Diagnosis and Treatment of Diaphragmatic Hernia in Dogs

Diaphragmatic hernia (DH) in dogs is an abnormal condition where abdominal organs protrude through the diaphragm into the thoracic cavity. This protrusion can be classified as either true hernia, where the herniated organs are enclosed in a sac formed by the pleura or peritoneum, or false hernia, lacking such a sac. Furthermore, based on etiology, DH can be categorized as traumatic or non-traumatic. This paper presents a case study of a traumatic diaphragmatic hernia in a dog, detailing the diagnostic process, surgical intervention, and postoperative care, culminating in a successful recovery.

I. Case Presentation

The patient was an 8-month-old female Cocker Spaniel weighing 4 kg, exhibiting good nutritional status and a history of good health prior to the incident. The dog was struck by a car while being walked at night without a leash. Immediately following the accident, the dog was unable to stand, exhibiting tachypnea (rapid breathing), and low whining. The owner promptly brought the animal to the veterinary clinic.

II. Clinical Examination

Initial examination revealed the following: Temperature: 37.8°C; Heart rate: 185 bpm; Respiratory rate: 75 bpm; Pale oral mucous membranes; Absent heart sounds on auscultation of the left thorax; Weak pulse; and dyspnea (difficulty breathing). Multiple superficial abrasions were observed on the body surface, but no muscle damage was detected.

III. Hematological and Biochemical Analysis

Table 1: Hematological Examination

| Parameter | Result | Reference Range | Unit |

|—————|—————–|———————-|——————-|

| RBC | 4.50 | 5.5–8.0 × 10¹²/L | ×10¹²/L |

| HCT | 0.25 | 0.37–0.53 L/L | L/L |

| HGB | 83 | 120–170 g/L | g/L |

Table 2: Biochemical Examination

| Parameter | Result | Reference Range | Unit |

|———————-|——–|—————–|——|

| Blood Glucose (GLU) | 15 | 4.5–8.5 | mmol/L|

| ALT | 188 | 8–75 | U/L |

The elevated ALT (alanine aminotransferase) level suggested liver injury, a potential complication of diaphragmatic hernia. The slightly lower than normal RBC, HCT, and HGB indicated mild anemia, likely resulting from blood loss due to the trauma. The elevated blood glucose may reflect stress hyperglycemia.

IV. Radiographic Diagnosis

Radiographic examination (Figure 2 – not included here, but would show increased opacity in the right caudodorsal thorax, loss of the cardiophrenic angle, and indistinct diaphragmatic silhouette) revealed increased opacity in the right caudodorsal thorax, obliteration of the cardiophrenic angle, and loss of the diaphragmatic silhouette. These findings strongly suggested a diaphragmatic hernia. The displacement of abdominal viscera into the thoracic cavity was clearly evident.

Given the dog’s weakened state, immediate surgery was deemed risky. A 24-hour observation period with supportive care was initiated.

V. Conservative Management

Conservative management consisted of oxygen therapy, haemostatic measures, analgesia, and broad-spectrum antibiotic administration. After 2 days of supportive care, the dog’s condition improved significantly (Temperature: 38.2°C; Heart rate: 155 bpm; Respiratory rate: 34 bpm; Able to stand and walk; Alert and responsive). The animal was then deemed suitable for surgery.

VI. Surgical Procedure

General anesthesia was induced using propofol (4 mg/kg IV) followed by endotracheal intubation and maintenance with isoflurane. The patient was placed in dorsal recumbency. A midline sternotomy was performed. Upon opening the thoracic cavity, the liver was found to have herniated through a diaphragmatic rupture, compressing the lungs and heart. The spleen was also congested and enlarged. The liver lobes were gently manipulated back into the abdominal cavity. The diaphragmatic defect was then repaired using continuous suture, approximating the edges of the defect to the adjacent costal muscles. A chest drain was placed for fluid removal, then removed following the assurance of proper seal during exhalation. The thoracic cavity was closed in layers. The abdomen was also closed routinely.

VII. Postoperative Radiography and Care

Postoperative radiography (Figure 3 – not included here, but would show a clear diaphragmatic line, clear cardiac silhouette, and increased lung opacity due to atelectasis and pneumothorax) confirmed the successful repair of the diaphragmatic hernia. However, some atelectasis (lung collapse) and pneumothorax (air in the pleural space) were present, which resolved gradually.

Postoperative care included three days of intravenous fluid therapy, analgesia, wound care, and broad-spectrum antibiotics. Oral fluids were introduced on the fourth day, and the dog was discharged ten days postoperatively with complete wound healing.

VIII. Discussion and Conclusion

This case highlights the successful management of a traumatic diaphragmatic hernia secondary to vehicular trauma. Key diagnostic findings included the radiographic evidence of herniated abdominal organs into the thorax. The elevated ALT indicated liver injury. The preoperative conservative management proved crucial in stabilizing the patient’s condition prior to surgery. Close monitoring during and after surgery, including the use of a heart rate monitor and intravenous catheter for emergency intervention, was essential. The successful outcome emphasizes the importance of prompt diagnosis, appropriate supportive care, and meticulous surgical technique in managing traumatic diaphragmatic hernia in dogs. The long-term prognosis is generally good with proper surgical repair and postoperative care. However, ongoing monitoring for potential complications such as pneumonia or adhesions is warranted.