What is a diaphragmatic hernia?
The diaphragm is the thin muscular wall that normally separates the abdomen from the thorax.
We speak of diaphragmatic hernia when the abdominal organs (liver, spleen, intestines, kidney) are introduced into the thoracic cavity due to a tear in the diaphragm or a congenital anomaly in its development which leads to a greater or lesser communication between the abdominal, thoracic and pericardial cavities.
What causes diaphragmatic hernia in dogs?
The most common cause of a diaphragmatic hernia is external trauma such as a road accident, crush or fall that causes the diaphragm to rupture.
But, more rarely, a diaphragmatic hernia can be of congenital origin. We are then dealing with either a pleuro-peritoneal hernia or a peritoneo-pericardial hernia. In the second case, there is continuity between the peritoneal space and the pericardial sac (the envelope that surrounds the heart) which can, in the most severe cases, result in heart rhythm disorders in particular.
A family trait is suspected for this anomaly so that certain breeds are more often affected, such as the German Shepherd and the Poodle.
What are the symptoms of a diaphragmatic hernia?
Symptoms depend on the severity of the hernia. Depending on its origin, they can appear from birth or following a trauma, sometimes even a few days or weeks after the latter.
When abdominal contents protrude into the chest cavity, it can compress the lungs and prevent them from fully inflating, causing breathing difficulties.
The pet owner may also notice symptoms such as gastrointestinal disorders (vomiting, diarrhea, constipation, pain) and anorexia. The dog's abdomen may appear hollow on palpation.
In severe or acute cases, there is often respiratory distress, abnormal heart rhythm, and other signs of systemic shock.
Some congenital diaphragmatic hernias are asymptomatic and discovered fortuitously during an operation for another reason or cause symptoms only following a trauma that aggravates the hernia.
How is a diaphragmatic hernia diagnosed?
The diagnosis is based on the memorials, the results of the clinical examination and the study of the radiographs of the chest x-rays.
In some cases, ultrasound or special x-ray studies using dyes will be needed to make a definitive diagnosis.
What is the treatment for diaphragmatic hernia?
If the diaphragmatic hernia follows recent trauma, the animal will need to be medically stabilized before the hernia can be surgically corrected.
Some dogs will even need an emergency thoracocentesis to remove any fluid that has accumulated in the chest cavity.
Once the dog is stabilized, the hernia is surgically corrected. The treatment is complex and includes reduction of the hernia (the organs are replaced in the abdominal cavity) followed by suturing of the diaphragmatic breach.
In forms of congenital diaphragmatic hernias, surgery as early as possible is often desirable.