DIAPHRAGMATIC HERNIA

Pashu Sandesh, 18 October 2023

Ankit Dangi¹and Devika Dangi²

 1. Assistant Professor, Veterinary Surgery and Radiology, International Institute of Veterinary Education & Research, Rohtak

 2. Animal Nutrition, Lala Lajpat Rai University of Veterinary & Animal Sciences, Hisar

Diaphragmatic hernia (DH) is a thoracic-digestive disorder in which there is the evisceration of abdominal viscera into the thoracic cavity through a congenital or acquired defect in the diaphragm. The continuity of the diaphragm is disrupted such that abdominal organs can migrate into the thoracic cavity.

Abdominal organs that herniate:

• Most commonly- Reticulum
• May get involved – omasum, abomasums, loops of intestine, spleen or liver 

It causes chronic ruminal tympany, anorexia and displacement of the heart. It is a chronic wasting and inflammatory disorder in adult buffaloes and cows, and also in buffalo bulls. In small animals mostly it is caused by trauma.

Aetiology:

• Weakening of the diaphragm by the lesions of TRP.
• Congenital weak points of the diaphragm. 
• Increased abdominal pressure during pregnancy or parturition.
• Foreign body – reticular contraction – pricking of the diaphragm constantly – perforation.
• Areas at the junction of muscular and tendinous portion – more prone – lack of tone and thickness.
• Trauma

Buffaloes are more prone than cattle:

• The right ventromedial tendinous zone is much thinner 
• Pericardiophrenic vessels missing 
• Lesser collagen content

Clinical signs:

• Recurrent tympany – proportional to the portion of reticulum herniated – more severe adhesions.
• Aspiratory pneumonia – regurgitation – adhesions cause distortion and derangement in normal alignment of oesophageal groove, cardia and reticulo-omasal opening – sojourn of ingesta in forestomach. 
• Abrupt fall in milk yield.
• Scant defecation or diarrhoea with a foul smell.
• Brisket oedema with or without jugular pulsation.
• Abduction of elbow.
• Chronic cough rarely. 
• If untreated – inanition – progressive emaciation

 – dehydration – death.

• Suspended rumination.

Diagnosis:

• Clinical signs
• Auscultation – muffled cardiac sounds, reticular sounds cranial to 6^th rib.
• Roentgenograms/Radiography:(contrast or simple)
• Right lateral recumbency – most hernia in right hemidiaphragm.
• Supine position – lateral projection – empty reticulum appears as an air-filled viscous in the thoracic cavity.
• Exploratory rumenotomy    
• Ultrasonography 

Treatment:

Firstly:

Laprorumenotomy

• Complete evacuation of rumen
• Removal of any foreign body if present
• Add prebiotic and probiotic 

Secondly :

Herniorrhaphy

• Ventral midline abdominal post-xiphoid approach
• Off-feed for 48 hours following rumen evacuation
• i/v fluids during fasting (polyionic solutions with dextrose)                                                    
• Regular monitoring- ECG, pulse rate, SpO2, blood pressure, heart rate. 
• Negative pressure within the chest cavity is created by suction of air under a water seal
• Extensive adhesions with the pulmonary lobe require partial or complete lobectomy
• Postoperative considerations 
• Antibiotics for 5 – 7 days 
• Analgesic for 3 - 5 days.
• Fluid therapy
• Easily digestible feed 
• Pregnant animal – check for viable foetus
• Suture ASD and removal after 10 – 12 days
• Consider vet advice regularly