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*Keeping the animal in '''sternal recumbency''' to allow more efficient thoracic excursion.
*Keeping the animal in '''sternal recumbency''' to allow more efficient thoracic excursion.
*'''Gastric decompression''' by orogastric tube or percutaneously if the stomach is though to be dilated.
*'''Gastric decompression''' by orogastric tube or percutaneously if the stomach is though to be dilated.
*Provision of '''analgesia'''.
*Other measures to treat other traumatic injuries.
*Other measures to treat other traumatic injuries.
====Surgical Repair====
====Surgical Repair====
Traditionally, it was recommended that 24 hours elapse from the traumatic event until the rupture was repaired to reduce perioperative mortality but newer evidence suggests that, if animals are adequately stabilised before this, surgical repair may still be successful. Post-operative mortality is also higher if the rupture is repaired after a very long interval (more than 1 year) due to the formation of extensive fibrous adhesions.
Traditionally, it was recommended that 24 hours elapse from the traumatic event until the rupture was repaired to reduce perioperative mortality but newer evidence suggests that, if animals are adequately stabilised before this, surgical repair may still be successful. If possible, the repair should be conducted in the first week after rupture as fibrous adhesions begin to form after this time. Post-operative mortality is also higher if the rupture is repaired after a very long interval (more than 1 year) due to the formation of extensive fibrous adhesions.
The defect is approached by a ventral midline coeliotomy (which may be extended cranially beside the xiphisternum or into a median sternotomy) and the abdominal organs are retracted. Fibrinous adhesions can be easily separated but strangulated organs (such as torsed liver lobes or loops of small intestine) should be resected. If the rupture has been present for a long period, its fibrous edges may be debrided before suturing using polydioxanone. If there is a large defect that cannot be closed without tension, the following approaches may be used:
*Transversus abdominis flap
*Use of porcine intestinal submucosa or synthetic mesh
*Graft of omentum over sutures placed in the diaphragm
====Post-operative Care====
Animals that have been treated for diaphragmatic rupture often require intensive care in a dedicated unit. The following aspects of care should be considered:
*'''Thoracostomy tube''': This can be placed through the diaphragm during surgery or a conventional tube can be passed through the chest wall. Negative pressure should restored to the pleural cavity after the rupture is repaired and the diaphragm should be seen to return to its concave shape when viewed from the abdomen. The chest should be drained (of air or fluid) regularly until no more can be aspirated than is expected due to the presence of the tube (~2 ml/kg/hour). Bupivacaine or another local anaesthetic agent can be instilled through the tube to provide topical analgesia.
*'''Pulmonary oedema''' may develop as the lungs re-expand due to physical forces acting on the alveoli and due to reperfusion injury to the alveolar capillaries. This condition should be suspected if the patient remains hypoxaemic even with oxygen therapy and it can be avoided by removing air from the pleural space slowly so that the lungs reinflate in a controlled manner.
*'''Incomplete repair''' or presence of a '''second rupture''': The whole diaphragm should be assessed before closure to ensure that a second tear is not present.
*Provision of '''analgesia'''.
===Prognosis===
In general, patients that