Diaphragmatic hernias in horses

Diagnostic and Treatment Challenges for Diaphragmatic Hernia in Equids: A Concise Review of Literature

Diaphragmatic hernia (DH) represents an acute abdominal crisis, but respiratory symptoms may be occurring. Different types of diaphragmatic hernias (DHs) like typical DH, Morgagni hernia, hiatal hernia and diaphragmatic diverticulum have been recorded in equids. These DHs have various clinical presentations and prognoses. Early diagnosis and prompt surgical repair are highly recommended in order to diminish the ischemic changes to thoracic and abdominal viscera, thus improving the overall prognosis of equids with DH. Over last decade, the prognosis of DH in equids was better than previously believed due to improvements in diagnostic tools, general anesthesia of equids, (particularly those with systemic compromise) and gastrointestinal surgery, development of thoracoscopic techniques and use of staples for surgical repair. Nevertheless, several diagnostic and treatment challenges are still present during management of DH in equids. Diagnostic challenges include inconsistent clinical signs of DH, acute nature of the associated colic and absence of highly qualified diagnostic tools. Increased awareness of the case, good clinical observation and availability of diagnostic tools are recommended to overcome these challenges. Also anesthesia, reduction of large herniated organs and herniorrhaphy are major challenges. Preoperative stabilization, careful monitoring, selection of the most accessible surgical approach and good intraoperative as well as postoperative support are highly recommended to overcome these challenges. Surgical repair, particularly prosthetic herniorrhaphy seems to be effective to close the diaphragmatic defect and prevent recurrences. The present review describes the different types of DHs in equids, their diagnostic and treatment challenges and how to overcome these challenges.