Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18‐year‐old mare

Abstract

Summary An 18‐year‐old Arabian‐mix mare was presented with a history of severe colic. Emergency exploratory celiotomy revealed diaphragmatic hernia, with a large rent in the left dorsal aspect of the diaphragm and large colon volvulus. Attempts to close the defect in the diaphragm in dorsal recumbency were unsuccessful. Therefore, a thoracic approach through lateral thoracotomy was elected, and a mesh was attached to the diaphragm using skin staples. While in dorsal recumbency, the mare suffered from significant respiratory acidosis. Thus, the mare was tilted into reverse Trendelenburg (30° head upward) and ventilation improved markedly. The mare recovered uneventfully, and was doing well 5 years after surgery.

Diaphragmatic hernias in horses

“…; Shnaiderman‐Torban et al . ). Reports of successful repair of DHs using minimally invasive techniques are still scarce but are expected to increase over the next few years.…”

“…Clinical signs associated with a DH may include signs of acute onset of severe colic as the horse in the report by Shnaiderman‐Torban et al . (); however, other affected horses may display mild or intermittent colic signs, respiratory difficulty, exercise intolerance, lethargy or general loss of condition (Perdrizet et al . ; Everett et al .…”

“…As highlighted in the report by Shnaiderman‐Torban et al . (), the typical dorsal location of the diaphragmatic rent and the deep‐chested anatomy of horses make repair of the defect challenging. As a consequence, dorsally located defects have frequently been left open after replacement of herniated bowel; however, recurrence of herniation has been recognised (Dabareiner and White ; Hart and Brown ; Romero and Rodgerson ; personal observation by the author).…”

“…This case report by Shnaiderman‐Torban et al . () describes the surgical closure of the DH in an 18‐year‐old mare through a conventional ventral midline laparotomy approach. The authors are to be commended for the successful completion of a lateral thoracotomy following a ventral midline laparotomy during the same anaesthetic procedure.…”

“…Initial reports on repair of DHs in horses have used ventral midline abdominal surgical approaches, which frequently require blind closure of the defect either by hand or by use of hand-held stapler or laparoscopic instrumentations (Romero and Rodgerson 2010). A thoracic approach after a partial rib resection has been used in cattle (Krishnamurthy et al 1980) and horses under general anaesthesia (Malone et al 2001;Shnaiderman-Torban et al 2015). Reports of successful repair of DHs using minimally invasive techniques are still scarce but are expected to increase over the next few years.…”