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Surgery of the diaphragm

image of Surgery of the diaphragm
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Abstract

The diaphragm is a musculotendinous sheet that separates the thoracic and abdominal viscera. This chapter covers anatomical relationships, detailed structure, nerves and vessels, embryology, clinical anatomy, function, and management of a range of congenital and acquired diseases of the diaphragm. : Surgery for diaphragmatic rupture

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Figures

Image of 17.1
17.1 Anatomy of the diaphragm. (a) Abdominal surface. (b) Thoracic surface. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 17.2
17.2 Embryological development of the diaphragm. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 17.3
17.3 Peritoneopericardial diaphragmatic hernia. (a) Lateral and (b) ventrodorsal views of the thorax, showing an enlarged cardiac silhouette containing loops of small intestine ventrally and to the right (arrowed). There are also a reduced number of sternebrae and failure of fusion of the caudal sternebra (dysraphism).
Image of 17.4
17.4 Peritoneopericardial diaphragmatic hernia: lateral view of the thorax following oral administration of barium suspension to the dog in Figure 17.3 . Barium-filled loops of small intestine are present within the pericardium and outline a cranial ventral abdominal hernia.
Image of 17.5
17.5 Peritoneopericardial diaphragmatic hernia: visualization of the heart through the defect in the diaphragm.
Image of 17.6
17.6 Protrusion of abdominal organs through the oesophageal hiatus, viewed from the ventral aspect. (a) Normal. (b) Type I: sliding or axial. (c) Type II: rolling or para-oesophageal. (d) Type III: combined types I and II. (e) Type IV: herniation of other organs. (f) Gastro-oesophageal intussusception. C = cardia; D = diaphragm; F = fundus; GOJ = gastro-oesophageal junction; L = left; Lig = phrenico-oesophageal ligament; O = oesophagus; R = right; SI = small intestine. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 17.7
17.7 Hiatal hernia: lateral view of the abdomen and caudal thorax following administration of barium suspension. There is herniation of the stomach through the oesophageal hiatus.
Image of 17.8
17.8 Hiatal hernia: following reduction of the stomach, the phrenico-oesophageal ligament is incised.
Image of 17.9
17.9 Hiatal hernia: closure of the oesophageal hiatus. Sutures have been placed in the diaphragmatic crura dorsal to the oesophagus, to maintain its position.
Image of 17.10
17.10 True pleuroperitoneal hernia. (a) Lateral view of the thorax. The cardiac silhouette is ill-defined ventrally and the trachea is elevated. The caudal sternebrae are fused. (b) Lateral view of the thorax following positive contrast peritoneography. Contrast medium outlines the cranial extent of the parietal peritoneum, which extends into the thorax and contains loops of intestine. (Courtesy of C Lamb)
Image of 17.12
17.12 Ruptured diaphragm. (a) Lateral view of the thorax. The cardiac silhouette and lungs are obscured by an ill-defined heterogeneous soft tissue/fat/gas opacity representing small intestine, colon and liver. The heart is displaced cranially and dorsally. (b) Dorsoventral view of the thorax. The right hemithorax contains an ill-defined heterogeneous soft tissue/fat/gas opacity representing small intestine, colon and liver. The heart is displaced cranially and to the left.
Image of 17.13
17.13 Ruptured diaphragm: visualization of the left caudal lung lobe through a radial tear in the dorsal aspect of the left side of the diaphragm.
Image of Cranial ventral midline laparotomy.
Cranial ventral midline laparotomy. Cranial ventral midline laparotomy.
Image of Exposure of the diaphragm.
Exposure of the diaphragm. Exposure of the diaphragm.
Image of Repositioning liver lobes.
Repositioning liver lobes. Repositioning liver lobes.
Image of Division of adhesions.
Division of adhesions. Division of adhesions.
Image of Examination of tear in diaphragm.
Examination of tear in diaphragm. Examination of tear in diaphragm.
Image of Placement of dorsal suture in diaphragm.
Placement of dorsal suture in diaphragm. Placement of dorsal suture in diaphragm.
Image of Closure of the defect.
Closure of the defect. Closure of the defect.

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