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Surgery of the diaphragm
/content/chapter/10.22233/9781910443347.chap17
Surgery of the diaphragm
- Author: Stephen Baines
- From: BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
- Item: Chapter 17, pp 209 - 229
- DOI: 10.22233/9781910443347.17
- Copyright: © 2018 British Small Animal Veterinary Association
- Publication Date: October 2018
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. Operative Technique: Surgery for diaphragmatic rupture
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Figures
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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. © 2018 British Small Animal Veterinary Association
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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.
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17.2
Embryological development of the diaphragm. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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17.2
Embryological development of the diaphragm. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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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). © 2018 British Small Animal Veterinary Association
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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).
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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. © 2018 British Small Animal Veterinary Association
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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.
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17.5
Peritoneopericardial diaphragmatic hernia: visualization of the heart through the defect in the diaphragm. © 2018 British Small Animal Veterinary Association
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17.5
Peritoneopericardial diaphragmatic hernia: visualization of the heart through the defect in the diaphragm.
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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. © 2018 British Small Animal Veterinary Association
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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.
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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. © 2018 British Small Animal Veterinary Association
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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.
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17.8
Hiatal hernia: following reduction of the stomach, the phrenico-oesophageal ligament is incised. © 2018 British Small Animal Veterinary Association
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17.8
Hiatal hernia: following reduction of the stomach, the phrenico-oesophageal ligament is incised.
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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. © 2018 British Small Animal Veterinary Association
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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.
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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) © 2018 British Small Animal Veterinary Association
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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)
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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. © 2018 British Small Animal Veterinary Association
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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.
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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. © 2018 British Small Animal Veterinary Association
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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.
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Cranial ventral midline laparotomy.
Cranial ventral midline laparotomy. © 2018 British Small Animal Veterinary Association
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Cranial ventral midline laparotomy.
Cranial ventral midline laparotomy.
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Exposure of the diaphragm.
Exposure of the diaphragm. © 2018 British Small Animal Veterinary Association
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Exposure of the diaphragm.
Exposure of the diaphragm.
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Repositioning liver lobes.
Repositioning liver lobes. © 2018 British Small Animal Veterinary Association
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Repositioning liver lobes.
Repositioning liver lobes.
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Division of adhesions.
Division of adhesions. © 2018 British Small Animal Veterinary Association
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Division of adhesions.
Division of adhesions.
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Examination of tear in diaphragm.
Examination of tear in diaphragm. © 2018 British Small Animal Veterinary Association
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Examination of tear in diaphragm.
Examination of tear in diaphragm.
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Placement of dorsal suture in diaphragm.
Placement of dorsal suture in diaphragm. © 2018 British Small Animal Veterinary Association
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Placement of dorsal suture in diaphragm.
Placement of dorsal suture in diaphragm.
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Closure of the defect.
Closure of the defect. © 2018 British Small Animal Veterinary Association
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Closure of the defect.
Closure of the defect.