Hiatal herniation as a complication of chronic diaphragmatic herniation

Three of four cases of chronic diaphragmatic herniation seen over a period of 12 months developed hiatal herniation within five to eight days of corrective surgery for the diaphragmatic herniation. None of the dogs had shown any prior signs referrable to hiatal herniation. The features that developed subsequent to diaphragmatic herniorrhaphy in all cases were dyspnoea, increased intra-abdominal pressure due to decreased abdominal domain and laxity of the oesophageal hiatus as judged subjectively at the time of surgery for hiatal herniation correction. These conditions may be significant underlying factors for the development of hiatal herniation not preceded by diaphragmatic herniation in the dog. Those associated factors accepted as important in humans, including reduced lower oesophageal sphincter tone and gastroesophageal reflux, may not be of similar importance in small animals.     

Hiatal Hernia Repair by Restoration and Stabilization of Normal Anatomy An Evaluation in Four Dogs and One Cat

Clinical signs of esophageal hiatal hernia in four dogs and one cat included regurgitation, vomiting, hematemesis, hypersalivation, dysphagia, and dyspnea. Thoracic radiographs, esophagram, and fluoroscopy were used to demonstrate cranial displacement of the esophagogastric junction and part of the stomach through the esophageal hiatus. Other findings included megaesophagus, esophageal hypomotility, gastroesophageal reflux, and pneumonia. Medical therapy failed to resolve the clinical signs. Reduction in size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and a left fundic gastropexy were performed. Surgical results were considered good to excellent.     

Gastric dilatation and volvulus in a brachycephalic dog with hiatal hernia

A brachycephalic dog was presented with an acute onset of retching and abdominal discomfort. The dog had a chronic history of stertor and exercise intolerance suggestive of brachycephalic airway obstructive syndrome. Radiographs were consistent with a Type II hiatal hernia. The dog was referred and within hours of admission became acutely painful and developed tympanic abdominal distension. A right lateral abdominal radiograph confirmed gastric dilatation and volvulus with herniation of the pylorus through the hiatus. An emergency exploratory coeliotomy was performed, during which the stomach was derotated, and an incisional gastropexy, herniorrhaphy and splenectomy were performed. A staphylectomy was performed immediately following the exploratory coeliotomy. The dog recovered uneventfully. Gastric dilatation and volvulus is a potentially life‐threatening complication that can occur in dogs with Type II hiatal hernia and should be considered a surgical emergency .     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Congenital Esophageal Hiatal Hernia in the Chinese Shar-Pei Dog

Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radio-graphic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs. (Journal of Veterinary Internal Medicine 1993; 7:210–215. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Laparoscopic esophagopexy,fundopexy, and hiatal herniorrhaphy for refractory regurgitation in a racing Alaskan husky sled dog

A 2-year-old intact female Alaskan husky sled dog was presented with a history of chronic exercise-induced regurgitation refractory to medical management. Previous diagnostics were unremarkable except for an endoscopic examination and histopathologic evaluation of the upper gastrointestinal tract that revealed the presence of Helicobacter spp. and mild non-specific inflammation of the proximal duodenum. A laparoscopic hiatal herniorrhaphy, esophagopexy, fundopexy, and ovariectomy were performed without complications in anesthesia or surgery and clinical improvement was observed with continued follow-up for 8 months after surgery.Key clinical message:Surgical treatment for hiatal hernia may be considered in racing Alaskan sled dogs with regurgitation refractory to gastric protectant therapy.     

Hiatal hernia in a harbor seal (Phoca vitulina) pup

A 2-wk-old stranded harbor seal (Phoca vitulina) rescued by Mystic Aquarium showed signs of the presence of a hiatal hernia during rehabilitation. Contrast radiographs of esophagus and stomach revealed an intrathoracic radiodensity that contains filling defects typical of stomach, consistent with gastric rugal folds. Mural thickening was observed at the level of the cardia consistent with a diagnosis of a hiatal hernia. Although clinical improvement was noted with medical therapy and tube feeding, surgical correction of the hiatal hernia was considered necessary for full resolution. However, owing to the animal's low body weight, the corrective hernia surgery was postponed until the body condition improved. The seal needed to be surgically treated for a corneal ulcer, and while anesthetized with isoflurane, the seal became dyspneic and developed cardiac arrhythmias; ultimately cardiac arrest ensued. Resuscitation was unsuccessfully attempted and the seal was euthanized. Necropsy confirmed the radiographic diagnosis and further characterized a paraesophageal hiatal hernia.     

TYPE-4 ESOPHAGEAL HIATAL HERNIA IN A CHINESE SHAR-PEI DOG

Thoracic radiography of a 3-month-old, female Chinese Shar-pei revealed an esophageal hiatal hernia with stomach, liver, and small intestine displaced into the thorax. Three days after the surgical correction, the dog developed ileal intussusception and was reoperated. Recovery was uncomplicated and the dog was asymptomatic 16 months after surgery.     

Gastric dilatation-volvulus associated with diaphragmatic hernia in three cats: clinical presentation, surgical treatment and presumptive aetiology

Three cats were examined because of acute dyspnoea and sudden abdominal enlargement. In all cats, radiographs revealed gastric dilatation-volvulus (GDV) and diaphragmatic hernia. Cardiovascular shock and dyspnoea were treated by intravenous fluid-therapy, oxygen administration and relief of diaphragmatic pressure by means of stomach decompression and in one case placing the patient in an inclined position. Gastric decompression was performed by needle gastrocentesis, placement of a rhino-gastric tube, or a combination of these. Diaphragmatic herniorrhaphy was performed in either case; one cat also underwent gastropexy. The immediate postoperative period resolved uneventfully and the cats were doing well at follow-up. Feline GDV is a rare event in which diaphragmatic hernia may be a predisposing factor.     

Small-intestinal volvulus as a complication of acquired inguinal hernia in two horses

Volvulus of the small intestine was diagnosed as a complication of acquired inguinal herniation in 2 horses. One of the horses continued to have signs of pain after reduction of the hernia. The volvulus was diagnosed at a second surgery, but the intestine was devitalized, and the horse was euthanatized. Ventral midline exploratory surgery was performed on the second horse, in conjunction with an inguinal approach. The small-intestinal volvulus was diagnosed and corrected at this time. It is suggested that ventral midline abdominal exploration be performed when acquired inguinal herniation causes acute small-intestinal obstruction in horses.     

Omental herniation through the esophageal hiatus in a cat

A four-year-old male cat was presented with regurgitation. Thoracic radiography and contrast radiogram showed a large oval mass and elevated esophagus. Exploratory thoracotomy showed omental herniation into the posterior mediastium through the esophageal hiatus. Because the mass of the omental herniation was so large, celiotomy through a paracostal incision was combined in order to return the omentum to its normal position. The diameter of the esophageal hiatus was approximately 1 cm but no fibrous adhesion was observed around the hiatus. Continuous 1-0 surgical sutures on the hiatus reduced the diameter of the hiatus. The cat made a successful postoperative recovery without complications.     

Bilateral Morgagni hernia in a donkey

This case report describes the clinical presentation and management of a donkey admitted with acute signs of abdominal pain that was diagnosed with a bilateral Morgagni hernia, a rare type of congenital diaphragmatic hernia. For more than 8 months before presentation, the donkey had been showing signs of recurrent mild abdominal pain that responded favourably to medical treatment. On admission, the donkey had mild tachycardia and tachypnoea. Radiography and ultrasound of the thorax and abdomen showed thoracic herniation of the large colon. Exploratory laparotomy was performed, and the sternal and diaphragmatic flexures of the large colon, as well as the left hepatic lobe, were found incarcerated in a bilateral Morgagni hernia. Intestine and liver were removed from the hernia, and the large colon was exteriorised. The defect in the diaphragm was repaired by stapling a polyester mesh circumferentially around the hernia ring and covering the mesh with an excised section of the greater omentum. No further complications and no recurrence of colic were observed during an 8-month follow-up period.     

Marked pleural effusion causing right atrial collapse simulating cardiac tamponade in a dog

A 16-month-old, female German shepherd dog was presented with severe bicavitary effusions. A diaphragmatic hernia was diagnosed by thoracic radiography. An echocardiogram performed prior to surgical repair of the hernia revealed signs of cardiac tamponade, with right atrial collapse, in the absence of pericardial effusion. Right atrial collapse was presumed to be secondary to severe pleural effusion. At surgery, no pericardial disease was identified. Surgical correction of the diaphragmatic hernia resulted in resolution of the pleural and peritoneal effusions. Follow-up echocardiography demonstrated resolution of the signs of cardiac tamponade.     

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.