Why is this Pekingese vomiting?

June 1, 2018

[1]

This 10 year old male Pekingese was presented for vomiting.

Questions:

1. Describe the radiograph.
2. What is your diagnosis?
3. Explain the surgical steps.
4. What is a critical precaution preop?

[1]

Answers:

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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