Congenital Peritoneopericardial Diaphragmatic Hernia in a Dog: Ventral Advancement Diaphragmatic Technique for Repair.

To characterize the association between peritoneopericardial diaphragmatic hernia (PPDH) or congenital central diaphragmatic hernia (CCDH) and ductal plate malformations (DPMs) in dogs and cats. 18 dogs and 18 cats with PPDH or CCDH and 19 dogs and 18 cats without PPDH or CCDH. Evaluation of clinical details verified PPDH or CCDH and survival times. Histologic features of nonherniated liver samples were used to categorize DPM. Immunohistochemical staining for cytokeratin-19 distinguished bile duct profiles per portal tract and for Ki-67-assessed cholangiocyte proliferation. Histologic features of herniated liver samples from PPDH or CCDH were compared with those of pathological controls (traumatic diaphragmatic hernia, n = 6; liver lobe torsion, 6; ischemic hepatopathy, 2). DPM occurred in 13 of 18 dogs with the proliferative-like phenotype predominating and in 15 of 18 cats with evenly distributed proliferative-like and Caroli phenotypes. Congenital hepatic fibrosis DPM was noted in 3 dogs and 2 cats and renal DPM in 3 dogs and 3 cats. No signalment, clinical signs, or clinicopathologic features discriminated DPM. Kaplan Meier survival curves were similar in dogs and cats. Bile duct profiles per portal tract in dogs (median, 5.0; range, 1.4 to 100.8) and cats (6.6; 1.9 to 11.0) with congenital diaphragmatic hernias significantly exceeded those in healthy dogs (1.4; 1.2 to 1.6) and cats (2.3; 1.7 to 2.6). Animals with DPM lacked active cholangiocyte proliferation. Histologic features characterizing malformative bile duct profiles yet without biliary proliferation were preserved in herniated liver lobes in animals with DPM. DPM was strongly associated with PPDH and CCDH. Because DPM can impact health, awareness of its coexistence with PPDH or CCDH should prompt biopsy of nonherniated liver tissue during surgical correction of PPDH and CCDH.

A 16‐month‐old, entire, male dobermann presented for evaluation of emesis, anorexia and lethargy. Upon examination, the dog was found to be severely icteric. Serum biochemistry revealed an elevated total bilirubin and alkaline phosphatase, and computed tomographic imaging revealed a peritoneopericardial diaphragmatic hernia with abdominal organ herniation and compression of the common bile duct, prompting surgical exploration. Herniation of abdominal organs, including a markedly distended gall bladder and common bile duct, was appreciated. Herniation reduction, herniorrhaphy and prophylactic gastropexy were performed. This is the first report to describe the incidence of canine extrahepatic biliary tract obstruction suspected to be secondary to herniation of the gall bladder through a peritoneopericardial diaphragmatic hernia, with reported good short‐ and long‐term outcomes.

Peritoneopericardial diaphragmatic hernia is a type of congenital diaphragmatic hernia that consists in the persistence of a communication between the peritoneal cavity and the pericardial sac, affecting dogs and cats. This condition occurs as a result of the defective development of the ventral segment of the diaphragm during embryogenesis. Due to the persistence of communication between the two cavities (peritoneal and pericardial), abdominal organs can protrude into the pericardial sac. The clinical signs are nonspecific, being consistent with the size of the diaphragmatic defect and the herniated organ(s). The afflicted animals can be asymptomatic or show severe clinical signs (cardio-respiratory and/or digestive), which can be life-threatening. The diagnosis is established by radiographic examination, without or after the administration of the contrast medium. In the case of symptomatic patients, the treatment is surgical, and in the case of asymptomatic patients, monitoring of digestive and respiratory functions is recommended.

Peritoneopericardial diaphragmatic hernia (PPDH) is a congenital communication between the pericardial sac and the abdominal cavity allowing displacement of abdominal organs to the pericardial sac. Peritoneopericardial diaphragmatic hernia is thought to occur due to a failure of the development of septum transversum. Vomiting, exercise intolerance and respiratory distress are the most common clinical signs. Diagnosis of PPDH is based on plain radiography. Physical examination and diagnostic imaging may detect the presence of other congenital anomalies. Surgical repair of the PPDH is the treatment of choice for animals with clinical signs. Prognosis following surgical repair of PPDH is favorable. Animals with no clinical signs related to PPDH may not undergo surgical repair.

Peritoneopericardial diaphragmatic hernia (PPDH) is a communication between the abdomen and the pericardial sac generated by congenital anomalies triggered during diaphragmatic and pericardial development. This report aimed to present the case of an adult, mixed-breed cat, affected by PPDH, focusing on the period from diagnosis to successful surgical correction. The patient had a capricious appetite and weight loss for about four months and started, at the end of this period, a state of apathy. On abdominal ultrasound, the gallbladder (GB) was close to the heart, suggesting diaphragmatic discontinuity. On thoracic radiography, there were changes suggestive of PPDH, pericardial efusion or cardiomegaly with probable dilated cardiomyopathy. Based on these findings, an echocardiogram was performed, highlighting the hepatic lobe and GB internally to the pericardium, causing cardiac compression, although without severe cardiac changes. During surgery, a diaphragmatic defect of 4 cm in diameter was observed with the congested right medial hepatic lobe and hyperemic GB in the pericardial sac. The defect was sutured using the sultan pattern in separate stitches and polyamide threads. The feline returned to feeding with greater interest soon after the surgery, and after 15 days it was fed with dry food and had normal behavior. PPDH can be diagnosed in healthy adult cats, even if there are no apparent respiratory, gastrointestinal, or cardiac signs. The echocardiogram is relevant in the definitive diagnosis, in addition to excluding differential diagnoses, and simple surgical treatment with polyamide thread and sultan suture is successful.

Peritoneopericardial diaphragmatic hernia (PPDH) is a communication between the abdomen and the pericardial sac generated by congenital anomalies triggered during diaphragmatic and pericardial development. This report aimed to present the case of an adult, mixed-breed cat, affected by PPDH, focusing on the period from diagnosis to successful surgical correction. The patient had a capricious appetite and weight loss for about four months and started, at the end of this period, a state of apathy. On abdominal ultrasound, the gallbladder (GB) was close to the heart, suggesting diaphragmatic discontinuity. On thoracic radiography, there were changes suggestive of PPDH, pericardial efusion or cardiomegaly with probable dilated cardiomyopathy. Based on these findings, an echocardiogram was performed, highlighting the hepatic lobe and GB internally to the pericardium, causing cardiac compression, although without severe cardiac changes. During surgery, a diaphragmatic defect of 4 cm in diameter was observed with the congested right medial hepatic lobe and hyperemic GB in the pericardial sac. The defect was sutured using the sultan pattern in separate stitches and polyamide threads. The feline returned to feeding with greater interest soon after the surgery, and after 15 days it was fed with dry food and had normal behavior. PPDH can be diagnosed in healthy adult cats, even if there are no apparent respiratory, gastrointestinal, or cardiac signs. The echocardiogram is relevant in the definitive diagnosis, in addition to excluding differential diagnoses, and simple surgical treatment with polyamide thread and sultan suture is successful.

Peritoneopericardial diaphragmatic hernia is a rare congenital malformation in dogs and cats that affects the diaphragm and the pericardial sac, resulting in communication between the abdominal and thoracic cavities. There is no consensus regarding the origin of this condition; however, the most widely accepted theory suggests a failure in the embryonic development of the transverse septum. Clinical signs may or may not be present in affected patients. A definitive diagnosis is established through complementary imaging examinations. Two treatment approaches are available: conservative and surgical. This case report describes a 7-year-old asymptomatic male mixed-breed dog in which a peritoneopericardial diaphragmatic hernia was incidentally diagnosed during preoperative examinations. The patient underwent surgical correction, which was completed without complications. The postoperative outcome was satisfactory, with favorable clinical progression to date.

A 1-year-old female Maine Coon cat presented with a history of labored breathing and intermittent cough. Thoracic radiography revealed a diaphragmatic hernia; echocardiography showed adhesions of a hepatic lobe and gall bladder to the left myocardium. After a final diagnosis of peritoneopericardial diaphragmatic hernia (PPDH), a surgical treatment was successfully done to repair the congenital PPDH. Blood transfusion was performed during surgical correction to ameliorate the excessive blood loss during liver lobectomy. This surgical technique can close the diaphragmatic defect and be used as a treatment option to prevent further herniation and reduce compliance with heart failure complications. Surgical treatment provides an excellent outcome for cats with a congenital pericardial-diaphragmatic anomaly. However, severe hemorrhage may occur with the abdominal organ’s adhesion to the pericardium, such as the liver. This study described the diagnosis and surgical treatment. The surgical procedure may provide the information for further successful treatment in the feline congenital pericardial defect.

A 4-year-old female spayed domestic longhair cat was referred for dyspnea. Further diagnostics revealed severe pleural effusion and a peritoneopericardial diaphragmatic hernia (PPDH). Following surgical correction of the PPDH the pleural effusion persisted. Re-check echocardiogram 4 weeks after initial evaluation revealed leftward deviation of the interventricular septum and interatrial septum occurring with inspiration. There were also exaggerated phasic changes in trans-tricuspid flow velocities suggestive of constrictive pericardial disease. Cardiac catheterization was performed and revealed elevated pressures in the right atrium and right ventricle. Constrictive pericarditis (CP) and epicarditis was confirmed at surgery, where subtotal pericardiectomy was performed with epicardial decortication. The cat continued to develop recurrent pleural effusion after surgery, although the volume and frequency of recurrence slowed over time. This is the first reported case of CP following PPDH repair in a cat.

Background: Pilonidal sinus is the relatively common condition affecting men almost twice as often as the women we experienced. The estimated incidence is 0.26 per thousand populations in general. The management of pilonidal sinus disease remains controversial, and gold standard treatment modality has yet to be established. Limberg procedure is a safe and reliable technique in the treatment of the sacrococcygeal pilonidal sinus disease, with a low complication and recurrence rates if performed according to the appropriate surgical principles.
 Methods: This is a Prospective study on 24 patients between the period from July 2014 to Dec 2018 in the Department of Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) as well as other different hospitals in Dhaka, Bangladesh. The patients having primary or recurrent pilonidal sinus disease underwent the foresaid surgical treatment.
 Results: Twenty four patients underwent this operation. Among them, the picture was that 20(83.3%) were males and 4(16.7%) were female. The mean age was 31, (Range: 17-45 years). 6(25%) patients were presented with recurrent sinus and 5 of them had one or more occasion previous surgery. Twenty one patients (87.5%) had full primary healing without any complication. But 1(4.2%) patient had minimal sarcoma, 1(4.2%) patient had superficial infection and the remaining other 1(4.2%) had partial flap necrosis. However, all three healed completely with conservative treatment. The mean length of hospital stay was 2.45 (Range: 1-5) days and the most patients returned to their work within 3 weeks.
 Conclusion: Limberg flap is very effective for sacrococcygeal pilonidal sinus disease with low complication rates, shorter hospital stay, low recurrence rates, earlier healing and reduced off-work period. The surgery can be easily mastered. We recommend Limberg flap as preferred surgery in the cases of Sacrococcygeal Pilonidal sinus.
 Bangladesh Journal of Medical Science Vol.19(1) 2020 p.105-109

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As a result of thoracic radiographs and physical examination, a stunted 16-month-old female miniature schnauzer weighing 3.22 kg was diagnosed as having peritoneopericardiol diaphragmatic hernia. The pericardial sac and diaphragm were corrected by the use of trans-sternal thoracotomy. Thereafter recovery was uncomplicated, and the dog resumed a completely normal appearance

Case summaryCranial ventral midline hernias, most often congenital, can be associated with other congenital abnormalities, such as sternal, diaphragmatic or cardiac malformations. A 4-year-old multiparous queen with a substernal hernia was admitted for evaluation of a mammary mass. During CT examination, a bifid sternum, the abdominal hernia containing the intestines, spleen, omentum, three fetuses, a mammary mass and an incidental peritoneopericardial diaphragmatic hernia were identified. Surgery consisted of a standard ovariohysterectomy and repair of the peritoneopericardial hernia. Primary closure of the abdominal hernia was attempted but deemed impossible even after the ovariohysterectomy, splenectomy and a partial omentectomy. An external abdominal oblique muscle flap was used to close with no tension on the cranial part of the hernia. One month postoperatively, the queen had no respiratory abnormalities and the herniorrhaphy was fully healed.Relevance and novel informationThis case is the first description of a 4-year-old multiparous pregnant queen with complex congenital malformations and surgical correction of a peritoneopericardial hernia and a 6 × 8 cmsubsternal hernia with an external abdominal oblique muscle flap. Life-threatening sequelae associated with large abdominal hernias can be attributed to space-occupying effects known as loss of domain and compartment syndrome, which is why a muscle flap was used in this case. The sternal cleft was not repaired because of the size of the cleft and the age of the cat.