Surgical Correction of Congenital Peritoneopericardial Diaphragmatic Hernia with Adhered Hepatic Lobes and Cholecystitis

A six months old, male Shih Tzu dog was referred to the Veterinary Medical Teaching Hospital at Kangwon National University, for lethargy, respiratory embarrassment. Survey radiography revealed enlarged cardiac silhouette due to displacement of gas-filled intestine in the pericardium. Although there were no specific clinical signs, this case was diagnosed as peritoneopericardial diaphragmatic hernia (PPDH) based on the results of positive contrast radiography and thoracic ultrasonograpic findings. In addition, the thickened gall bladder wall observed in ultrasonography, increase of alkaline phosphatase and neutrophils indicated cholecystitis. Two hepatic lobes and gall bladder were severely necrotized and adhere to the diaphragm. Direct reduction of the herniated organs might cause hepatic hemorrhage and bile juice leakage which may induce very poor prognosis. To solve the problems, the adhered organs were dissected with part of diaphragm, and lobectomy with cholecystectomy was performed for prevention of some possible complications including peritonitis. This is case report describing resection of part of diaphragm adhered to herniated organ reduce the risk of possible hepatic hemorrhage during surgical correction of PPDH followed bycholecystectomy and lobectomy.

간엽유착과 담낭염을 동반한 선천성 복막심낭 횡격막 허니아의 효과적 수술처치