Pericardiodiaphragmatic hernia:

A dog presented for an umbilical hernia repair was found to have a pericardiodiaphragmatic hernia.  This is a congenital condition where the pericardial sac surrounding the heart is fused to the right and left crura of the diaphragm resulting in a hernia opening into the abdomen.  Pericardiodiaphragmatic hernias can be of varying size and are dangerous because abdominal contents such as intestines, liver or other abdominal organs can move forward into the pericardial sac. These organs then are at risk of having their blood supply compromised by the hernial ring.  This can result in fluid production if a liver lobe or spleen is herniated causing pericardial and/or pleural effusions.  If intestine is herniated it is at risk not only of swelling but of intestinal blockage and potentially ischemic necrosis which would result in intestinal rupture.  This is a condition where the intestine dies due to inadequate blood flow.  Severe infection (peritonitis) and death would follow.  This particular dog had approximately 1/2 of his small intestines herniated into the pericardium.

The hernial ring as seen on opening the umbilical hernia site. The abdominal incision is held open with a balfor retractor. The pericardiodiaphragmatic hernia is seen above the blades of the retractor and the heart can be seen through the hernia.

The diaphragmatic portion of the hernia has been closed with simple interupted absorbable mattress sutures. The hernia is still open where the diaphragm normally would be attached to the sternum. The heart can just barely be glimpsed through the remaining hernia.

Another view of the partially closed pericardiodiaphragmatic hernia. The forcepts are in the hernia where the diaphragm needs to be sutured to the ventral chest wall by the sternum.

The remaining portion of the pericardiodiaphragmatic hernia has been closed by suturing the diaphragm to the ventral chest wall by the sternum. The abdominal incision around the originally diagnosed umbilical hernia is still open, visable in the bottom half of the photograph.

With the pericardiodiaphragmatic hernia completly closed, the abdominal incision has now also been closed.

The skin edges have now been closed with subcutaneous absorbable sutures. Only skin sutures are necessary to complete the surgery.

The hernial ring as seen on opening the umbilical hernia site. The abdominal incision is held open with a balfor retractor. The pericardiodiaphragmatic hernia is seen above the blades of the retractor and the heart can be seen through the hernia.