Why is this Pekingese vomiting?

Test your knowledge with the June 2018 Brain Teaser


  1. Intestinal loops are superimposed to the cardiac silhouette. Meanwhile, there are few intestinal loops in the abdomen.
  2. Peritoneo-pericardial diaphragmatic hernia (PPDH).
  3. During laparotomy, intestinal loops and other viscera are gently pulled into the abdomen, and the hernia is sutured.
  4. This is a tricky but vital question. Many PPDHs are incidental findings. After all, this patient has been living with a hernia for 10 years. The challenge is to be convinced that the hernia is truly the cause of the vomiting before surgery is considered.

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