Recurrent tension pneumothorax during herniorrhaphy in a dog with concurrent peritoneopericardial diaphragmatic hernia and pleuropericardial hernia

Authors: Siow JW, Chau L, Wilson L, Rose AM
Publication: Australian Veterinary Practitioner, Volume 50, Issue 1, pp 6-16, Mar 2020
Publisher: Australian Veterinary Association

Animal type: Dog
Subject Terms: Abdomen, Clinical examination, Congenital disease, Surgery
Article class: Clinical Report

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Abstract:

Case report: A 10-month-old male neutered English setter presented for vomiting, inappetence, lethargy and abdominal pain. The dog had a history of previous congenital umbilical hernia repair. Radiography and computed tomography revealed a peritoneopericardial diaphragmatic hernia, and a pleuropericardial hernia via a suspected pericardial defect. The spleen, multiple liver lobes, gall bladder, omentum, and multiple loops of small intestine had herniated into the pericardial sac, with fatty tissue also herniating into the left caudal pleural space. The peritoneopericardial diaphragmatic hernia was surgically repaired without repairing the pleuropericardial hernia, during which multiple episodes of tension pneumothorax occurred. The dog was discharged 36 hours post-operatively. At recheck two weeks later, the dog was clinically well. At verbal follow-up 14 months post-operatively, the owner reported that the dog was clinically normal with excellent quality of life.

Conclusion: To the authors' knowledge, concurrent peritoneopericardial diaphragmatic hernia and pleuropericardial hernia have not been reported in the veterinary literature. The presence of herniated fat in the pleural space and pericardial sac allowed identification of the pericardial defect via computed tomography. The occurrence of multiple tension pneumothoraxes during routine peritoneopericardial diaphragmatic herniorrhaphy is unusual, and the concurrent pericardial defect is suspected to have been the main contributing factor.

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