Clinical evaluation and surgical intervention for diaphragmatic eventration mimicking peritoneopericardial hernia in a cat.

A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.

[Diaphragmatic hernia in a female alpaca (Vicugna pacos)]. / Zwerchfellhernie bei einer Alpakastute (Vicugna pacos).

A 3-year-old pregnant female alpaca was noticed due to increased lying and decreased feed intake after shearing. Twelve days after shearing, she aborted an almost completely developed cria. After another two days, the alpaca was recumbent and subsequently died during transport to the clinic. A dissection of the carcass revealed a diaphragmatic hernia. Diaphragmatic hernias have been described in many different species, diagnosis can be made by radiography or ultrasound. Depending on the extent, surgical therapy may be successful.

Eleven-year retrospective analysis of acquired diaphragmatic hernia in 49 dogs and 48 cats.

Data on dogs and cats that underwent surgery for a traumatic diaphragmatic hernia were retrospectively collected and analyzed, with an objective to identify factors that influenced the survival rate. Forty-nine dogs and 48 cats were included. The predominant respiratory clinical sign was dyspnea, and the interval from trauma to development of clinical signs did not influence patient survival. Concurrent orthopedic and/or soft tissue injuries were identified in 48.45% of the animals. Intraoperative complications occurred in 14 dogs and 5 cats, and postoperative complications in 7 dogs and 6 cats. Intraoperative death occurred in 6.2% and postoperative death in 8.3% from 1 h to 10 d after surgery. Animals that received surgical treatment within 48 h after diagnosis had a lower risk of death. Conversely, concurrent injuries and intraoperative and postoperative complications were the main factors associated with a higher risk of death.

Analyse rétrospective sur onze ans des hernies diaphragmatiques acquises chez 49 chiens et 48 chats. Les données sur les chiens et les chats ayant subi une intervention chirurgicale pour une hernie diaphragmatique traumatique ont été recueillies et analysées rétrospectivement, dans le but d'identifier les facteurs qui ont influencé le taux de survie. Quarante-neuf chiens et 48 chats ont été inclus. Le signe clinique respiratoire prédominant était la dyspnée, et l'intervalle entre le traumatisme et le développement des signes cliniques n'a pas influencé la survie des patients. Des lésions orthopédiques et/ou des tissus mous concomitantes ont été identifiées chez 48,45 % des animaux. Des complications peropératoires sont survenues chez 14 chiens et cinq chats, et des complications postopératoires chez sept chiens et six chats. Le décès peropératoire est survenu chez 6,2 % et le décès postopératoire chez 8,3 % de 1 h à 10 j après la chirurgie. Les animaux qui ont reçu un traitement chirurgical dans les 48 h après le diagnostic avaient un risque de décès plus faible. À l'inverse, les blessures concomitantes et les complications peropératoires et postopératoires étaient les principaux facteurs associés à un risque de décès plus élevé.(Traduit par Dr Serge Messier).

Pneumopericardium after peritoneopericardial diaphragmatic hernia repair in a dog.

A one-year-old neutered, Goldendoodle presented for evaluation. One week prior to presentation, the surgical closure of a peritoneopericardial diaphragmatic hernia was performed via ventral midline celiotomy. Since the procedure, the dog had been lethargic and anorexic at home. Thoracic radiographs revealed a pneumopericardium. Pericardiocentesis was performed which evacuated approximately 100 mL of air from the pericardial sac. The dog recovered well and began eating in the hospital and resumed normal activity. This is the first reported case of a pneumopericardium post-peritoneopericardial diaphragmatic hernia repair requiring pericardiocentesis. Clinicians should be aware of this rare complication in patients with post-operative peritoneopericardial diaphragmatic hernia.

Mediastinal Serous Cavity Mesothelioma in Two Dogs.

The mediastinal serous cavity (MSC)-well documented but seldom recognized in the caudal mediastinum-is embryologically derived from the omental bursa. Mesothelioma arising from the MSC in two dogs is described. Both dogs presented with acute life-threatening hemorrhagic pleural effusion. Contrast computed tomography revealed a large solitary spherical-to-cylindrical tumor in the caudal mediastinum with variably thick, contrast-enhancing walls with lobular to frond-like proliferations that arose circumferentially and projected internally into a single, variably sized, fluid-attenuating lumen. The wall and lumen corresponded to the serous membrane and serous cavity of the MSC. Surgical exploration confirmed that both tumors arose from the mediastinum. Both had similar histologic findings, and special stains were necessary for definitive diagnosis. The tumor was nonresectable in one dog, and it was euthanized intraoperatively. The other survived 7 mo. An MSC mesothelioma should be considered a possible cause of hemothorax in dogs that may be detected on thoracic radiography and computed tomography. Differential diagnoses include esophageal foreign body or neoplasm, paraesophageal diaphragmatic hernia, MCS empyema, and pulmonary adenocarcinoma, with thoracic computed tomography helping to rule out foreign body and diaphragmatic hernia. For confirmed neoplasms, histochemistry and immunohistochemistry should be performed to differentiate between mesothelioma and pulmonary adenocarcinoma.

Diagnostic imaging features of hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat.

A 1-year-old male Persian cat was presented for castration. Liver incarcerated in a peritoneopericardial diaphragmatic hernia (PPDH) was diagnosed through pre-anesthetic tests. Multiple homogeneous hyperechoic nodules in the hepatic parenchyma were identified using ultrasound. The nodules showed decreased attenuation compared with normal hepatic parenchyma, and the herniated hepatic parenchyma showed increased arterial and decreased portal enhancement on computed tomography. From the histopathology, we diagnosed hydropic degeneration with portal fibrosis and myelolipoma. This report presents diagnostic imaging features of hepatic myelolipoma incarcerated in a PPDH in a cat. When perfusion of the hepatic parenchyma is altered, surgical treatment should be considered.

Repair of a delayed, traumatic dorsal diaphragmatic hernia using a single paracostal approach in a dog.

CASE HISTORY: A 1-year-old German Shepherd dog presented for delayed onset of a traumatic, dorsal diaphragmatic hernia of the pars lumborum. CLINICAL FINDINGS AND TREATMENT: Herniorrhaphy via a ventral midline celiotomy (with and without a paracostal extension) were unsuccessful and the hernia recurred. The hernia was successfully repaired using a single lateral paracostal surgical approach. This approach provided excellent exposure and should be considered for dorsal pars lumborum diaphragmatic hernia repairs. DIAGNOSIS: Dorsal diaphragmatic hernia of the pars lumborum. CLINICAL RELEVANCE: Whilst uncommon, tears to the dorsal aspect of the diaphragm should be considered as well as the more common radial or circumferential pars costalis tears. Pre-operative computed tomographic imaging can identify the exact location of the hernia in order to allow the best surgical approach to be determined. A lateral paracostal approach should be considered as an alternative to a ventral midline celiotomy with or without paracostal extension for repair of dorsal diaphragmatic hernias affecting the pars lumborum, as it provides excellent exposure. A single lateral paracostal approach has not been reported previously for diaphragmatic hernia repair in dogs.

Use of a new device for gasless endosurgery in a laparoscopic diaphragmatic hernia repair ex vivo canine model: A pre-clinical study.

OBJECTIVES: To test the feasibility of a new device for gasless laparoscopy in providing working space for diaphragmatic hernia repair in an ex vivo canine model as a pre-clinical study. STUDY DESIGN: Technical feasibility study. ANIMAL: Eight beagles and two greyhound cadavers (not client-owned). METHODS: The new device was used for abdominal traction in gasless laparoscopic reconstruction of diaphragmatic hernias produced in dog cadavers. It consists of three main parts (vertical and horizontal rods, a three-piece structure, and a 3D-printed unit that incorporates slots for haemostatic forceps). Composite hernias (two incisions of about 4 cm) were closed by an intra-corporeal suture [suture group (GS), n = 5] or by a central suture and a polypropylene mesh [mesh group (GM), n = 5]. Surgical steps were T1 (primary port access up to third port placement), T2 (defect development), and T3 (diaphragmatic reconstruction). Total surgical time (TT) was also recorded. RESULTS: The defect was successfully developed and reconstructed in all cadavers. To close the defect, 7.0 ± 0.7 crossed mattress sutures were required in the GS, and 15.2 ± 1.9 hernia staples and one intra-corporal suture were used in the GM. T3 was longer (p = 0.0076) in GS (50.00 ± 16.46 min) than in GM (23.24 ± 5.25 min). TT was 87.22 ± 19.23 min in GS and 66.45 ± 6.38 min in GM (p = 0.0547). CONCLUSIONS: Gasless laparoscopic diaphragmatic hernia repair using the developed device is feasible in the canine cadaver model. Both suture and mesh graft techniques for experimental diaphragmatic herniorrhaphy can be performed using this new device in this pre-clinical model. CLINICAL SIGNIFICANCE: This new device for gasless laparoscopy allows diaphragmatic herniorrhaphy by intra-corporeal suture or mesh implantation in ex vivo canine model. The device demonstrates potential for future use in clinical cases.

J-incision to approach the cranial abdomen in the adult horse.

OBJECTIVE: To describe a modified celiotomy to improve access to cranial abdominal structures in horses. ANIMALS: Four horses. STUDY DESIGN: Short case series. METHODS: Three horses with gastric impactions were treated with gastrotomies. One horse was treated for a diaphragmatic hernia with herniorrhaphy and mesh augmentation. In all horses, the ventral midline celiotomy was modified cranially with a J-incision through the body wall, along the paracostal arch. RESULTS: The only surgical complications were midline incisional infections in all horses. Three of the four horses had good long-term outcomes; the remaining horse underwent euthanasia for reasons likely unrelated to incisional complications. CONCLUSION: The J-incision improved access to the stomach and diaphragm in these horses. The paracostal component healed in all cases without evidence of infection or dehiscence. CLINICAL SIGNIFICANCE: This modified celiotomy may be considered to improve access during gastrotomy and repair of dorsally located diaphragmatic hernias.

Peritoneal-pericardial diaphragmatic hernia in a 6-year-old male intact pug dog.

A 6-year-old intact male pug dog was referred to the Atlantic Veterinary College veterinary teaching hospital for a surgical consultation after survey radiographs taken by the referring veterinarian led to a tentative diagnosis of a peritoneal-pericardial diaphragmatic hernia. Computed tomography of the thorax and abdomen prior to surgery further characterized the lesion and aided in surgical planning. Surgical correction of the defect was achieved via primary herniorrhaphy. The patient was discharged and was reported to be doing well 7 months after surgery.

Hernie péritonéale-péricardique diaphragmatique chez un carlin mâle non-castré âgé de 6 ans. Un carlin mâle non-castré âgé de 6 ans fut référé à l'hôpital d'enseignement vétérinaire de l'Atlantic Veterinary College pour une consultation chirurgicale à la suite des radiographies prises par le vétérinaire référant qui ont mené à un diagnostic préliminaire d'hernie péritonéale-péricardique diaphragmatique. La tomodensitométrie du thorax et de l'abdomen avant la chirurgie a permis de mieux caractériser la lésion et a aidé dans la planification de la chirurgie. La correction chirurgicale du défaut fut réalisée par hernioraphie primaire. Le patient obtint son congé et allait bien 7 mois après la chirurgie.(Traduit par Dr Serge Messier).

Caval foramen hernia in a dog: Preoperative diagnosis and surgical treatment.

A 13-year-old, 5.6-kg castrated-male Maltese was presented for reverse sneezing. A dome-shaped round mass abutting diaphragm was incidentally found ventral to caudal vena cava, which had the same echogenicity and density as that of the liver during ultrasonography and computed tomography, showing isoattenuation with a contrast study. Vascular distribution was identified throughout the mass. A caval foramen hernia (CFH) was diagnosed tentatively, followed by a herniorrhaphy and splenectomy of the chronically congested spleen. The patient had been doing well for 5-month postoperative but died because of aspiration pneumonia. CFH is an extremely rare condition, requiring surgery due to compression of the vena cava. It should be considered as a differential diagnosis when intrathoracic, mass-like lesions are identified near the diaphragm.

Multiple acquired portosystemic shunts subsequent to traumatic diaphragmatic hernia in a dog.

A 4-year-old castrated male dog was presented because of acute, severe neurologic signs 4 months after a 10-meter fall. Liver enzyme activity was high. Imaging and surgery revealed diaphragmatic hernia, liver entrapment, and multiple acquired portosystemic shunts. Initial recovery indicated improved liver enzyme activity and neurologic status although pancreatitis ultimately ensued.

Shunts porto-systémiques multiples acquis à la suite d'une hernie diaphragmatique traumatique chez un chien. Un chien mâle castré âgé de 4 ans fut présenté à cause de signes neurologiques aigus sévères 4 mois après une chute de 10 mètres. L'activité des enzymes hépatiques était élevée. L'imagerie et la chirurgie ont révélé une hernie diaphragmatique, un coincement du foie et de multiples shunts porto-systémiques acquis. Le rétablissement initial montrait une amélioration de l'activité des enzymes hépatiques et du statut neurologique bien qu'une pancréatite ait finalement suivi.(Traduit par Dr Serge Messier).

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs.

OBJECTIVE: To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. METHODS: Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. RESULTS: Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). CONCLUSION: Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. CLINICAL SIGNIFICANCE: A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Congenital sternal defect repair in an adult cat with incomplete pentalogy of Cantrell.

CASE DESCRIPTION: A 1-year-old spayed female domestic shorthair cat was evaluated for a sternal defect and ventral abdominal wall hernia. CLINICAL FINDINGS: The cat appeared healthy. Palpation revealed a sternal defect, and the heart could be observed beating underneath the skin at the caudoventral aspect of the thorax. A 3-cm-diameter freely movable mass, consistent with a hernia, was also palpated at the cranioventral aspect of the abdomen. Thoracic radiographic and CT images revealed a sternal cleft, cranial midline abdominal wall hernia, and peritoneopericardial diaphragmatic hernia (PPDH). TREATMENT AND OUTCOME: Thoracotomy and celiotomy were performed. The sternal cleft was repaired with a porcine small intestinal submucosa graft, titanium contourable mesh plate, and interrupted 25-gauge cerclage wires. A diaphragmatic herniorrhaphy was used to correct the PPDH. Thoracic radiographs were obtained immediately after surgery to confirm repair of the sternal cleft, abdominal wall hernia, and PPDH and at 1 and 3 months after surgery to assess the surgical implants, which had not migrated and were intact with only mild bending at the cranial and caudal margins of the mesh plate. At both recheck examinations, the cat appeared healthy with no complications reported by the owner. CLINICAL RELEVANCE: A novel surgical technique was used to successfully repair a large sternal cleft in an adult cat with no postoperative complications reported. This technique may be useful for the treatment of sternal clefts in other cats. This was the first report to describe an adult cat with congenital defects consistent with incomplete pentalogy of Cantrell.

Diaphragmatic hernia in a pet chinchilla (Chinchilla lanigera).

A 10-year-old pet chinchilla (Chinchilla lanigera) was referred for ultrasound investigation of a thoracic mass. The mass was initially believed to be a pulmonary abscess or tumor based on radiographs and ultrasound. Cytological examination suggested the presence of a gastrointestinal structure in the thorax, and necropsy revealed a true diaphragmatic hernia subdividing the stomach into thoracic and abdominal portions.

Hernie diaphragmatique chez un chinchilla de compagnie(Chinchilla lanigera). Un chinchilla (Chinchilla lanigera) domestique mâle castré de 10 ans a été référé pour investigation échographique d'une masse thoracique. Basé sur les radiographies et l'échographie, il fut initialement pensé que la masse était un abcès ou une tumeur pulmonaire. L'analyse cytologique suggérait la présence d'une structure gastro-intestinale dans le thorax et la nécropsie a révélé une vraie hernie diaphragmatique qui divisait l'estomac en une partie thoracique et une partie abdominale.(Traduit par les auteurs).

Morphology of the Diaphragm Muscle in Southern Tamandua (Tamandua tetradactyla) and its Importance in Cases of Traumatic Hernia.

The wall of the diaphragm can be affected by changes caused by physical trauma, allowing the passage of viscera between the abdominal cavity and thoracic cavity, thus reducing the space for pulmonary expansion, leading to the formation of hernia and possible death. Thus, we aimed to characterize, size and determine the topography of the diaphragmatic muscle in the Southern Tamandua, since clinical and surgical activities in wild animals have become a reality more and more present in veterinary medicine. We used six adult animals, x-rayed and dissected, followed by collection of fragments of muscular portions for histological analysis. Initially we observed that the animals presented 17 thoracic vertebrae, 3 lumbar vertebrae and 5 sacral vertebrae. The diaphragm was conformed by three segments: sternal, costal and right and left diaphragm pillar, with presence of tendinous centre that housed the passage of the caudal vena cava, called foramen of the caudal vena cava. Dorsally to the tendinous centre, already in the muscle portion, we located the esophageal and aortic hiatus. These findings, as well as the microscopic, were equivalent to that found in the general literature also, corroborating with descriptions already carried out in other mammals' diaphragms.

Major Histocompatibility Complex Dmα/ß Genes and Their Expressional Diversity in Healthy and Diseased Water Buffalo Bubalus bubalis.

BACKGROUND/AIMS: The major histocompatibility complex (MHC) categorized into three (I, II and III) classes elicits the immunogenic response by presenting exogenous peptides to T cells. The MHC-II DM is composed of DMα and DMß, two polypeptide chains, both are encoded by separate MHC genes involved in antigen processing and presentation. Despite the acknowledged role of MHC complex in humans, the literature is silent on the organization and expression of these genes in water buffalo Bubalus bubalis, an agriculturally important animal species. METHODS: We deduced the full-length mRNA sequences of DMα and DMß genes, localized them onto the chromosome 2, assessed their copy number per haploid genome and studied tissue and disease specific expression. RESULTS: The Real Time PCR showed higher expression of both the genes and their seven interacting partners in spleen, gonads and spermatozoa. Significantly, upregulation of DMα and DMß genes and their interacting partners were detected in diseased group of buffaloes as compared to that in healthy ones. CONCLUSION: The upregulation of Bubalus bubalis (BuLA)-DMα and DMß genes and their interacting partners reflect their role in regulating immune responses towards the amelioration of diseases. Work on this line would enhance our understanding on the overall roles of MHC locus, allowing development of possible therapeutic treatment strategies.