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.     

Splenic rupture and splenectomy in a foal

A 45‐day‐old foal was presented for abdominal pain. Examination revealed the presence of haemoabdomen. An exploratory celiotomy was performed that revealed a large tear on the visceral surface of the spleen. A splenectomy was performed without rib resection. An abdominal wall hernia and leucocytosis had developed by 6 weeks post surgery. A second celiotomy to repair the hernia and explore the cause of the leucocytosis was performed 10 weeks after the first surgery. A portion of the caecum and colon had become adhered to the body wall at the site of the hernia; these areas were resected and the hernia repaired with a polypropylene mesh. The filly made a good recovery and is currently in training. Splenic rupture should be considered in any horse showing signs of abdominal pain with ultrasonographic findings consistent with haemoabdomen.     

Volvulus of the large colon in a neonatal foal

A one‐day‐old Thoroughbred colt foal was presented for assessment of abdominal pain and reduced urine output. Physical examination of the foal revealed marked abdominal distension, mild tachycardia, tachypnoea and congested mucous membranes. A marked anechoic peritoneal effusion, intestinal hypomotility and mural thickening of the large colon were detected sonographically. Serosanguinous fluid was obtained by abdominocentesis. After haemodynamic stabilisation, the foal underwent general anaesthesia and exploratory laparotomy and a 720° volvulus of the large colon at the sternal and diaphragmatic flexures was identified. After correction of the volvulus, the intraoperative findings were consistent with nonviability of the affected portion of the colon. The owner declined partial colon resection and elected for euthanasia of the foal. Although rare in neonatal foals, large colon volvulus should be considered in foals with signs of abdominal pain, abdominal distension and ultrasonographic findings of colonic mural thickening and luminal distension.     

Large colon strangulation due to a diaphragmatic hernia in a mare: A case report

This report describes a case of diaphragmatic hernia with incarcerated large colon in a 16-year-old Tennessee Walking Horse mare. This mare was presented with an acute episode of abdominal pain that was not responsive to analgesic therapy. Treatment consisted of resection of the devitalized large colon and closure of the rent in the diaphragm.     

Retrosternal (Morgagni) diaphragmatic hernia

This study presents the case of a shih tzu puppy, in which a rare congenital Morgagni diaphragmatic hernia was diagnosed. The diagnosis was based on abdominal and thoracic radiographs, including a contrast study of the gastrointestinal tract, which revealed a co-existing umbilical hernia. Both hernias were repaired by surgery.     

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.     

Diaphragmatic Hernia Repair in Three Young Horses

Objective- This clinical report describes surgical correction of diaphragmatic hernia in three young horses.
Study Design- Retrospective investigation of medical records and subsequent racing performance.
Animals- Three young horses with diaphragmatic hernia.
Results- Three young horses with signs of abdominal pain had diaphragmatic hernia causing small intestinal strangulation. The strangulated small intestine was resected and an end-to-end jejuno-jejunal (two horses) or a side-to-side jejuno-cecal anastomosis (one horse) was performed. Diaphragmatic hernias were closed with a continuous suture pattern. All horses recovered and raced. No difference in race records was found between the subject horses and their siblings. One subject horse died of colic at 5 years of age, but the cause of the colic was undetermined. The remaining two horses are in use as broodmares and have produced multiple foals without recurrence of signs of diaphragmatic hernia
Conclusions- Diaphragmatic hernias can be repaired in horses. These horses can achieve race records similar to their siblings and can produce foals without recurrence of signs of diaphragmatic hernia.     

Surgical management of foreign body obstruction of the small and large colons in 29 equids (2004–2016)

The objectives of the study were to describe the clinical presentation, surgical findings, complications and outcome of a case series of small and large colon obstruction by foreign bodies (FBs) in horses. The study is a retrospective case series which included 29 equids (28 horses and one donkey). Medical records of cases diagnosed with FB obstruction of the large or small colon between the years 2004 and 2016 that underwent surgery were reviewed. Data regarding signalment, clinical signs, surgical findings and post-operative variables were recorded. Short- (survival to hospital discharge) and long- (1 year after surgery) term survival rates were obtained. Cases had a mean age of 4.2 years, with both females and Arabian horses being overrepresented. Abdominal distention was the most common observation on presentation and the FB could be palpated in 20% of the cases during rectal examination. The most common reason to go into surgery was severe pain with abdominal distention. Significantly more FBs were found in the small colon during surgery (P<0.0001) and most were removed by small colon enterotomy. Complications rate post-operatively was relatively high (41%) with fever and diarrhoea being most common. Twenty-three cases (79%) were released from the hospital and all cases that were available for long-term follow-up were alive and returned to previous activity. No correlation between the chosen method of surgical removal of the FB and survival or complications post-operatively was noted. These data reflect favourable prognosis for surgical removal of colonic FBs. Few techniques are available to improve the safety of removal and the preferred method depends on the FB location, appearance and mobility. As FB obstruction resembles ‘noncomplicated’ colonic impaction, it is essential to try and recognise FB cases since deterioration can be rapid and surgery is the only sufficient treatment.     

Successful outcome after surgical correction of large colon atresia in a colt foal

This report describes successful surgical correction and long-term survival of a case of large colon atresia in a 24-h-old Warmblood colt, referred with signs of unrelenting abdominal pain and a suspicion of meconium impaction. Radiographic and ultrasonographic examination was indicative of large colon meconium impaction with secondary ileus. Due to deterioration of the foal, surgery was recommended. An atretic segment was found between the left ventral and dorsal large (ascending) colon. A band of fibrous tissue with no identifiable lumen connected the segments. Surgical correction was done by performing a stapled side-to-side anastomosis. Twelve days after surgery, the foal was discharged. Twenty-two months after discharge, the owner reported the foal developing as expected compared with its peers, but had a mild, self-limiting episode of colic at 20 months of age.     

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.     

Chronic diaphragmatic hernia in 34 dogs and 16 cats

Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.     

Extensive umbilical herniation of the large colon in a foal

A 5‐month‐old Warmblood cross colt was presented with focal swelling of the ventral abdomen extending from the umbilicus to the scrotum in the absence of colic signs. Palpation and ultrasound examination revealed the presence of incarcerated large intestine within the subcutaneous space adjacent to the caudal ventral abdomen and prepuce. Surgery was performed and revealed that the umbilical hernia sac had ruptured, and confirmed that the left dorsal and ventral colon were present in the subcutaneous space. The mild degree of vascular compromise of the large colon did not necessitate resection and so it was replaced within the abdomen. The abdominal wall defect was closed and the subcutaneous dead space was reduced by using a walking suture pattern. Herniation of the large colon through the umbilicus with dissection through the subcutaneous tissues of the ventral abdominal wall and prepuce has not been previously reported in foals. Ultrasonography permits differentiation of herniated small intestine from large intestine.     

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.     

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.     

An unusual cause of colic in a neonatal foal

A case of a neonatal foal with acute colic and respiratory distress is described. The foal presented with signs of acute colic and was treated medically. The foal did not respond to treatment and 2 h after admission the foal began to demonstrate signs of respiratory distress. Thoracic and abdominal radiographs were obtained and a diagnosis of a diaphragmatic hernia was made. Surgical repair of the hernia was recommended but the owner declined and the foal was subjected to euthanasia. Post mortem findings confirmed the diagnosis and revealed that the defect was of congenital origin. Congenital diaphragmatic hernia is an unusual cause of colic in a neonatal foal.     

Strangulated umbilical hernias in horses: 13 cases (1974-1985)

The medical records of 13 horses with strangulated umbilical hernias were reviewed. Typical history included increased swelling, warmth, and firmness of the hernial sac. Enterocutaneous fistulas had developed in 2 horses. Four horses had signs of abdominal pain. Surgery was performed on all horses, and the hernia was reduced by an open reduction technique. Incarcerated tissue included omentum (1 horse), jejunum (5), ileum (4), cecum (1), and ventral colon (2). All horses survived and were discharged from the hospital. Follow-up information on 9 horses (5 to 52 months after discharge) revealed no complications in 6 horses. Of the remaining 3 horses, one horse was euthanatized 5 months after discharge because of laminitis. One horse had persistent drainage from the skin incision requiring removal of nonabsorbable suture material 8 months after discharge. One foal required a second surgery because of signs of abdominal pain 17 days after the initial surgery. The foal was euthanatized during surgery because of severe peritonitis secondary to anastomotic leakage.     

Single‐port laparoscopic incisional hernia repair in a horse

A 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses     

Mesh repair of a large traumatic lateral abdominal wall hernia in an 8‐day‐old foal

An 8‐day‐old French trotter colt was admitted with a traumatic lateral abdominal wall hernia with reducible intestinal content. A 15 cm long full thickness tear was identified in both the internal abdominal oblique and transverse abdominal muscles. This case report describes the surgical repair of the hernia using a polypropylene mesh.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Acute necrotising pancreatitis following grain overload in a donkey

A donkey developed abdominal discomfort and distension together with cardiovascular collapse and gastric reflux 24 to 36 hours after ingesting a large amount of poultry feed. Rectal findings prompted a laparotomy that identified extensive gastric dilation, an empty, atonic small intestine, dry colonic content and an easily corrected caecal displacement. These findings were not consistent with the severity of the signs, which were attributed to endotoxaemia. The donkey was euthanased during recovery. Necropsy revealed acute necrotising pancreatitis with massive gastric dilation and right dorsal colon impaction. The clinicopathological features of acute equine pancreatitis associated with grain overload are discussed.