Peritoneopericardial Diaphragmatic Hernia Research Articles

A ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog.

To report a ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog. A 5-month-old 15-kg entire male Labrador Retriever. The dog presented with a history of diarrhea for a week and acute-onset lethargy and vomiting for 3 days. Clinical examination revealed borborygmi on auscultation of the chest, and subsequent imaging showed a congenital peritoneopericardial diaphragmatic hernia. The ventro-central diaphragmatic defect was repaired with a pericardial flap, which subsequently failed 7 months later. The revision surgery was performed with a novel surgical technique. The defect was closed by means of incising the ventral attachments of the diaphragm either side of the defect and sliding it medially to allow a tension-free closure. The ventral aspect of the incised diaphragm was reattached with circumcostal sutures and the central defect closed. The dog recovered rapidly and without complication. An excellent outcome was reported after surgery. This novel technique was a simple method to repair a peritoneopericardial diaphragmatic hernia and had good clinical results in this case.

Use of autologous pericardial patch graft for treatment of large congenital peritoneopericardial diaphragmatic hernia in two cats

AbstractPeritoneopericardial diaphragmatic hernia is a congenital structural anomaly that results in a communication between the pericardial sac and the peritoneal cavity. About 50% of cats are asymptomatic at the time of diagnosis, and the remaining animals may show respiratory (dyspnoea, tachypnoea, exercise intolerance), gastrointestinal, cardiac tamponade or non‐specific clinical signs. Median celiotomy for herniorrhaphy without tension (primary closure, muscle flaps, synthetic mesh, pericardium) is the treatment of choice for symptomatic patients. Two cats were referred with respiratory signs, secondary to a peritoneopericardial diaphragmatic hernia. A pericardial patch graft was obtained and sutured to the diaphragm as an alternative technique to close the large defect and not cause excessive tension on the diaphragm and caval foramen. Patients recovered well without any complications after surgery. Re‐examination and thoracic radiographs at 1 week, 2 weeks, 3 months, 6 months and 3 years postoperatively showed no signs of recurrence and the patients remained asymptomatic.

Diagnosing and treating pericardial disease in dogs and cats

Background: Pericardial disease accounts for approximately 10 per cent of all cardiac referrals. It is seen in all species, but is most commonly diagnosed in dogs and occasionally in cats. Pericardial disease comprises both acquired and congenital conditions, of which pericardial effusion (PE) associated with acquired disease is most common. PEs are most frequently either idiopathic or secondary to neoplasia, although other causes such as left atrial tear (secondary to myxomatous valvular disease), infectious pericarditis, an extension of congestive heart failure (CHF) and secondary to trauma are all possible causes. Congenital pericardial disease is rare, but includes peritoneopericardial diaphragmatic hernia, benign intrapericardial cysts and pericardial defects. This rare and small group of congenital conditions are important, as prompt recognition and management usually infers an excellent prognosis. Where there is sufficient volume within the pericardial sac, intrapericardial pressure can rise, leading to cardiac tamponade and signs of right‐sided CHF (R‐CHF) and low cardiac output. Importantly, management of R‐CHF in cases of pericardial disease requires a completely different approach to other diseases causing R‐CHF.Aim of the article: This article reviews the most common conditions that cause PE, common clinical signs and appropriate management strategies.

Clinical and radiographic aspects in peritoneopericardial diaphragmatic hernia in dogs and cats

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 and concomitant lung lobe torsion in a dog

AbstractA 7‐month‐old, male, entire Weimaraner was referred for surgical repair of a peritoneopericardial diaphragmatic hernia. Thoracic radiographs confirmed a peritoneopericardial diaphragmatic hernia and showed a vesicular emphysema pattern, suggestive of lung lobe torsion. Herniorrhaphy to repair the peritoneopericardial diaphragmatic hernia was performed, and exploratory median sternotomy revealed a torsion of the right middle lung lobe, as well as complete atelectasis of the right caudal lung lobe. Lung lobectomies were performed, and an autologous pericardial flap was used to repair the diaphragmatic defect. A second operation was required because of the suspicion of active bleeding. It was discharged after 6 days of hospitalisation. It is our hypothesis that peritoneopericardial diaphragmatic hernia contributed to the lung lobe torsion due to alterations in the spatial dimensions of the thoracic cavity. Lung lobe torsion has been previously associated with traumatic diaphragmatic herniation in dogs and cats, and has also been reported in a cat with a congenital peritoneopericardial diaphragmatic hernia and chylothorax.

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.

Pneumopericardium with concomitant pericardial effusion following peritoneopericardial diaphragmatic hernia repair in a dog

AbstractPeritoneopericardial diaphragmatic hernia (PPDH) is a congenital defect allowing communication between the peritoneal cavity and the pericardial sac, through which abdominal organs may herniate into the pericardial space. The condition can be asymptomatic or symptomatic, and if symptomatic, accompanied mostly with non‐specific gastrointestinal or respiratory clinical signs. A 2‐year‐old, male, neutered mixed breed dog was referred due to fever, lethargy and decreased food intake over the last 2 weeks. Abdominal ultrasound was performed and a transposition of abdominal organs into the thoracic cavity was suspected. Further diagnostic imaging confirmed PPDH with herniation of the gall bladder and spleen into the pericardial sac. The dog underwent surgery for hernia repair. Severe pneumopericardium subsequently complicated by pericardial effusion developed postoperatively. Both complications resolved without intervention. The dog never showed signs of haemodynamic instability or cardiac tamponade.

A retrospective study on diaphragmatic hernia in cats.

Diaphragmatic rupture is introduced as one of the most common injuries occurring in small animals. In our retrospective report, 14 cats with a mean age of 12 months (male = 8, female = 6) that underwent diaphragmatic herniorrhaphy were studied. The data included the following: age, sex, breed, and clinical signs. The cause of diaphragmatic hernia, diaphragmatic rupture area, herniated organs, concomitant injuries, and survival rate after surgical treatment were detailed. The cats included 11 domestic shorthair (DSH) and three Persian. Trauma was the most common cause of rupture in these patients and one 3-month old Persian cat had peritoneopericardial diaphragmatic hernia (PPDH). The most common clinical sign was dyspnea. Concurrent disorders included fractures of pelvic, long bones and ribs and mild pneumothorax. One of the five cats survived with concurrent disorders. In this study, the frequency of rupture sites was as follows: the right-side (11 cats), left-side (2 cats), and dorsal side of diaphragm in one case. The most frequently inserted organ into the chest was liver. In our study, the survival rate after surgical treatment was 71.00%. In conclusion, we suggested that stabilization of the patient was important before herniorrhaphy. Based on our study, the concurrent damages affected the survival rate.

Relationships between congenital peritoneopericardial diaphragmatic hernia or congenital central diaphragmatic hernia and ductal plate malformations in dogs and cats.

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.

Pulmonary adenocarcinoma causing oesophageal and bronchial compression in a cat with concurrent peritoneopericardial diaphragmatic hernia

AbstractA 13‐year‐old female neutered domestic longhair cat was presented for intermittent, self‐limiting episodes of laboured breathing and wheezing and also vocalising, coughing, retching, vomiting and inappetence. Abdominal ultrasound and thoracic radiographs revealed a peritoneopericardial diaphragmatic hernia (PPDH), and the cat was referred for further investigations and surgical treatment. Computed tomography (CT) of the thorax confirmed the presence of a large PPDH and individuated the existence of a heterogeneous mass lesion in the caudal mediastinum. Additionally, there were disseminated lesions affecting multiple organs, numerous skeletal muscles, and several lymph nodes. On the basis of these findings and a likely neoplastic cause, the owner elected to have the cat euthanised. Postmortem examination and histopathological analysis revealed the presence of a pulmonary adenocarcinoma, invading and compressing the distal part of the oesophagus and a large bronchus, and likely representing the cause of the patient's main clinical signs.

Fatal congenital peritoneopericardial diaphragmatic hernia in a sable antelope (Hippotragus niger) calf

AbstractCongenital peritoneopericardial diaphragmatic hernia was diagnosed in a 2‐week‐old sable antelope (Hippotragus niger) calf with subsequent fatal acute heart failure. Histopathological examination of the lung, liver and heart revealed lesions supportive of acute heart failure that consisted of pulmonary oedema, periacinar hepatocellular necrosis and myocardial degeneration and necrosis. The external pressure on the coronary arteries by the liver and abomasum most likely resulted in ischaemic injury of the cardiomyocytes and the resultant acute heart failure.

Case Report: Unusual Peritoneopericardial Diaphragmatic Hernia in an 8-Month-Old German Shepherd Dog, Associated With a Pericardial Pseudocyst and Coexisting Severe Pericardial Effusion Resulting in Right-Sided Heart Failure

Objective: This study aims to describe an unusual peritoneopericardial diaphragmatic hernia (PPDH) in an 8-month-old German shepherd dog, associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in right-sided heart failure.Case Summary: An 8-month-old, male, intact, German shepherd dog, was referred for ascites. Echocardiography revealed a severe pericardial effusion with a cyst-like structure within the pericardium and consequently decompensated right-sided heart failure. The ascites was secondary to right-sided heart failure (cardiac tamponade). Computed tomography (CT) of the thorax and abdomen was performed and showed PPDH with severe pericardial effusion and presence of a pericardial cyst-like structure; xyphoid cleft and Y-shaped seventh sternebra; and mild thickening along the cranioventral abdominal wall consistent with scar tissue from the previous umbilical hernia surgical repair. During surgery, the PPDH was corrected, and it was revealed that the remnant of the umbilical cord passed through it, into the pericardium. The cyst-like structure was successfully resected and sent for pathology. Histopathology showed signs of a chronic suppurative inflammation, with absence of a mesothelial or endothelial wall layer, thus consistent with a pseudocyst. Based on tomographic and surgical findings, it is suspected that the pseudocyst, together with the pericardial effusion, evolved by an inflammation of the remnant of the umbilical cord during the umbilical hernia surgical repair 1 month prior to presentation. The underlying PPDH most likely favored the development of the pericardial pseudocyst. However, due to prior antibiotic therapy initiated by the private vet, an infectious origin cannot be ruled out completely.New or Unique Information Provided: There are a few case reports describing PPDH and/or pericardial pseudocysts in veterinary patients, but the current case report is unique, since it describes PPDH associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in cardiac tamponade. As far as the authors know, such a case has not been described in veterinary medicine before.

The surgical repair of a congenital peritoneopericardial diaphragmatic hernia in Maine Coon cat

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.

Peritoneopericardial Diaphragmatic Hernia in a Persian Cat

Background: Peritoneopericardial diaphragmatic hernia is a congenital defect characterized by an anomalous communication between the abdominal cavity and pericardial sac, which can lead to displacement of the abdominal viscera into the thoracic cavity. The occurrence in felines is higher among long-haired breeds, mainly the Persian breed, possibly based onan autosomal recessive inheritance. The diagnosis of PPDH is performed by means of chest radiography with or without contrast, in association with other imaging tests such as ultrasonography and echocardiography. Our objective in this study was to report the occurrence and macroscopic changes in a case of peritoneopericardial diaphragmatic hernia in a Persian feline. Case: A 9-year-old male Persian cat weighing 3.4 kg was referred to the HPET-Private Veterinary Clinic, Salvador, Bahia, with an history of weight loss and chronic intermittent vomiting during the preceding 6 months, with lateral decubitus and breathing difficulties. Ultrasonography revealed findings suggestive of an infiltrative process in the stomach and duodenum, enlarged gastric lymph nodes, and some nodular images indicating slight displacement of the liver. Chest radiography revealed a cardiac silhouette with markedly enlarged dimensions associated with a dorsal deviation of the terminal trachea, and echocardiography revealed a small amount of pericardial effusion. The patient showed initial clinical improvement after blood transfusion; however, after 2 days, he exhibited significant clinical worsening and was therefore euthanized with the owner's consent. Post mortem evaluation revealed partial herniation of the liver and gallbladder into the chest cavity through a diaphragmatic hernia ring. The heart was partially surrounded by the left medial lobe of the liver, which was displaced into the pericardial sac. Herniated hepatic lobes had an irregular capsular surface with evident lobulation and tension lipidosis. In the abdominal cavity, the remainder of the liver (right lateral and medial lobes) was observed to be slightly enlarged, with an irregular surface, diffusely reddish with intense evidence of the lobular pattern and white and firm multifocal areas (fibrosis). In the duodenum, close to the pylorus, there was a nodule measuring 2.8 x 2.5 x 1.0 cm, with a whitish and ulcerated surface. When cut, it was soft and exhibited a homogeneous, whitish compact surface.Histopathological examinationshowed marked proliferation of fibrous connective tissue, which for the most part separated the lobes by septa and surrounded the portal space (fibrosis), a marked diffuse chronic inflammatory infiltrate composed of lymphocytes and plasma cells. In addition, marked bile duct hyperplasia and multifocal areas of fatty degeneration (steatosis).Discussion: The diagnosis was based on the association of clinical and pathological findings. Considering the age and clinical signs presented by the patient in this report, as well as the presence of few radiographic signs that were indicative of PPDH, the first differential diagnosis thought was pericardial neoplasia. Peritoneopericardial diaphragmatic hernia in felines is always of congenital origin and may occur asymptomatically depending on the number and involvement of herniated viscera. In this case, the patient's diagnosis of peritoneopericardial hernia was a necropsy finding; the fact that in agreement with previous reports of high rates of incidental diagnoses reinforces the importance of performing necropsy for confirmation or diagnosis of unexpected pathologies. In the present case, peritoneopericardial diaphragmatic hernia in isolation may not have led to severe anemia that culminated in the patient's death. The anatomopathological findings were compatible with biliary cirrhosis and multifocal liver fibrosis, accompanied by the presence of anemia and consequent hypovolemia. Keywords: congenital diaphragmatic hernia, congenital abnormalities, cats. Título: Hérnia Diafragmática Peritoneopericárdica em um Felino da Raça PersaDescritores: hérnia diafragmática congênita, anomalias congênitas, felinos.

Peritoneopericardial diaphragmatic hernia in a healthy adult feline (Felis catus domesticus): diagnosis to surgical treatment - Case repor

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.

Diagnosis and repair of peritoneopericardial diaphragmatic hernia (PPDH) in a Doberman dog: A first report from India

Diagnosis and repair of peritoneopericardial diaphragmatic hernia (PPDH) in a Doberman dog: A first report from India

DIAGNOSIS AND TREATMENT OF A PERITONEOPERICARDIAL HERNIA IN AN ADULT DOG: A CASE REPORT

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.

Congenital peritoneopericardial diaphragmatic hernia in an geriatric Persian cat

Peritoneopericardial diaphragmatic hernia (PPDH) is a rare condition that is caused by defective diaphragm and pericardium development. It occurs in dogs and cats and is most prevalent in Weimaraner and Persian breeds. This study presents the first report of a congenital peritoneopericardial diaphragmatic hernia in a geriatric cat in Espírito Santo in Brazil. A 12-year old male Persian cat was referred to the veterinary hospital. Clinical examination revealed hyporexia, cachexia, alopecia, dyspnea, and an adherent and irregularly shaped nodule in the left caudal breast. Cytopathological examination of the abdominal nodulation revealed a mammary carcinoma. Thoracic radiography revealed PPDH. The animal was euthanized. On necropsy, the abdominal cavity revealed a part of the liver inside the diaphragm, and the thoracic view revealed the heart and liver inside the pericardial sac. Histopathological analysis confirmed mammary carcinoma and revealed dermatophytic pseudomycetoma. This is the first report of PPDH, which was incidentally detected, in a geriatric Persian cat that had survived for several years without diagnosis in Espírito Santo, Brazil. From the observations made, we conclude that comprehensive clinical examination, involving imaging, is important in detecting congenital abnormalities such as PPDH.

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs.

To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). Retrospective study. One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Novel peritoneopericardial diaphragmatic hernia in a dog

A 23-month-old German shepherd dog (GSD) with chronic intermittent gastrointestinal signs presented following acute deterioration compatible with gastrointestinal obstruction and suspected peritoneopericardial diaphragmatic hernia (PPDH). Physical examination revealed depression, abdominal...