10.6.2: Hernias and rupture

Question 1

Possible hernia locations

Answer 1

• Umbilical
• Inguinal
• Incisional
• Diaphragmatic
• Perineal
• Pericardio-peritoneal
• Hiatal

Question 2

Which breeds are predisposed to hiatal hernias?

Answer 2

• Brachycephalic breeds: English bulldogs, French bulldogs, pugs
• Shar Peis

Question 3

Clinical signs of hiatal hernia

Answer 3

• Clinically similar to oesophagitis: regurgitation, hypersalivation, visceral discomfort
• Normally thin
• Often seen in conjunction with BOAS

Question 4

Diagnosis of hiatal hernia

Answer 4

• Ideally: fluoroscopy
• Radiography - could do barium swallow and take serial images quickly
• ± endoscopy (unlike to get definitive diagnosis from this)

Question 5

Peritoneopericardial diaphragmatic hernia (PPDH)

Answer 5

Congenital communication between pericardial sac and abdomen due to faulty development of septum transversum.

Often associated with cardiac/sternal deformity.

Question 6

Breed predisposition to PPDH

Answer 6

Weimaraner and Cocker Spaniels

Question 7

Clinical signs of PPDH

Answer 7

• Can be asymptomatic
• GI or resp signs e.g. V+/D+, anorexia, weight loss, wheezing, dyspnoea

Question 8

Diagnosis of PPDH

Answer 8

• Radiograph (enlarged cardiac silhouette, dorsally displaced trachea, gas opacities in the pericardial sac)
• Ultrasound
• Contrast radiography (barium swallow)

Question 9

Treatment of PPDH

Answer 9

Surgery:
* Ventral midline coeliotomy
* Incise sternum if necessary
* Reduce viscera
* Suture diaphragm
* No need to separately close the pericardium