Diaphragmatic hernia

Laparoscopic extra-abdominal transfascial suturing technique for diaphragmatic rupture repair in a cat

OBJECTIVE

To describe the technique, complications, and outcome of the laparoscopic extra-abdominal transfascial suturing method for diaphragmatic rupture repair in a cat.

STUDY DESIGN

Case report.

ANIMALS

A 10 year old, female domestic shorthair cat.

METHODS

An acute traumatic diaphragmatic rupture was diagnosed in a cat. Following initial stabilization, 3-port laparoscopic surgery was performed. After the laparoscopic reduction of herniating organs, a circumferential diaphragmatic tear was diagnosed, which was repaired using a multiple extra-abdominal transfascial suture technique. The total surgical time was 50 min with no intraoperative complications encountered.

RESULTS

The successful procedure was confirmed by normalization of chest radiography, clinical signs, and blood gas analysis in the perioperative and postoperative periods. Mild skin irritation occurred 3 weeks after surgery but was resolved following the removal of sutures. The cat recovered well without major complications; the final reexamination was performed 3 months postoperatively.

CONCLUSION

The laparoscopic extra-abdominal transfascial suturing technique appears to be a feasible, and effective technique for feline diaphragmatic circumferential rupture repair. This technique may be an alternative option to intracorporeal suturing for diaphragmatic rupture treatment in the cat.

Concomitant Congenital Diaphagmatic Hernia (CDH) and bilateral bacterial glomerulonephritis in a pet chinchilla (Chinchilla lanigera)

Background

The domestic chinchilla has been descended from Chinchilla lanigera (long-tailed Chinchilla) or Chinchilla chinchilla (short-tailed Chinchilla). Both species of chinchilla are currently listed as endangered by the IUCN Red List of Threatened Species. Over the past 20 years, they have spread as pets and overall knowledge about their care is improving. The present case report describes a congenital diaphragmatic hernia in a Chinchilla lanigera.

Case presentation

A 1-year-old, 420 g female chinchilla (Chinchilla lanigera) was presented for clinical examination due to 2 days haematuria episodes and anorexia. A complete haematological analysis was performed, showing a moderate neutrophilia and severe renal involvement. X-rays showed severe intestinal meteorism affecting mostly the cecum, and a soft tissue density mass with translucent areas located in the caudal thorax, making it hard to distinguish the cardiac silhouette. A barium swallow (barium sulfate) was performed and after 20 min, radiograms were performed again, showing part of the stomach dislocated in thorax. Ultrasound was also carried out, confirming the partial stomach herniation into the thoracic cavity and a severe nephropathy. The patient was euthanized according to the owner’s wish and a complete necropsy was performed. The diagnosis was congenital diaphragmatic hernia concomitant to a severe bilateral bacterial glomerulonephritis.

Discussion and conclusions

Diaphragmatic hernias can be either congenital or acquired. About CDHs in pet chinchillas, literature is still lacking. In this patient there was no history of previous traumas. No scar tissue or thickening involved margins of the pathological diaphragm window at the necropsy, supporting the hypothesis of a congenital defect. Glomerulonephritis most often results from immune-mediated mechanisms, generally after the deposition of soluble immune complexes within the glomeruli. This mechanism is favoured by a prolonged antigenemia that could occur during specific viral infections, chronic bacterial infections, chronic parasitism, autoimmune diseases and neoplasia. Few cases of nephritis are described in chinchillas (Chinchilla lanigera), mostly related to bacterial sepsis or less commonly involving fungi. The evidence of bacterial aggregates in kidneys at the histopathology, confirmed the infective aetiology. No relationship between the diaphragmatic hernia and glomerulonephritis was found in this report.

Morphology of the Diaphragm Muscle in Southern Tamandua (Tamandua tetradactyla) and its Importance in Cases of Traumatic Hernia

The wall of the diaphragm can be affected by changes caused by physical trauma, allowing the passage of viscera between the abdominal cavity and thoracic cavity, thus reducing the space for pulmonary expansion, leading to the formation of hernia and possible death. Thus, we aimed to characterize, size and determine the topography of the diaphragmatic muscle in the Southern Tamandua, since clinical and surgical activities in wild animals have become a reality more and more present in veterinary medicine. We used six adult animals, x-rayed and dissected, followed by collection of fragments of muscular portions for histological analysis. Initially we observed that the animals presented 17 thoracic vertebrae, 3 lumbar vertebrae and 5 sacral vertebrae. The diaphragm was conformed by three segments: sternal, costal and right and left diaphragm pillar, with presence of tendinous centre that housed the passage of the caudal vena cava, called foramen of the caudal vena cava. Dorsally to the tendinous centre, already in the muscle portion, we located the esophageal and aortic hiatus. These findings, as well as the microscopic, were equivalent to that found in the general literature also, corroborating with descriptions already carried out in other mammals' diaphragms.

Diaphragmatic hernia in a cat mimicking a pulmonary mass

A seven-year-old castrated British shorthair cross cat was presented for coughing of five-weeks duration. Thoracic radiographs and an unguided bronchoalveolar lavage showed changes consistent with inflammatory airway disease. In addition, a soft tissue density was evident in the thoracic films between the heart and the diaphragm. Exploratory thoracotomy demonstrated a diaphragmatic hernia, probably congenital in origin, with incarceration of a portion of the hepatic parenchyma. The herniated portion of liver was resected surgically and the defect in the diaphragm closed. The cat was given a 10-day course of doxycycline post-operatively and the cough did not recur subsequently. In retrospect, the hernia was potentially an incidental problem, the cat's coughing being attributable to inflammatory airway disease.

Reparação do diafragma de cães com segmento muscular homólogo ortotópico conservado em solução supersaturada de açúcar

O uso de enxerto muscular homólogo conservado em solução supersaturada de açúcar a 300% foi pesquisado no músculo diafragma de cães. Foram utilizados 12 cães adultos, quatro machos e oito fêmeas, sem raça definida, com peso entre 9 e 18kg, para confecção de um defeito diafragmático na porção muscular, com dimensões de 4,0 × 4,5cm, seguido da implantação de um segmento de músculo diafragma homólogo. Seis cães foram observados por um período de 30 dias de pós-operatório e seis por 60 dias, quando foram reoperados para observação macroscópica e coleta de amostra para avaliação histológica. Nos animais do grupo de 30 dias de pós-operatório verificou-se substituição parcial e nos de 60 dias, substituição total da porção muscular do diafragma por tecido de granulação, o que permitiu o restabelecimento completo do diafragma por meio de firme inserção. O segmento de músculo diafragma homólogo conservado em solução supersaturada de açúcar a 300%, em temperatura ambiente, pode ser utilizado para reparação de defeitos diafragmáticos, uma vez que é substituído por tecido conjuntivo fibroso, sem apresentar sinais clínicos nem histológico de rejeição.

Management of fracture-associated thoracic trauma

Animals with thoracic injury that survive long enough to receive veterinary attention are often through the most critical post-traumatic period. A small proportion will require prompt, aggressive treatment of life-threatening injuries. Many have self-limiting thoracic injuries that can endanger the animal if overlooked when general anaesthesia is attempted for surgical repair of more obvious injuries. Other lesions can be exacerbated by inappropriate therapy. Through evaluation is needed for recognition and proper management of thoracic injuries that pose both immediate and delayed threat to life.