Equis ISSN 2398-2977

Diaphragm: hernia

Contributor(s): Christopher Brown, Timothy Mair

Introduction

  • Rare
  • Cause: congenital (rare) or acquired (trauma).
  • Signs: death, colic, respiratory embarrassment, but very variable.
  • Diagnosis: radiography, ultrasound, clinical signs; often not diagnosed until laparotomy.
  • Treatment: surgery.
  • Prognosis: guarded.

Pathogenesis

Etiology

  • Congenital: either as a result of failure of fusion of diaphragm during fetal development or from rupture during parturition. Congenital defects most commonly reported in the left dorsal quadrant of the diaphragm.
  • Acquired: usually in association with a fall, violent exercise, external trauma, or increased abdominal pressure. Most often seen in the middle portion of diaphragm.
  • Euthanasia: ruptured diaphragms have been reported at postmortem in animals with no previous history or clinical signs. Such defects are usually located dorsal to the xiphoid and are presumed to occur at the time of euthanasia.

Pathophysiology

  • Small defects allow herniation of small intestine; accumulation of gas and ingesta in these cases leads to rapid incarceration and strangulation, leading to severe abdominal pain and and deterioration in cardiovascular staus due to endotoxemia.
  • Large defects allow the large colon and liver to enter the thoracic cavity; strangulation in these cases is uncommmon. Signs probably related to bowel distension and mesocolon tension.

Timecourse

  • Onset of clinical signs variable and dependent on volume of intestines herniated and if there is any strangulation.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Palmer J E (2012)Colic and diaphragmatic hernias in neonatal foals.Equine Vet Educ24(7), 340-342 Wiley Online Library.
  • Boerma S, Back W & Sloet van Oldruitenborgh-Oosterbaan M M (2012)The Friesian horse breed: A clinical challenge to the equine veterinarian?Equine Vet Educ24(2), 66-71 VetMedResource.
  • Collier D S (2000)Comparative aspects of diaphragmatic hernia.Equine Vet J31(5), 358-359 PubMed.
  • Goehring L S, Goodrich L R & Murray M J (2000)Tachypnoea associated with a diaphragmatic tear in a horse.Equine Vet J31(5), 427-432 PubMed.
  • Edwards G B (1993)Diaphragmatic hernia - a diagnostic and surgical challenge.Equine Vet Educ5(5), 267-269 VetMedResource.
  • Proudman C J & Edwards G B (1992)Diaphragmatic diverticulum (hernia) in a horse.Equine Vet J24(3), 244-246 PubMed.


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