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===Radiography===
===Radiography===
'''Plain chest radiographs''' will show that the margin of the diaphragm is no longer evident and abdominal organs, particularly gas-filled loops of small intestine, may be observed within the chest. This appearance should be distinguished from that of [[Hernia, Peritoneo-pericardial Diaphragmatic|peritoneopericardial diaphragmatic hernia]] in which abdominal organs only overly the cardiac silhouette. If the diagnosis is not certain, a barium swallow series could be performed or contrast medium could be instilled directly into the peritoneal cavity but these procedures have largely been superseded by the use of ultrasound.
'''Plain chest radiographs''' will show that the margin of the diaphragm is no longer evident and abdominal organs, particularly gas-filled loops of small intestine, may be observed within the chest. This appearance should be distinguished from that of [[Hernia, Peritoneopericardial Diaphragmatic|peritoneopericardial diaphragmatic hernia]] in which abdominal organs only overly the cardiac silhouette. If the diagnosis is not certain, a barium swallow series could be performed or contrast medium could be instilled directly into the peritoneal cavity but these procedures have largely been superseded by the use of ultrasound.
===Ultrasonography===
===Ultrasonography===
The edges of the tear are gradually replaced by fibrous tissue and these may need to be resected if a surgical repair is subsequently attempted.
The edges of the tear are gradually replaced by fibrous tissue and these may need to be resected if a surgical repair is subsequently attempted.
==Treatment==
===Stabilisation===
In most acute cases, animals must be stabilised before the tear in the diaphragm can be repaired surgically. This may involve the following steps:
In most acute cases, animals must be stabilised before the tear in the diaphragm can be repaired surgically. This may involve the following steps:
*Provision of '''oxygen''' to dyspnoeic animals, using a mask, flow-by or intra-nasal catheter.
*Provision of '''oxygen''' to dyspnoeic animals, using a mask, flow-by or intra-nasal catheter.
*Other measures to treat other traumatic injuries.
*Other measures to treat other traumatic injuries.
===Surgical Repair===
Traditionally, it was recommended that at least 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.
Traditionally, it was recommended that at least 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.
*Graft of omentum over sutures placed in the diaphragm.
*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:
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 restore 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.
*'''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 restore 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.
*Provision of '''analgesia'''.
*Provision of '''analgesia'''.
==Prognosis==
Patients that undergo surgical repair of a rupture have a favourable prognosis, with around 90% being discharged after treatment. Animals that survive the first 24 hours after surgical repair are generally considered to do well subsequently.
Patients that undergo surgical repair of a rupture have a favourable prognosis, with around 90% being discharged after treatment. Animals that survive the first 24 hours after surgical repair are generally considered to do well subsequently.
==References==
[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11491 Image of traumatic diaphragmatic hernia with displaced intestine in a dog by Cornell Veterinary Medicine]
[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11491 Image of traumatic diaphragmatic hernia with displaced intestine in a dog by Cornell Veterinary Medicine]
Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition) Mosby Elsevier
Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition) Mosby Elsevier