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Peritoneal-pericardial diaphragmatic hernia (PPDH)

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Synonym(s): Pericardiodiaphragmatic hernia


Introduction

  • Rare condition.
  • Peritoneal-pericardial diaphragmatic hernia (PPDH) is a congenital communication remaining between the pericardial and peritoneal spaces, through the diaphragm.
  • Other congenital defects may be present, eg umbilical hernia, sternal deformity or ventricular septal defect Ventricular septal defect.
  • Signs: usually referable to the respiratory or gastrointestinal systems. 
  • Frequently the patient is asymptomatic and PPDH is found as an incidental finding.
  • Diagnosis: radiography, ultrasonography.
  • Treatment: surgical correction is indicated if the patient is symptomatic. Surgical repair should be performed as early as possible in young animals.
  • Prognosis: good following surgical correction.
Print off the owner factsheet Hernias in cats (diaphragmatic) to give to your client.

Pathogenesis

Etiology

  • Embryological failure of diaphragm development - failure of closure of septum transversum or lateral pleuro-peritoneal folds.

Predisposing factors

General

  • Other family members affected.

Specific

  • Occasionally trauma can precipitate development of clinical signs - presumably by causing further herniation of abdominal organs, but trauma in and of itself is not a cause of PPDH.

Pathophysiology

  • Embryological failure of normal development of the diaphragm.
  • May affect septum transversum or lateral pleuro-peritoneal folds.
  • Communication between pericardial and peritoneal cavities.
  • If large enough defect, herniation of abdominal contents may occur into pericardial sac.
  • Herniation of the liver or gall-bladder may not result in symptoms or signs; occasionally vague malaise, vomiting, inappetence, weight loss.
  • Herniation of gastrointestinal tract usually results in symptoms, with vomiting, inappetence and weight loss to variable severity.
  • Rarely, an entrapped liver lobe may cause a transudate, and pericardial effusion results in signs of compliance failure.

Timecourse

  • Many patients may be asymptomatic for life.
  • Once clinical signs develop, tend to be slowly progressive if defect not corrected.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Reimer S B, Kyles A E, Filipowicz D E et al (2004) Long-term outcome of cats treated conservatively or surgically for peritoneopericardial diaphragmatic hernia: 66 cases (1987-2002). JAVMA 224 (5), 728-732 PubMed
  • Lamb C R, Mason G D, Wallace M K (1989) Ultrasonic diagnosis of peritoneopericardial diaphragmatic hernia in a Persian cat. Vet Rec 125 (8), 186 PubMed.

Other sources of information

  • Miller M W & Sisson D D (1995) Pericardial disorders. In: Textbook of Veterinary Internal Medicine. Eds: S J Ettinger & E C Feldman. Philadelphia: W B Saunders. pp 1032-1045.

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