Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18‐year‐old mare

An 18‐year‐old Arabian‐mix mare was presented with a history of severe colic. Emergency exploratory celiotomy revealed diaphragmatic hernia, with a large rent in the left dorsal aspect of the diaphragm and large colon volvulus. Attempts to close the defect in the diaphragm in dorsal recumbency were unsuccessful. Therefore, a thoracic approach through lateral thoracotomy was elected, and a mesh was attached to the diaphragm using skin staples. While in dorsal recumbency, the mare suffered from significant respiratory acidosis. Thus, the mare was tilted into reverse Trendelenburg (30° head upward) and ventilation improved markedly. The mare recovered uneventfully, and was doing well 5 years after surgery.     

Right Dorsal Colon Resection and Bypass for Treatment of Right Dorsal Colitis in a Horse

Objective: To describe a novel surgical technique for management of right dorsal colitis in the horse. Study Design: Clinical report. Animals: 14‐year‐old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side‐to‐side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery. Results: Resection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long‐term antimicrobial treatment. Conclusion: Right dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity. Clinical Relevance: RDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.     

Congenital diaphragmatic eventration in a stillborn foal.

A stillborn full term foal was presented at necropsy.The dilated duodenum and the dorsal and ventral left colon and cecum extended into the thoracic cavity and were encased by a thin transparent membrane originating from the diaphragm. The congenital condition was diagnosed as a developmental anomaly with diaphragmatic eventration. To the authors' knowledge, this is the first report of diaphragmatic eventration in a Thoroughbred stillborn foal.     

ULTRASONOGRAPHIC DIAGNOSIS OF DIAPHRAGMATIC RUPTURE IN A HORSE

Real–time ultrasonography was used to confirm diaphragmatic rupture in a horse that developed pleural effusion following a traumatic event. Pleural effusion, a cranially displaced crus, and a cranially positioned sacculated loop of bowel were seen radiographically. The presence of gas–filled intestine cranial and dorsal to the diaphragm was detected by ultrasound imaging. The use of ultrasound and radiography in the diagnosis of diaphragmatic rupture is discussed.     

Comparison of techniques for transdiaphragmatic thoracic drainage after diaphragmatic defect closure in dogs: a cadaveric study

Four thoracic evacuation techniques for pneumothorax elimination after diaphragmatic defect closure were compared in 40 canine cadavers. After creating a defect in the left side of the diaphragm, thoracic drainage was performed by thoracostomy tube insertion through the defect and a small (DD-SP) or large (DD-LP) puncture created in the caudal mediastinum, or through both the diaphragmatic defect and intact contralateral diaphragm with a small (DI-SP) or large (DI-LP) puncture in made in the caudal mediastinum. Differences in intrapleural pressure (IPP) between the right and left hemithoraxes after air evacuation along with differences in IPP before making a defect and after air evacuation in each hemithorax were calculated. A difference (p ≤ 0.0011) in IPP between the left and right hemithoraxes after air evacuation as well as before making a defect and after air evacuation in the right hemithorax was detected for the DD-SP group. No significant differences (p ≥ 0.0835) were observed for the DI-LP, DD-LP, or DI-SP groups. Creation of a large mediastinal puncture or thoracic evacuation through both a diaphragmatic defect and intact contralateral diaphragm can facilitate proper pneumothorax elimination bilaterally after diaphragmatic defect closure in dogs with a small puncture in the caudal mediastinum.     

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.     

Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a solitary diaphragmatic mesothelioma in a dog

CASE DESCRIPTION: A 2-year-old Siberian Husky was evaluated because of a 2-week history of coughing and gagging and decreased appetite and activity level. CLINICAL FINDINGS: Radiography, surgery, and immunohistochemical examination revealed a solitary sclerosing mesothelioma extending from the left thoracic diaphragmatic surface that was adherent to the pericardium and the caudal mediastinum. TREATMENT AND OUTCOME: The tumor was resected along with most of the left hemidiaphragm, and the left transversus abdominis muscle was used to reconstruct the diaphragm. The 13th rib formed the base of the muscle flap. The muscle flap was transposed into the defect so that the mesothelium-lined surface faced the thoracic cavity and the deep aspect of the muscle formed the abdominal surface of the diaphragm. To minimize risk of adhesions, the exposed raw aspect of the abdominal surface was covered with porcine small intestinal submucosa. Recovery was uncomplicated, and the dog's appetite and activity level soon returned to normal. Evaluation 54 days after surgery revealed 2 subcutaneous masses on the thorax and masses in the liver and both kidneys; histologic and immunohistochemical analyses revealed metastasis of the original tumor. The dog was euthanatized. CLINICAL RELEVANCE: Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a diaphragmatic tumor was successful. The muscle flap was easily harvested and transposed into the diaphragmatic defect.     

USE OF ULTRASOUND TO DIAGNOSE DIAPHRAGMATIC RUPTURE IN DOGS AND CATS

Twenty-one cats and six dogs that presented to a first-opinion clinic with signs of dyspnea and muffled cardiac auscultation received ultrasonography to look for signs of diaphragmatic rupture. The presence or absence of diaphragmatic rupture was subsequently determined on the basis of unequivocal radiographic signs, surgical findings, or necropsy. Consistent findings in animals with diaphragmatic rupture were irregular or asymmetric cranial aspect of the liver and abdominal viscera in the thorax. Accuracy of ultrasonography was 25/27 (93%). One false-negative result occurred in a cat with a chronic diaphragmatic rupture in which adhesions between the liver and lung simulated the appearance of an intact diaphragm. One false-positive result occurred in a dog with an abscess involving the left lung and pleural cavity, which was misinterpreted as the stomach. The results of this study support use of ultrasonography in animals with suspected diaphragmatic rupture.     

Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture,diaphragmatic tear,and rupture of the spleen in a dog

Objective– To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary– A 1‐year‐old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco‐ and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided– Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen.     

Congenital retrosternal (Morgagni) diaphragmatic hernias in three horses

CASE DESCRIPTION: 3 Horses were examined and treated because of sudden onset of signs of abdominal pain. CLINICAL FINDINGS: All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac. TREATMENT AND OUTCOME: Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correction, no major postoperative complications developed, and all 3 horses have been free of signs of abdominal pain. CLINICAL RELEVANCE: Horses with retrosternal hernias involving the diaphragm can develop clinical signs of intermittent obstruction of the large colon and chronic colic. In horses, retrosternal diaphragmatic hernias appear to develop exclusively in the right ventral aspect of the diaphragm and could represent an embryologic defect of diaphragm formation. Affected horses can be successfully treated with mesh herniorrhaphy or, in some instances, with conservative management.     

Anatomical study of the diaphragm of the opossum (Didelphis albiventris)

The anatomical characteristics of the South American opossum diaphragm were described. Five male and seven female adult opossums, weighing between 700 and 1110 g, were used. Animals were killed by ether inhalation saturation. The abdominal and thoracic walls were dissected and opened, the viscerae were removed and the diaphragm anatomy was described and photographed in situ. After diaphragm removal, some dimensional data were taken and tabled. Primary branches of the phrenic nerves were dissected under a surgical microscope. The secondary branches were studied and described by transillumination after clarification in acetic acid. The opossum diaphragm is domed and has a mean area of 54.33 +/- 3.8 cm2. Well-identified costal, sternal and lumbar parts form the peripheral muscular region. The central tendinous region presents with a V-like form. Three folioles comprise the phrenic centre and present different dimensions. The caudal vena cava passes through its foramen between the ventral and right dorsal folioles. Both right and left phrenic nerves present one ventral branch and one dorsolateral trunk in 50.0% and 66.67% of the cases, respectively.     

Gross anatomy of the portal vein and hepatic artery ramifications in dogs: corrosion cast study

The anatomical variations of the portal vein and the hepatic artery ramifications were analysed on liver corrosion casts in 20 dogs as a possible aid in the surgical management of the organ. The portal vein ramified similarly in all dogs. It divided into the smaller right portal branch from which vessels for the caudate process and both right lobes arose and the substantial left portal branch, which supplied the remaining liver portions and in 12 cases also the dorsal part of the right lateral lobe. Right lateral, right medial and left branches are the major arteries originating from the hepatic artery; however, their origin and course varied among individual animals. In 10 livers, the right lateral and the left branches originated from the hepatic artery, while the right medial branch arose from the left branch and usually supplied the right medial lobe solely. In nine livers, the right medial branch arose directly from the hepatic artery and supplied quadrate lobe and gallbladder as well, while in one liver the common artery, which subsequently divided into lobar branches, branched away from the hepatic artery. An additional branch for the caudate process, originating directly from the hepatic artery, was observed in 10 livers. Certain liver portions received the arterial blood from two major branches, which was particularly characteristic for the right medial lobe (six livers) and caudate process (10 livers). The course of the major arterial branches was also variable, although they proceeded in close anatomical relationship with the portal vein branches. The left arterial branch accompanied the left portal branch on its dorsal aspect (15 cases) or crossed it from the caudal aspect (five cases). The right lateral branch crossed the initial parts of the left and right portal branches either from cranial (12 cases) or caudal aspects (eight cases), while the right medial branch always crossed the left portal branch from its caudal aspect.     

Congenital diaphragmatic eventration in two closely related British Shorthair cats

Two closely related British Shorthair cats, which died after surgery performed in the dorsal position, were presented for dissection. In both, a thin, flaccid, enlarged transparent tendinous diaphragmatic portion protruded cranially into the thoracic cavity, forming a cupola in which left, right medial and quadrate hepatic lobes were encased in both cats and the stomach in one cat. Microscopically, no muscle fibres were observed in the membrane, but numerous hepatocytes and bile ducts were incorporated in its central part. The anomaly was diagnosed as a congenital diaphragmatic eventration.     

IMAGING DIAGNOSIS—HYPOGLYCEMIA ASSOCIATED WITH CHOLANGIOCARCINOMA AND PERITONEAL CARCINOMATOSIS IN A HORSE

An 8‐year‐old Thoroughbred mare presented for decreased appetite, ataxia, and weakness. Abdominal ultrasound revealed a large volume of anechoic fluid along with multiple masses involving the spleen, liver, and diaphragm. Pleural fluid was identified via ultrasonography and thoracic radiography. Thoracic radiographs also identified pulmonary interstitial nodules, an undulant dorsal diaphragmatic margin and enlargement of tracheobronchial lymph nodes. Clinical signs of weakness and mild seizures were concurrent with hypoglycemic episodes. The final diagnosis was cholangiocarcinoma with extensive metastasis. Clinical signs of weakness, ataxia, and seizures were attributed to a paraneoplastic syndrome of tumor‐associated hypoglycemia that has been infrequently reported in horses.     

Sand colic in a mule: A case report

A 25-year-old mule was showing signs of colic. Clinical examination revealed acute pain, bilateral abdominal distention, stretching out and standing in this position. Rectal palpation revealed a hardened mass in the ventral region of the pelvic inlet. Surgical intervention was accomplished and faecaliths removed by colotomy. The mule died unexpectedly and postmortem examination revealed sand masses within the right ventral and right dorsal colon which caused obstruction of the intestinal tract in sternal and diaphragmatic flexures, respectively. This appears to be the first report of sand colic in a mule in Iran.     

Left Cranial Vena Cava in a Horse

A complete left cranial vena cava (LCVC) was found in a normal horse. The LCVC was well developed, but there was a complete absence of the right cranial vena cava. The azygous vein was normally distributed on the right side of the thoracic vertebral bodies but passed ventral to the aortic arch to empty into the cranial vena cava on the left close to the origin of the aortic arch. The LCVC passed over the dorsal aspect of the left atrium to reach the coronary sulcus on the caudal aspect of the heart. The LCVC opened into the right atrium via a 5 cm diameter orifice (orifice of coronary sinus). The vena cordis magna joined the LCVC 6 cm from the orifice of the coronary sinus. Complete dissection of the horse revealed no other developmental abnormalities. This case is compared with similar cases in the literature.     

Diaphragmatic herniation as a cause of lethargy and exercise intolerance in a mare.

A diaphragmatic hernia in which 90% of the large colon had herniated through a 16-cm linear tear in the diaphragm was found in a 12-year-old Quarter Horse mare. Clinical signs included lethargy and exercise intolerance. Diagnosis of diaphragmatic hernia was made based on careful thoracic auscultation, combined with ultrasonographic and radiographic examination of the thorax.     

Clinical and Surgical Parameters in Dogs with Perineal Hernia Analysis of Results of Internal Obturator Transposition

The results of treatment of 31 dogs with perineal hernia by internal obturator muscle transposition were evaluated by comparing the clinical signs reported by the owner before surgery with those reported 11 or more months following surgery. The severity and frequency of pre- and postoperative clinical signs were categorized numerically, and composite scores were obtained for each dog. In addition, the dogs were examined 11 or more months following surgery. The presence or absence of an externally obvious perineal swelling was noted, and rectal examination was performed to detect rectal sacculation and the integrity of the pelvic diaphragm dorsal and ventral to a line drawn between the center of the anus and the ischiatic tuberosity. These results were correlated with the postoperative composite scores. Postoperative complications included wound infection (2), wound seroma (2), rectal prolapse (4), urinary incontinence (2), and flatus as a new postoperative problem (11). The postoperative composite score was significantly lower (improved function) following surgery. Dogs with worse signs preoperatively or bilateral perineal hernia benefited less from surgery. More dogs showed improvement when the operation was performed by experienced surgeons. Factors detected at follow-up examination that correlated with more severe postoperative clinical signs were perineal swelling, absence of the ventral portion of the pelvic diaphragm, and rectal sacculation. The presence or absence of reformation of the dorsal aspect of the pelvic diaphragm did not correlate with postoperative clinical signs.     

Canine Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia, affecting both sexes, was present in five of 27 puppies from three father-daughter matings. A purebred Golden Retriever was the common sire. The defect occurred in the left dorsolateral portion of the diaphragm, suggesting failure of closure of the left pleuroperitoneal canal during embryonic development. These findings, and a previous report of a similar defect in neonatal puppies, are consistent with autosomal recessive inheritance of canine diaphragmatic defects.