Complications and outcome of traumatic diaphragmatic hernia repair without post-operative chest drain: Retrospective study in 90 cats.

Background: Diaphragmatic herniorraphy is the treatment of choice for traumatic diaphragmatic hernia (TDH). Several methods have been described for the removal of residual air and fluid during and after surgery, such as the insertion of chest drains, intercostal thoracentesis, and transdiaphragmatic thoracentesis. However, there are no indications regarding the most useful technique and the impact that choice of technique could have in the immediate postoperative period. Aim: To evaluate the development of complications and outcomes associated with the use of intraoperative transdiaphragmatic thoracentesis in cats undergoing diaphragmatic herniorrhaphy for TDH. Methods: Medical records of cats treated for acute and chronic TDH between 2010 and 2019 were reviewed. Cats were included if intraoperative pneumothorax was treated with transdiaphragmatic thoracentesis, without the use of intercostal chest drain. Outcome, intra- and post-operative complications were recorded. Results: Intraoperative and postoperative complication rates were 3.3% and 12.4%, respectively. Development of postoperative pneumothorax was associated with the presence of comorbidities (p = 0.046). The overall survival rate was 93.3%. Long-term survival had a significant association with the presence of comorbidities (p = 0.045), if the procedure was performed as an emergency (p = 0.041) or in older cats (p = 0.011). Conclusion: Intraoperative transdiaphragmatic thoracentesis could be considered an effective method for the removal of residual air after surgery for TDH, because it ensures a good outcome for the patient, with low development of complications, especially for uncomplicated cases. The presence of comorbidities, the need to perform a surgical procedure in emergency, and the age of the patient can be considered factors influencing the development of complications. Critical patient selection, based on assessment of potential risk factors for complications is warranted to understand which patient will benefit from thoracostomy tube placement.

Hérnia torácica traumática associada a laceração de lobo pulmonarcaudal em cão / Traumatic thoracic hernia associated with laceration of the caudal lung lobe in a dog

Traumas torácicos são comuns em pacientes traumatizados e incluem principalmente contusão pulmonar, laceração pulmonar, pneumotórax, hemotórax, fraturas de costela e esterno e hérnia diafragmática. As principais causas são acidentes automobilísticos, quedas e mordeduras. Taquipneia ou dispneia são possíveis sinais clínicos, associados a choque hipovolêmico e sinais gastrointestinais. Lesões torácicas podem ser negligenciadas quando lesões distrativas, como fratura de membros, estão presentes. Assim, o exame clínico minucioso é obrigatório e os animais com insuficiência respiratória podem necessitar de estabilização e cirurgia de emergência. Considerando a importância do trauma torácico na prática clínica, o objetivo deste manuscrito é relatar o caso de hérnia espúria torácica associada a laceração traumática de lobo pulmonar caudal em uma cadela apresentando dispneia intensa após trauma automobilístico. Após uma avaliação emergencial e exames radiográficos, foi diagnosticado tórax instável, fraturas de costelas, contusão pulmonar e pneumotórax grave. Após estabilização clínica, foi realizado tratamento cirúrgico para estabilização do tórax instável. Durante a cirurgia, observou-se herniação e laceração do lobo caudal esquerdo do pulmão, sendo realizadas suturas para correção da laceração pulmonar e estabilização do gradil costal, além da toracostomia para controle do pneumotórax. Nos casos de tórax instável e encarceramento lobar, o tratamento cirúrgico é fundamental, como realizado neste caso, com o objetivo de reparar e reposicionar o lobo pulmonar e estabilizar o tórax instável. A herniação pulmonar traumática é um possível diagnóstico diferencial no tórax instável pós-traumático, assim como a reparação do lobo e a estabilização das costelas por meio de suturas são técnicas eficazes de tratamento cirúrgico.

Thoracic traumas are common in trauma patients and mainly include pulmonary contusion, pulmonary laceration, pneumothorax, hemothorax, rib and sternum fractures and diaphragmatic hernia. The main causes are car accidents, falls and bites. Tachypnea or dyspnea are possible clinical signs, associated with hypovolemic shock and gastrointestinal signs. Thoracic injuries may be overlooked when distracting injuries, such as limb fractures, are present. Thus, thorough clinical examination is mandatory and animals with respiratory failure may require stabilization and emergency surgery. Considering the importance of thoracic trauma in clinical practice, the manuscript aimed to report the case of spurious thoracic hernia associated with traumatic laceration of the caudal lung lobe in a bitch with severe dyspnea after car trauma. After an emergency evaluation and radiographic examinations, a flail chest, rib fractures, pulmonary contusion and severe pneumothorax were diagnosed. After clinical stabilization, surgical treatment was performed to stabilize the flail chest. During surgery, herniation and laceration of the left caudal lobe of the lung were observed, and sutures were performed to correct the pulmonary laceration and stabilize the rib cage, in addition to thoracostomy to control the pneumothorax. In cases of flail chest and lobar entrapment, surgical treatment is essential, as in this case, with the aim of repairing and repositioning the pulmonary lobe and stabilizing the flail chest. Traumatic pulmonary herniation is a possible differential diagnosis in post-traumatic flail chest, as well as repairing the lobe and stabilizing the ribs using sutures are effective surgical treatment techniques.

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).

Repair of an acquired diaphragmatic hernia with surgical mesh in a foal.

A foal born with assisted delivery developed rib fractures and a diaphragmatic hernia. The hernia was repaired using surgical mesh. The filly was healthy 42 months later. Dystocia is a risk factor for rib fractures and traumatic acquired diaphragmatic herniation. Surgical mesh repair is an option for diaphragmatic defects.

Réparation d'une hernie diaphragmatique acquise à l'aide d'un treillis chirurgical chez un poulain. Un poulain né lors d'une parturition assistée a développé des fractures des côtes et une hernie diaphragmatique. La hernie a été réparée à l'aide d'un treillis chirurgical. La pouliche était en santé 42 mois plus tard. La dystocie est un facteur de risque pour les fractures des côtes et une hernie diaphragmatique acquise lors d'un traumatisme. Le treillis chirurgical est une option pour les défauts diaphragmatiques.(Traduit par Isabelle Vallières).

The impact of surgical timing and intervention on outcome in traumatized dogs and cats.

OBJECTIVE: To review the relevant human and veterinary literature regarding the timing of surgical intervention for trauma patients and the impact on outcome. DATA SOURCES: Original research, clinical studies, and review articles with no date restrictions from both human and veterinary literature. HUMAN DATA SYNTHESIS: Despite extensive research into the ideal timing of surgical intervention for human trauma victims, debate is ongoing and views are still evolving. Prior to the 1970s, the standard of care consisted of delayed surgical treatment, as these patients were considered too ill to undergo surgery. Beginning in the 1970s, and continuing for nearly 2 decades, early definitive surgical treatment was recommended. The most recent evolution of human trauma management incorporates the concept of damage control surgery, which acknowledges the importance of early skeletal stabilization or laparotomy for reducing morbidity while attempting to avoid complications such as acute respiratory distress syndrome or multiple organ dysfunction syndrome. VETERINARY DATA SYNTHESIS: Despite a relatively large amount of literature available regarding veterinary trauma, no evidence exists to provide the clinician guidance as to the ideal timing of surgery for trauma patients. With the exception of diaphragmatic hernia, no studies were identified that attempted to evaluate this variable. CONCLUSIONS: Veterinary-specific studies are needed to evaluate the impact of surgical timing on outcome following trauma. The information that can be obtained from studies in this area can improve veterinary trauma care and may be used as models for human trauma care through translational applications.

Traumatic diaphragmatic hernia in a 5-month-old boxer dog.

A 5-month-old intact male boxer dog was presented to the Metro Animal Emergency Clinic, Dartmouth, Nova Scotia after being hit by a car. Radiography identified a diaphragmatic hernia with the stomach herniated into the thoracic cavity. Diaphragmatic herniorrhaphy and splenectomy were performed without complication. The patient returned to his regular active lifestyle.

Hernie diaphragmatique traumatique chez un chien Boxer âgé de 5 mois. Un chien Boxer mâle intact âgé de 5 mois a été présenté à la clinique Metro Animal Emergency Clinic à Dartmouth, en Nouvelle-Écosse, après avoir été heurté par une automobile. La radiographie a identifié une hernie diaphragmatique avec l'estomac hernié dans la cavité thoracique. Une hernioplastie diaphragmatique et une splénectomie ont été réalisées sans complications. Le patient est retourné à son style de vie actif régulier.(Traduit par Isabelle Vallières).

Transient megaoesophagus and oesophagitis following diaphragmatic rupture repair in a cat.

A 6-month-old domestic shorthair female cat was presented with suspected diaphragmatic hernia (DH) that was later confirmed by thoracic radiography. The cat underwent exploratory celiotomy with a diaphragmatic rupture (DR) repair and recovered. Six days later, it was represented with vomiting and anorexia. Megaoesophagus (MO) and gastric dilatation were diagnosed by contrast radiography. A second celiotomy revealed no abnormalities and gastropexy was performed. Endoscopy demonstrated MO, oesophagitis and gastro-oesophageal reflux. MO persisted for several weeks and was an unexpected complication as no association between DR (or DH) and MO has never been described in the veterinary literature. The cat was treated medically with aggressive prokinetic and antacid therapy along with prolonged temporary oesophageal diversion (percutaneous endoscopic gastrostomy tube) with an excellent outcome.

Traumatic diaphragmatic rupture in a cat with partial kidney displacement into the thorax.

A two-year-old, male, neutered, domestic shorthair cat was presented after suspected trauma. Diaphragmatic rupture with concomitant displacement of the right kidney into the thorax was diagnosed using ultrasound and intravenous urography. Avulsion of the renal pedicle and diaphragmatic rupture were confirmed and treated surgically with excellent outcome.

Undiagnosed diaphragmatic hernia--the importance of preanesthetic evaluation.

A 6-year-old, neutered male, Pembroke Welsh corgi was presented for hind limb paralysis. After anesthetic induction, marked cyanosis and hypotension were noted. Diaphragmatic hernia was diagnosed based upon radiographic findings. Risks and complications associated with undiagnosed diaphragmatic hernia and the importance of thorough physical examination and patient assessment are discussed.

Thoracic trauma in horses.

Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed.

Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002).

OBJECTIVE: To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. DESIGN: Retrospective study. ANIMALS: 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. PROCEDURE: Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. RESULTS: Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. CONCLUSIONS AND CLINICAL RELEVANCE: Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

Traumatic diaphragmatic hernia in cats: 34 cases (1991-2001).

OBJECTIVE: To determine whether signalment, duration of hernia, clinical signs, contents of hernia, CBC and serum biochemical abnormalities, concurrent injuries, perioperative treatment and administration of analgesics, results of intraoperative anesthetic monitoring data, or level of training of the veterinarian performing the herniorrhaphy was associated with mortality rate after surgical repair of traumatic diaphragmatic hernia in cats. DESIGN: Retrospective study. ANIMALS: 34 cats. PROCEDURE: Review of medical records and a telephone follow-up with owners and referring veterinarians were performed. RESULTS: Mean age of affected cats was 3.6 years; cats that survived to the time of discharge were significantly younger than cats that died or were euthanatized. Tachypnee was the most common clinical sign at hospital admission; cats that survived to the time of discharge had significantly higher respiratory rates than cats that died or were euthanatized after surgery. Postoperative complications developed in 50% of cats; tachypnea and dyspnea were most common. Mortality rate was not associated with duration of hernia or results of preoperative CBC and serum biochemical analyses, but was significantly associated with concurrent injuries. Mortality rate was not associated with hernia contents, intraoperative use of positive inotropes or corticosteroids, episodes of hypotension or severe hypoxia during anesthesia, or level of training of the veterinarian performing the surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Cats that are older or have low to mildly increased respiratory rates and concurrent injuries are more likely to die after surgical repair of traumatic diaphragmatic hernia.

Traumatic diaphragmatic hernia in a clinically normal dog.

A 3.5-year-old border collie was presented for routine ovariohysterectomy. A preoperative physical examination revealed no abnormalities, but, under anesthesia, the patient became dyspneic and cyanotic. Plain radiography indicated the presence of a diaphragmatic hernia. The herniated structures were returned to the abdomen and the diaphragmatic defect was surgically repaired.