A modified technique for surgical repair of oesophageal hiatal herniation in the dog

The surgical repair of oesophageal hiatal herniation in five dogs is described. The initial presenting signs included regurgitation, vomiting, hypersalivation, anorexia, coughing, dyspnoea and exercise intolerance. Diagnosis was based upon the clinical signs, plain radiography and contrast fluoroscopic examination. The hernias were corrected by a hiatal plication technique which moved the diaphragmatic oesophagus to a new anatomical position, a 360° oesophagopexy and a proximal fundic gastropexy. Surgical results were considered excellent in all cases.     

Paraesophageal hiatal hernia and pyloric obstruction in a dog

Paraesophageal hiatal herniation and pyloric obstruction were diagnosed in a pup with a history of vomiting. Findings of contrast radiography included esophageal reflux, delayed gastric emptying time, and paraesophageal herniation. Exploratory celiotomy revealed increased firmness of the pylorus and a primary defect in the esophageal hiatus, which allowed gastric herniation. Nissen fundoplication was performed following reconstruction of the esophageal hiatus, and pyloroplasty was performed to relieve the gastric outlet obstruction. Pyloric biopsy findings were consistent with a diagnosis of chronic gastritis. Recovery from surgery was initially unremarkable; however, the dog died suddenly 3 weeks after surgery. Necropsy revealed a large diaphragmatic hernia adjacent to the esophageal hiatus; the hernia had resulted in incarceration of the abdominal organs. The hiatal hernia reconstruction remained intact and was not the cause of the diaphragmatic disruption.     

Hiatal hernia with focal megaoesophagus in a Friesian stallion

Hiatal hernia with focal megaoesophagus was diagnosed in a 10-year-old Friesian stallion presenting to the referral hospital for further investigation of recurrent oesophageal obstruction. Oesophageal endoscopy revealed dilation of the distal oesophagus with alterations in the mucosa characteristic of gastric mucosa in the distal oesophagus. In addition, a moderate amount of feed material was identified in the distal oesophagus. Positive contrast radiography showed that approximately half of the stomach was herniated cranially through the diaphragm. Management of the disease included recommendations to elevate the patient’s torso during feeding and provide mash-only feeds. Provided that successful control of the megaoesophagus could be achieved, surgical repair of the hiatal hernia may be an option for the future. This is the first report of hiatal herniation in horses. We report the successful conservative management of a stallion with both megaoesophagus and hiatal herniation through elevated feedings and selective exercise management.     

Congenital oesophageal hiatal hernia in a pug

Congenital sliding, oesophageal or type I hiatal hernia was diagnosed in a five-month-old pug puppy presented for evaluation of dyspnoea post feeding. The diagnosis was confirmed using plain film radiography. Surgical reduction of the hernia followed by plication of the oesophageal hiatus, oesophagopexy and left flank gastropexy permitted restoration of normal function. At 12 months of age, the dog was asymptomatic. This article describes the diagnosis and treatment of a congenital type 1 oesophageal hiatal herniation with unusual clinical presentation.     

Diaphragmatic herniation in the horse: 31 cases from 2001-2006

Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46% for those cases for which surgical management was elected.     

Oesophageal hiatal hernia in two cats

Sliding oesophageal hiatal hernia was diagnosed radiographically in two domestic short-haired cats. The hernias were corrected by hiatal tightening, modified Nissen fundoplication and permanent gastropexy. One cat recovered without complication, and the other developed severe necrotic gastritis following surgery. Both cats were asymptomatic and had normal radiographic studies nine months and one year after surgery.     

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.     

Functional outcome in dogs after surgical treatment of caudal lumbar intervertebral disk herniation.

Caudal lumbar disk herniations (i.e., third lumbar [L3] to seventh lumbar [L7] intervertebral spaces) represent approximately 15% of surgically treated thoracolumbar disk herniations in dogs. A retrospective case-control study was conducted to determine the postoperative outcome of this subset of dogs in the authors' neurosurgical practice. Medical records (1985 through 1996) were reviewed for dogs with caudal lumbar disk herniation confirmed at surgery. Thirty-six cases were identified. For each case, two dogs that underwent surgical treatment for upper motor neuron thoracolumbar disk herniation (tenth thoracic [T10] to L3 intervertebral spaces) were selected as controls. Probabilities of functional recovery for cases and controls were 81% and 85%, respectively (p value of 0.49). In dogs with caudal lumbar disk herniation, complete sensorimotor loss was the only significant predictor of functional recovery (p value of 0.005). Disk herniations that occur at the thoracolumbar junction and those that occur in the caudal lumbar region should not be considered to be different in terms of surgical treatment and postoperative outcome. The lower motor neuron signs that often accompany caudal lumbar disk herniation reflect the site of spinal cord injury and do not necessarily predict a poor prognosis.     

Hiatal hernia controversies--a review of pathophysiology and treatment options

OBJECTIVE: To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. DESIGN: Review article. SUMMARY: Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Hiatal hernia controversies - a review of pathophysiology and treatment options

Objective To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments.
Design Review article.
Summary Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment.
Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present.
Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplica-tion in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Diaphragmatic hernia in a two-year-old alpaca (Vicugna pacos)

A 2-yr-old male intact alpaca (Vicugna pacos) was admitted for a 4-day history of anorexia and colic. Five months prior, the alpaca had undergone surgical removal of a duodenal trichophytobezoar and had recovered uneventfully. The alpaca died under anesthesia, and diaphragmatic herniation of the third gastric compartment (C3) was diagnosed at necropsy. A defect was identified in the left dorsal hemidiaphragm accompanied by herniation of 80% of C3 and the aboral portion of the second gastric compartment into the pericardial sac. The smooth margins and dorsal location of the diaphragmatic defect suggested a congenital origin. Diaphragmatic herniation is uncommon in camelids, and only one other case has been reported. Due to the dorsal location of the diaphragmatic defect in this animal, positioning during the previous surgery may have initiated a partial entrapment of gastric compartments, leading to a more complete incarceration between when the animal was discharged and presented again.     

Characterization of primary pulmonary adenosquamous carcinoma‐associated pleural effusion

A 10‐year‐old, female spayed Shih Tzu was presented due to weight loss, increased respiratory effort and lethargy, determined to be secondary to a congenital para‐esophageal diaphragmatic defect with partial herniation of the stomach and spleen. Four days following reduction surgery of the displaced abdominal organs thoracic effusion developed. Thoracic fluid evaluation revealed a cell‐rich, protein‐poor modified transudate with neutrophils, reactive mesothelial cells, and atypical epitheloid cells which occasionally appeared to be keratinizing, consistent with neoplastic exfoliation. Thoracic effusion recurred 2 days later, with similar characteristics as the initial sample. Computed tomography (CT) indicated consolidation and displacement of the right middle and accessory lung lobes. Exploratory thoracic surgery demonstrated a thickened, hyperemic right middle lung lobe, and thickened pericardial diaphragmatic ligament. Histologic evaluation of these tissues identified a primary pulmonary adenosquamous carcinoma with intravascular and pleural invasion. Based on these cytologic, histologic, and clinical findings, we conclude that primary pulmonary carcinomas may involve superficial thoracic structures and exfoliate into a thoracic effusion.     

THORACOLUMBAR INTRADURAL DISC HERNIATION IN EIGHT DOGS: CLINICAL,LOW‐FIELD MAGNETIC RESONANCE IMAGING,AND COMPUTED TOMOGRAPHIC MYELOGRAPHY FINDINGS

Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low‐field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low‐field MRI.     

Electromyographic study of the cat''s diaphragm during oesophageal distension

In 10 cats, under acute experimental conditions, the effects of distension of the oesophagus on diaphragmatic activity were studied. Bipolar recording electrodes were implanted in the diaphragmatic dome muscular fibres and crura muscular fibres. Electrodes similar to those in the diaphragm were inserted in the oesophageal muscular wall above the hiatus and in the rectus abdominis muscle. Changes in the intrathoracic pressure and blood pressure were recorded by catheters placed in the pleural cavity and carotid artery respectively. Distension of the lower part of the thoracic oesophagus (at the level between the heart and the hiatus, 5 to 7 cm from the hiatus) by inflating a balloon with 10 to 15 ml of air produced a partial or total inhibition of the inspiratory electrical activity of the inner hiatal muscular fibres, while the inspiratory electrical activity of the dome muscular fibres was generally unchanged. This inhibition was increasingly pronounced as the distension volume increased and as the balloon was positioned nearer to the hiatus. During the distension period, only electrocardiographic potentials were recorded on the oesophageal muscular wall and rectus abdominis muscle traces and no significant changes were observed from intrathoracic pressure or blood pressure channels. Distension by means of a balloon either inflated with up to 5 ml of air when placed 5 to 7 cm cranial to the hiatus or inflated with 15 ml of air when localised in the cervical oesophagus and intrahiatally produced no effect. All areas of the diaphragm were silent during expiration.     

2002: Hiatal hernia in a puppy

A sliding hiatal hernia (where the terminal oesophagus, oesophagogastric junction and part of the stomach move cranially through a diaphragmatic defect) was diagnosed in a 4-month-old, Shar-Pei puppy presented for evaluation of regurgitation. The diagnosis was confirmed using radiography. Herniorraphy consisted of repositioning the stomach within the abdomen, plicating the diaphragmatic hiatus and performing a tube gastropexy to the left abdominal wall. Veterinary practitioners should have a high index of suspicion of hiatal hernia in young puppies, particularly Shar-Peis and British Bull Dogs, that present with persistent vomiting or regurgitation.     

Two cases of intraoperative herniation of the endotracheal tube cuff

During anaesthesia for elective procedures, 2 dogs developed acute airway obstruction caused by herniation of the endotracheal cuff.This is an uncommon but potentially fatal complication especially when minimal monitoring of the patient leads to late recognition of the condition. The most typical symptoms are decreased thoracic excursions and tidal volume, absence of gas flow through the endotracheal tube, change in the capnographic waves morphology and increased airway pressures. In both cases desaturation of haemoglobin (measured by pulse oximetry) occurred in-between 6 and 8 minutes after cuff herniation. All signs normalised following partial deflation of the cuff. Careful management of cuff pressures especially when nitrous oxide is used, awareness of the condition and monitoring of the patient can prevent fatal consequences.     

Hiatal hernia and diaphragmatic eventration in a leopard (Panthera pardus).

A 1-yr-old male leopard (Panthera pardus) presented for intermittent anorexia, emaciation, and generalized muscle wasting. Plain radiographs, ultrasonography, and esophageal endoscopy led to a diagnosis of diaphragmatic eventration with probable concurrent hiatal hernia. An exploratory laparotomy confirmed both diagnoses, and surgical repair and stabilization were performed. After surgery, the leopard was maintained on small liquid meals for 4 days, with a gradual return to normal diet over 2 wk. By 4 wk after surgery, the leopard was eating well and gaining weight, and it showed no recurrence of clinical signs for 2 yr subsequently, becoming mildly obese.     

Six cases of inguinal urinary bladder herniation in entire male domestic rabbits

Six entire male rabbits, between four and eight years old, were presented with a fluctuant scrotal and/or inguinal swelling resulting from inguinal herniation of the urinary bladder. Concurrent problems included urinary sediment (two rabbits), multiple uroliths (one rabbit) and testicular tumour (one rabbit). All rabbits underwent herniorrhaphy surgery. There was a successful outcome in four of the six cases.     

Concurrent gastro-oesophageal intussusception,trichobezoar and hiatal hernia in a cat

CASE HISTORY: An adult male Birman cat was evaluated for recurrent, intermittent vomiting or regurgitation, occasionally associated with abdominal discomfort.

CLINICAL FINDINGS AND DIAGNOSIS: Radiographs, including an oesophogram, indicated an oesophageal obstruction. Prior to treatment, the cat's condition deteriorated and it was euthanised at the owner's request. Post-mortem examination revealed a gastro-oesophageal intussusception, a trichobezoar impacted into the intussusceptum, and a dilated oesophageal hiatus consistent with a chronic hiatal hernia.

CLINICAL RELEVANCE: Gastro-oesophageal intussusception is a rare condition in cats. Its aetiology in relation to a pre-existing hiatal hernia and a trichobezoar is discussed.     

Hiatal hernia in the dog and cat: A retrospective study of 16 cases

Sixteen cases of hiatal hernia were diagnosed in cats and dogs at the University of Tennessee between 1978 and 1989. Three cases were found as incidental findings during thoracic or abdominal radiography and another two cases were found during post mortem examination. The remaining 11 cases were evaluated clinically and radiographically. The results of conservative or surgical therapy were reviewed. Not all animals with a hiatal hernia were symptomatic. Five animals with signs underwent surgery and another three had surgical intervention but were asymptomatic. Medical management was successful in controlling the signs in two animals showing signs consistent with reflux oesophagitis. One dog with ‘shortened oesophagus syndrome’ was treated inappropriately with conventional surgical techniques used in veterinary medicine for hiatal hernia. This study clearly emphasises the need to evaluate carefully each dog or cat with hiatal hernia before choosing the best therapeutic plan.