Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi‐institutional study of 128 dogs

Abstract

ObjectiveTo compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT).Study designRetrospective study.Sample populationOne hundred twenty‐eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed.MethodsMedical records were reviewed for demographics, perioperative findings, and outcomes. Follow‐up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups.ResultsDogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety‐seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow‐up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively).ConclusionPreoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long‐term survival.Clinical significanceA diagnosis of PPDH can confer a good long‐term prognosis for both ST and CT dogs.

Diagnostic imaging features of hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

“…Based on the histopathology results and perfusion of the herniated liver on CT, the hepatic parenchyma incarcerated in a PPDH showed chronic liver changes, although the patient had no symptoms and abnormal blood work results. In a retrospective study of dogs with PPDH, histopathologic results of the herniated liver with grossly abnormal appearance were also hepatic or portal fibrosis [ 11 ]. To our knowledge, there are no imaging studies of altered perfusion in incarcerated liver in a PPDH.…”

“…Large defects in the diaphragm can result in adhesions of abdominal organs to the pericardium and incarcerate of organs in the pericardium [ 12 ]. Dogs that received surgical treatment tended to show clinical signs associated with PPDH, and the herniation of liver was confirmed in 66% of them [ 11 ]. It has also been reported that herniation of the liver is associated with a poor prognosis in fetal congenital diaphragmatic hernia in human medicine, suggesting compression of the lung by the herniated liver, and increased size of defect in the diaphragm and disturbed regulation of liver growth [ 13 ].…”

Case Report: Unusual Peritoneopericardial Diaphragmatic Hernia in an 8-Month-Old German Shepherd Dog, Associated With a Pericardial Pseudocyst and Coexisting Severe Pericardial Effusion Resulting in Right-Sided Heart Failure

“…There are three classifications of the pentalogy of Cantrell. In class 1, patients have all five defects, patients with class 2 have four defects, including intracardiac and ventral wall anomalies, and patients with class 3, also known as the incomplete expression, have various combinations of abnormalities including a sternal defect ( 4 , 5 ). To date, in veterinary medicine, this classification does not exist.…”

“…Animals with PPDH often have other concurrent congenital abnormalities such as midline defects (e.g., umbilical hernia, cleft palate, sternal abnormalities) and cardiac defects (e.g., ventricular septal defects, subaortic stenosis, pulmonic stenosis, atrial septal defect) (4)(5)(6)(7)(8). Peritoneopericardial diaphragmatic hernia is commonly seen as a congenital abnormality in several animals of the same litter (6)(7)(8)(9).…”

Pneumopericardium with concomitant pericardial effusion following peritoneopericardial diaphragmatic hernia repair in a dog

“…2,[4][5][6][7] Theoretically all visceral organs may be displaced, but liver, gall bladder and small intestines are most commonly herniated. 2,5,7 Physical examination may reveal muffled heart sounds, heart murmurs or decreased lung sounds, thoracic borborygmi or an empty abdomen on palpation. [2][3][4]6,7 Affected animals are asymptomatic or show non-specific clinical signs like lethargy, weight loss, anorexia, exercise intolerance, gastrointestinal or respiratory clinical signs or even cardiovascular collapse.…”