Diaphragmatic hernia

Abstract

PHOTOS 1,2: Diaphragmatic hernia is the protrusion of abdominal organs into the thoracic cavity through an abnormal opening in the diaphragm. Diaphragmatic hernia may be congenital or acquired as a result of blunt trauma due to being hit by a car, high-rise syndrome, fighting, dog attacks. It may also be iatrogenic. Clinical signs include respiratory distress, borborygmus over the chest, asymmetrically quiet heart or lung sound and failure to distinguish between organs when the abdomen is palpated. Thoracocentesis and gastrocentesis may be done to relieve the dyspnoea. Immediate surgical correction is needed if the stomach has herniated, the bowel or organs are strangulated, the viscera have ruptured or if there is an inability to oxygenate after medical treatment. A traumatic diaphragmatic hernia is caused by an abrupt increase in intra abdominal pressure due to a forceful blow to the abdominal wall. The lungs then deflate rapidly resulting in a pleuroperitoneal gradient which causes the diaphragm to rupture at its weakest points. Congenital diaphragmatic hernias are due to dysfunctional development during embryogenesis. The defect causing the hernia may arise due to prenatal injury to the septum transversum or faulty development thereof. PHOTOS 3,4: Radiographic imaging may be necessary to confirm a diagnosis of a diaphragmatic hernia. In these radiographs of a Dachshund puppy, gas-filled loops of bowel can be seen crossing the diaphragm.

REFERENCES: PHOTOS 1,2: Morgan, RV (ed) 1997, ‘Handbook of small animal practice’, 3rd ed., WB Saunders, Philadelphia, pp. 200-201.