RadLand: Weird Hernia

This cat presented to DoveLewis with a lack of organs in his abdomen. Alan Lipman, DVM, DACVR, provides his assesment. 

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A six-year-old DLH feline presented to DoveLewis with a two-day history of intermittent vomiting, lethargy and partial anorexia. Abdominal palpation revealed mild discomfort, however, overt evidence of a mass or obstruction was not identified. Blood work was unremarkable with the exception of a moderately elevated ALT of 440 U/L. Abdominal radiographs were performed.

Right lateral abdominal radiograph

Right lateral thoracic radiograph

Radiographic findings included the absence of visualization within the peritoneal cavity of the liver, or the majority of the small intestine. The stomach appeared mildly distended with gas and fluid. No evidence of peritoneal effusion or free peritoneal gas was identified. A peritoneopericardial hernia was suspected and confirmed with thoracic radiographs.  

Herniation of abdominal viscera into the pericardial sac results from the creation of a communication between the tendinous portion of the diaphragm and the pericardial sac. Herniation may result from a congenital defect or may be an acquired process. Clinical signs are not always present and many of these cases are discovered as an incidental finding.

Radiographic findings include identification of abdominal viscera within the pericardial sac, globoid enlargement of the cardiac silhouette, absence of abdominal viscera within the peritoneal cavity, a confluent silhouette between the cardiac silhouette and diaphragm and visualization of the dorsal peritoneopericardial mesothelial remnant. This structure can be identified between the caudodorsal aspect of the cardiac silhouette and diaphragm on the lateral projection and is usually dorsal to the location of the caudal vena cava. A small quantity of positive contrast medium can be administered orally to identify small intestinal segments within the pericardial sac if radiographic findings are equivocal. Alternatively, ultrasound has been used to establish a definitive diagnosis.

Abdominal exploratory with reduction of the herniated material was performed. The hiatus was closed and the patient was discharged several days later.

Have you ever diagnosed and/or treated a PPDH? Was is it caused by trauma or congenital?

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