Ch 85 - Diaphragmatic hernia

Question 1

Seibert JAVMA 2021

Relationships between congenital peritoneopericardial
diaphragmatic hernia or congenital central diaphragmatic
hernia and ductal plate malformations in dogs and cats

Answer 1

PROCEDURES
Evaluation of clinical details verified PPDH or CCDH and survival times.
Histologic features of nonherniated liver samples were used to categorize
DPM. Immunohistochemical staining for cytokeratin-19 distinguished bile
duct profiles per portal tract and for Ki-67–assessed cholangiocyte proliferation.
Histologic features of herniated liver samples from PPDH or CCDH
were compared with those of pathological controls (traumatic diaphragmatic
hernia, n = 6; liver lobe torsion, 6; ischemic hepatopathy, 2).
RESULTS
DPM occurred in 13 of 18 dogs with the proliferative-like phenotype predominating
and in 15 of 18 cats with evenly distributed proliferative-like and
Caroli phenotypes. Congenital hepatic fibrosis DPM was noted in 3 dogs
and 2 cats and renal DPM in 3 dogs and 3 cats. No signalment, clinical signs,
or clinicopathologic features discriminated DPM. Kaplan Meier survival
curves were similar in dogs and cats. Bile duct profiles per portal tract in
dogs (median, 5.0; range, 1.4 to 100.8) and cats (6.6; 1.9 to 11.0) with congenital
diaphragmatic hernias significantly exceeded those in healthy dogs
(1.4; 1.2 to 1.6) and cats (2.3; 1.7 to 2.6). Animals with DPM lacked active
cholangiocyte proliferation. Histologic features characterizing malformative
bile duct profiles yet without biliary proliferation were preserved in herniated
liver lobes in animals with DPM.
CONCLUSIONS AND CLINICAL RELEVANCE
DPM was strongly associated with PPDH and CCDH. Because DPM can
impact health, awareness of its coexistence with PPDH or CCDH should
prompt biopsy of nonherniated liver tissue during surgical correction of
PPDH and CCDH.

Question 2

Conte Vet Surg 2020

Computed tomographic comparison of esophageal hiatal
size in brachycephalic and non-brachycephalic breed dogs

Answer 2

Methods: Clinical records and images of dogs that underwent computed
tomography between June 2015 and September 2018 were reviewed. For the
first part of the study, EH and aortic (Ao) cross-sectional surface areas were
measured in brachycephalic (group 1) and nonbrachycephalic dogs of similar
body size (<15 kg) without respiratory or gastroesophageal (GE) signs (group
2) by using multiplanar reconstruction. Esophageal hiatus:aortic ratio was calculated.
In the second part of the study, absolute EH measurements were also
compared in weight-matched (WM) dogs (8-10 kg) from groups 1 and 2.
Results: Mean (±SD) of EH:Ao values for group 1 (8.1 ± 2.8) were higher
(P < .0001) than those for group 2 (3.7 ± 1.1). In addition, EH measurements
of 20 WM dogs in group 1 were higher than those of 20 dogs in
group 2 (P < .05).
Conclusion: Esophageal hiatus cross-sectional surface area (directly and indirectly
measured) in brachycephalic dogs was considerably larger than that in
nonbrachycephalic dogs of generally similar body size.
Clinical significance: Results of this study provide evidence to support the
existence of a specific anatomical factor that could likely correlate to functional
GE alterations (eg, regurgitation, gastroesophageal reflux, and sliding
hiatal hernia) commonly seen in brachycephalic dogs.

Question 3

Morgan Vet Surg 2020

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

Answer 3

Results: Dogs 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). Followup
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).
Conclusion: Preoperative 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 significance: A diagnosis of PPDH can confer a good long-term
prognosis for both ST and CT dogs.