDH. PROCEDURES: Evaluation of clinical details verified PPDH or CCDH and survival times. Histologic features of nonherniated liver samples were used to categorize DPM. Immunohistochemical staining for cytokeratin-19 distinguished bile duct profiles per portal tract and for Ki-67-assessed cholangiocyte proliferation. Histologic features of herniated liver samples from PPDH or CCDH were compared with those of pathological controls (traumatic diaphragmatic hernia, n = 6; liver lobe torsion, 6; ischemic hepatopathy, 2). RESULTS: DPM occurred in 13 of 18 dogs with the proliferative-like phenotype predominating and in 15 of 18 cats with evenly distributed proliferative-like and Caroli phenotypes. Congenital hepatic fibrosis DPM was noted in 3 dogs and 2 cats and renal DPM in 3 dogs and 3 cats. No signalment, clinical signs, or clinicopathologic features discriminated DPM. Kaplan Meier survival curves were similar in dogs and cats. Bile duct profiles per portal tract in dogs (median, 5.0; range, 1.4 to 100.8) and cats (6.6; 1.9 to 11.0) with congenital diaphragmatic hernias significantly exceeded those in healthy dogs (1.4; 1.2 to 1.6) and cats (2.3; 1.7 to 2.6). Animals with DPM lacked active cholangiocyte proliferation. Histologic features characterizing malformative bile duct profiles yet without biliary proliferation were preserved in herniated liver lobes in animals with DPM. CONCLUSIONS AND CLINICAL RELEVANCE: DPM was strongly associated with PPDH and CCDH. Because DPM can impact health, awareness of its coexistence with PPDH or CCDH should prompt biopsy of nonherniated liver tissue during surgical correction of PPDH and CCDH.

Diagnostic and Treatment Challenges for Diaphragmatic Hernia in Equids: A Concise Review of Literature.

Diaphragmatic hernia (DH) represents an acute abdominal crisis, but respiratory symptoms may be occurring. Different types of diaphragmatic hernias (DHs) like typical DH, Morgagni hernia, hiatal hernia and diaphragmatic diverticulum have been recorded in equids. These DHs have various clinical presentations and prognoses. Early diagnosis and prompt surgical repair are highly recommended in order to diminish the ischemic changes to thoracic and abdominal viscera, thus improving the overall prognosis of equids with DH. Over last decade, the prognosis of DH in equids was better than previously believed due to improvements in diagnostic tools, general anesthesia of equids, (particularly those with systemic compromise) and gastrointestinal surgery, development of thoracoscopic techniques and use of staples for surgical repair. Nevertheless, several diagnostic and treatment challenges are still present during management of DH in equids. Diagnostic challenges include inconsistent clinical signs of DH, acute nature of the associated colic and absence of highly qualified diagnostic tools. Increased awareness of the case, good clinical observation and availability of diagnostic tools are recommended to overcome these challenges. Also anesthesia, reduction of large herniated organs and herniorrhaphy are major challenges. Preoperative stabilization, careful monitoring, selection of the most accessible surgical approach and good intraoperative as well as postoperative support are highly recommended to overcome these challenges. Surgical repair, particularly prosthetic herniorrhaphy seems to be effective to close the diaphragmatic defect and prevent recurrences. The present review describes the different types of DHs in equids, their diagnostic and treatment challenges and how to overcome these challenges.

Pleuroperitoneal true diaphragmatic hernia of the liver in a cat.

A 2-year old female domestic shorthair cat was referred with intermittent vomiting. Laboratory analyses revealed only an elevated alanine aminotransferase activity. Plain thoracic radiographs showed a right-sided transdiaphragm protrusion of a liver lobe into the thoracic cavity. On abdominal ultrasound the diaphragm and liver parenchyma also presented a bulge towards the thoracic cavity. By cranial median laparotomy herniation of the quadrate liver lobe through the right aspect of the diaphragm into the thoracic cavity was confirmed. The protruding quadrate liver lobe was covered by intact parietal peritoneum. Following relocation of the liver lobe the defect was closed. Postoperatively the intermittent vomiting stopped. The purpose of this case report was to present plain radiography and abdominal ultrasonography as effective tools in the diagnosis of this rare and usually asymptomatic true herniation case along with its operative treatment.

Congenital pleuroperitoneal hernia presenting as gastrothorax in five cavalier King Charles spaniel dogs.

Five cavalier King Charles spaniels were examined for acute onset of respiratory distress. Thoracic radiographs demonstrated diaphragmatic hernia and tension gastrothorax, visible as a distended stomach occupying the left caudal thoracic cavity. Exploratory midline coeliotomy confirmed congenital pleuroperitoneal diaphragmatic hernia with herniation and dilatation of the stomach. The hernia configuration was consistent in all cases, with a defect affecting the left diaphragmatic crus. Congenital pleuroperitoneal diaphragmatic hernia is a rare condition caused by a defect in the dorsolateral diaphragm. Defects of the left crus of the diaphragm could result in the herniation of the stomach into the thoracic cavity with possible subsequent tension gastrothorax. Cavalier King Charles spaniels may have a predisposition to this condition. Tension gastrothorax is an acute life-threatening consequence of gastric herniation through a diaphragmatic defect that must be promptly recognised and surgically treated.

Cholecystopexy and Pericardial Pseudocyst Removal in a Dog with a Congenital Peritoneopericardial Diaphragmatic Hernia.

A 4 mo old spayed female golden retriever was presented with a peritoneopericardial diaphragmatic hernia (PPDH) that was diagnosed during neutering. Echocardiography revealed a fluid-filled structure and parts of the liver in the pericardial cavity. Computed tomography confirmed the existence of the PPDH and the herniation of the right medial liver lobe and the gallbladder. Cystic masses were observed in the pericardial and the peritoneal cavities, possibly communicating through the PPDH. A median laparotomy revealed a single lobulated cystic lesion extending into both the pericardial and peritoneal cavities through the PPDH. Because of the nonviable aspect of some parts of the liver parenchyma, the gallbladder was dissected from the fossa, and the central division of the liver was resected. A cholecystopexy was performed on the diaphragm to limit gallbladder mobility. The PPDH was closed in the standard fashion. Histopathology of the cystic structure was compatible with a pericardial pseudocyst. Two months postoperatively, the dog was healthy, and the results of blood biochemistry and abdominal ultrasonography were normal. A pericardial pseudocyst can be associated with a PPDH in young dogs. Moreover, cholecystopexy appears to be a safe and effective method of limiting gallbladder mobility after resection of the central hepatic division.

Clinical diagnosis and surgical management of diaphragmatic retroperitoneal perirenal fat and kidney herniation in a pet rabbit.

CASE DESCRIPTION A 6-year-old 2.08-kg (4.58-lb) neutered male Lionhead-mix pet rabbit (Oryctolagus cuniculus) was examined because of sneezing and increased respiratory effort. CLINICAL FINDINGS On the basis of the rabbit's radiographic findings, a diagnosis of diaphragmatic retroperitoneal perirenal fat and kidney herniation was made. Nine months later, physical examination revealed increased respiratory rate and effort and slightly decreased body weight. Thoracic radiography revealed decreased lung aeration and further craniomedial displacement of the right kidney, compared with the initial evaluation findings, suggesting progressive herniation of the retroperitoneal perirenal fat. TREATMENT AND OUTCOME During exploratory celiotomy, a tear in the right dorsal tendinous portion of the diaphragm was noted. The right kidney and perirenal fat were found to be displaced into the thorax. Diaphragmatic herniorrhaphy was performed after replacement of the right kidney and the perirenal fat in the retroperitoneal space. The rabbit recovered uneventfully from anesthesia and surgery. Clinical signs did not recur during the following 16 months. CLINICAL RELEVANCE For rabbits with increased respiratory effort, diaphragmatic retroperitoneal perirenal fat and kidney herniation should be included as a differential diagnosis. As illustrated by the case described in this report, appropriate surgical management can provide a successful outcome for affected pet rabbits.

Pericardial cyst in a 2-year-old Maine Coon cat following peritoneopericardial diaphragmatic hernia repair.

A pericardial cyst developed in a 2-year-old male neutered Maine Coon cat following surgery for an incidentally diagnosed congenital peritoneopericardial diaphragmatic hernia. The cyst caused no clinical signs in the cat, although clinical findings included positional right-sided cardiac tamponade and compression of thoracic structures, associated with a cardiac arrhythmia and axis deviation on electrocardiography. Extensive assessment of the cyst included radiography, echocardiography, computed tomography, exploratory thoracotomy, electrocardiography, histopathology and fluid analysis. Surgical removal of the cyst was curative, and the arrhythmia and axis deviation resolved. This report details case management from initial diagnosis to long-term follow-up, adding to the limited body of literature available on feline pericardial cysts. This is also the first report to associate cardiac arrhythmia with a pericardial cyst.

Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus)

ABSTRACT The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.

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.

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.

Multiple congenital defects in a newborn foal / Defeitos congênitos múltiplos em um potro recém-nascido

A case of multiple congenital defects in a newborn foal is reported. The animal showed hypoplasia of the left pelvic limb bones, uterus unicornis, congenital diaphragmatic hernia, and unilateral renal and ureteral agenesis. This report includes the macroscopic and microscopic lesions observed in the case...

Relata-se um caso de defeitos congênitos múltiplos em um potro recém-nascido. O animal apresentou hipoplasia dos ossos do membro pélvico esquerdo, útero unicorno, hérnia diafragmática congênita e agenesia renal e ureteral unilateral. Este relato inclui as lesões macroscópicas e microscópicas observadas no caso...