Chronic Diaphragmatic Hernia Research Articles

Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990–2002)

To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. Retrospective study. 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

Abdominal Approach to Chronic Diaphragmatic Hernias: Is it Safe?

Standard teaching has been to approach chronic diaphragmatic hernias (CDH) via a thoracotomy. It has been our experience that CDH can be safely approached via an abdominal incision. The objective of this study was to evaluate the outcome of patients undergoing the transabdominal approach for repair of CDH and comparing the outcome with that of patients undergoing a transthoracic (TT) approach. This is a retrospective chart review and was performed of patients with CDH secondary to trauma. Patient demographics, presenting symptoms, operative approach, and complications were collected. Patients were stratified by the surgical approach, TA versus TT. The endpoints of analysis were need for second incision, intraoperative and postoperative complications (enterotomies, pneumonia), need for a chest tube, mechanical ventilation postoperatively, and ICU and hospital days. Twenty-eight patients with CDH repairs performed between Jan 1993 and Dec 2002 were identified. Nineteen patients were in the TA group, and nine were in the TT group. Patients in the TA group had a higher incidence of emergent surgery (68% vs 11%, P = 0.005) and had a lower incidence of postoperative pneumonia (0% vs 33%, P = 0.009). No case of enteric injury from lysis of adhesions in the chest was identified. The need for a second incision (11%), the mortality (11%), ICU stay, and hospital stay were the same between the two groups. It appears that repair of CDH can be performed safely through an abdominal approach.

Clinical determination of preoperative and postoperative intra-abdominal pressures in dogs.

Intra-abdominal pressure (IAP) was indirectly measured, using a transurethral catheterization technique, in 20 client-owned dogs before and after elective ovariohysterectomy. Mean preoperative IAP was 4.50 +/- 0.44 cm H2O. Elective abdominal surgery caused significant elevations in mean postoperative IAP (mean 7.50 +/- 0.45 cm H2O, range 0 to 15 cm H2O) that persisted for at least 24 hours. However, the increase in IAP caused no clinically evident complications; thus, after elective abdominal surgery an elevation in IAP up to 15 cm H2O is to be expected. Intra-abdominal pressure was also measured in 20 consecutive clinical cases with gross abdominal distension, before or after laparotomy, or both. Included in this group were dogs with gastric dilation and volvulus, closed pyometra, hemoperitoneum, acute ascites, and diaphragmatic hernias. All dogs with gross abdominal distension had an elevated IAP (> or = 16 cm H2O) either before or after surgery. Severe elevations of IAP were associated with anuria in two dogs, necessitating surgical decompression; one with hemoperitoneum (47 cm H2O) and one after repair of a chronic diaphragmatic hernia (30 cm H2O).

Chronic diaphragmatic hernia in the horse

Chronic diaphragmatic hernia in the horse

Blunt diaphragmatic rupture

Diaphragmatic injury is often a missed diagnosis in patients with multiple trauma. For this reason, mortality can be high. From 1970 to 1981, 32 patients with diaphragmatic injuries were seen at Maisonneuve-Rosemont Hospital. Twenty-four of the patients (22 men and 2 women aged 18 to 79 years) had blunt abdominal or thoracic trauma causing diaphragmatic disruption. Rupture occurred 20 times on the left side of the diaphragm, and 3 times on the right side. There was one pericardiophrenic rupture. Motor vehicle accident was the most common cause of trauma. On arrival, 21 patients had acute diaphragmatic rupture. Clinical signs and radiography permitted early diagnosis in 15 patients, whereas diagnosis was made later in 3 other patients because of deterioration of vital signs. In two patients, diagnosis was made at laparotomy for another reason. Four patients were operated on for post-traumatic chronic diaphragmatic hernia. The abdominal approach was used in 18 patients, the thoracic approach in 4, and the thoracoabdominal approach in 2. Three patients died, two of whom had a late diagnosis. Fourteen patients had no complications. Diaphragmatic trauma can be easily managed surgically when diagnosis is made early after trauma. It must always be looked for in patients with multiple trauma.

An unusual complication of chronic diaphragmatic hernia in an adult patient

An unusual complication of chronic diaphragmatic hernia in an adult patient

On the clinical picture of diaphragmatic hernias with a description of a case of a carcinomatous stomach in a hernial sac

Lifetime recognition of chronic diaphragmatic hernias is rare. According to Lachers statistics in 1880. In 276 cases, accurate intravital recognition of diaphragmatic hernias was decreed only once - Leich tens ter n'om. Later, the number of such cases increased significantly, but nevertheless, their correct recognition is still very rare. These are the cases: Ahlfeld'a, Kaufmann'a, Abe 1'ya, A. V. Bergmann'a, Strupler'a, Pluckler'a, Herz'a. Here, recognition was possible, for the most part, thanks to fluoroscopy. Wullstein says in this regard that the diagnosis of congenital diaphragmatic hernia was probably never made with certainty. Thus, the description of our case in connection with the observations of other authors known from the literature may be of certain interest.