Diaphragmatic Hernia in Horses

Diaphragmatic Hernia in Horses - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

Most common symptoms

Pain / Shallow Rapid Breathing

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Most common symptoms

Pain / Shallow Rapid Breathing

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Diaphragmatic Hernia in Horses - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

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What is Diaphragmatic Hernia?

Clinical signs that may be seen in horses are difficulty breathing and signs of severe abdominal pain. These are often non-specific symptoms, however, following proper veterinary assessment this condition will often be suspected due to changes in chest sounds, and confirmed using numerous diagnostic techniques. As chances of full recovery increase greatly with early diagnosis it is vital that if you suspect your horse may be suffering from this condition, you contact your veterinarian.

A diaphragmatic hernia is a potentially life-threatening condition in which the intestines protrude into the thorax, causing severe pain and complications such as pneumothorax, pleural effusion or strangulation of the intestine. This condition can be caused by congenital defects or trauma, such as rib fractures or blunt trauma to the chest.

Symptoms of Diaphragmatic Hernia in Horses

The clinical signs may vary. The most common symptom seen is signs of severe abdominal pain. Other symptoms may include: 

  • Respiratory distress such as difficulty with breathing
  • Rapid breathing
  • Blue mucous membranes
  • Signs due to complications such as pneumothorax (fluid in the thoracic cavity)
  • Muffled heart and lung sounds

Causes of Diaphragmatic Hernia in Horses

Congenital Diaphragmatic Hernia (CDH)

This may occur as a secondary condition to pulmonary hypoplasia. There are many forms of CDH, which include forms in which the intestinal contents enter the thorax in complete hernia cases. In incomplete hernias, such as diaphragmatic diverticulum, the abdominal contents enter the thorax, however, are covered by a thin membrane.

Acquired diaphragmatic hernia (ADH)

This often occurs following a trauma, such as a fall while running or a collision with a vehicle.  In some cases, internal pressures may cause ADH, such as advanced pregnancy.

Diagnosis of Diaphragmatic Hernia in Horses

Your veterinarian will carefully examine your horse, performing a head to tail examination. During this time, he will carefully listen to the heart, lungs and gastrointestinal tract. While auscultating the thorax the veterinarian may be able to hear clinically abnormal sounds, such as decreased lung sounds during respiration, decreased or muffled heart sounds, and increased gut sounds in the thoracic cavity. Your veterinarian will carefully palpate your horse’s abdomen, and may able to feel organ displacement. Rectal palpation may also be performed by your veterinarian which may show further organ displacement. 

Your veterinarian will discuss the clinical history with you; if you have witnessed any trauma to your horse it is vital you discuss this with your veterinarian. 

Ultrasonography will likely be utilized in order to diagnose your horse as it allows visualisation of the abdomen and thorax, with the small intestine visible as small, gas or fluid filled tube like structures, while the large colon is seen as a thick-walled structure filled with fluid. The visualisation of these structures will also allow your veterinarian to identify the degree of herniation and involvement of the small intestine or large colon. 

Radiography may also be used visualise the thorax, with contrast medium used to provide further visualisation of the small intestines. Explorative surgeries such as laparoscopy and exploratory celiotomy may also be indicated, although there are risks involved with these and they are contraindicated in horses suffering from acute colic. Your veterinarian may also choose to perform the following diagnostic tests

  • Blood test for complete blood count
  • Nasogastric intubation (as the abdominal contents in the thorax will compress the esophagus, intubation may identify abdominal involvement as expansion of the esophagus will cause acute abdominal distress)
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Treatment of Diaphragmatic Hernia in Horses

Surgical treatment will likely be indicated for your horse. This will be done under general anesthetic, during which your horse’s oxygen levels and saturation will be monitored closely. 

If your horse has suffered a large hernia and is not yet showing severe symptoms, your veterinarian may recommend that surgery is delayed for 4-12 weeks following the trauma in order to allow tissue to form at the site of protrusion. This tissue will provide a better margin to suture and increase the chance of surgical success, rather than friable tissue immediately following the trauma.  

For horses that have suffered small hernias, prompt surgical correction will likely be recommended to prevent frequent, repeat small intestine incarceration and damage. 

During surgery, your veterinarian will carefully return the intestines to the abdominal cavity. The hernia will then be closed using suture material for large hernias, or surgical mesh for smaller defects. In the preoperative period, your horse will be supported via oxygen support, intravenous fluid therapy, analgesia, and antimicrobial therapy.

Recovery of Diaphragmatic Hernia in Horses

The prognosis for horses suffering from this condition is good following prompt veterinary attention. Although often the prognosis was listed as poor, recent research has shown a drastic improvement in outcomes for horses suffering from this conditions, young horses who suffered from this condition and received surgical treatment going on to recover fully and race competitively.

The challenges around anesthesia and surgical treatment may decrease the chance of successful treatment, as poor respiration due to complications such as pneumothorax increase anesthetic risk.

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Diaphragmatic Hernia Average Cost

From 525 quotes ranging from $6,000 - $12,000

Average Cost

$8,000

Diaphragmatic Hernia Questions and Advice from Veterinary Professionals

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Amigo

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Quarter Horse

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17 Years

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Critical condition

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Critical condition

Has Symptoms

Colic Like Symptoms

I recently had a horse PTS due a Diaphragmatic Heria. He presented with colic symptoms, and was diagnosed with an impaction colic. All vitals were normal, an ultrasound showed some fluid in his abdomen, and an impaction in his ileum. Treatment included nasal gastric tube, the vet got over 8 gallons of reflux. She did not oil him due to apparently nothing was getting through. The horse was give fluids via IV, and pain management. After about a day he appeared to feel better, and we were instructed to start with light refeeding. Five minutes to start on grass, several times a day, and water. The first day of refeeding he got painful at the end of the day. We went back to IV fluid, and pain management for the night. Next morning he was clearly feeling better and hungry. We were instructed, to start with small periods of grass, and water. His urine output was normal, his manure was sporatic, we were not surprised as he had not been eating, but we could tell that he was still passing feed stuff from the last time he had eaten, leading us to believe he still had a partial impaction, but something was getting through. Every day around dinner time he would get painful. The first couple times the pain was attributed to the refeeding and inflammation. Unfortunately the cycle of feeling great all day, eating grass, drinking water, then getting painful at the end of the day continued. After 6 days the vet thought it was time for oil, water and electrolytes via nasal gastric tube, to hopefully help what we assumed to be a partial blockage come loose once and for all. The interesting thing the entire time was that his vitals were always normal. His heart rate was not elevated, his temperature, capillary refill, breathing, all normal. The colic symptoms had begun on a Thursday. The oil was administered on Tuesday the following week. He was acting fine after the oil, drinking wanting to eat. Then just like clock work he got painful around dinner time. But it was a different pain the previous days. He was running, throwing himself on the ground, sweating. We got his halter on and administered banimine IV. It took an hour for him to feel any relief, when previously it had only taken a few minutes. He was then given xylazine, which helped him to relax, but he was clearly still painful. We did out best to keep him comfortable over night, administering pain medication when indicated. He layed down most of the night, getting up once in a while to urinate, and re-position. At this point we were still operating on the notion of a blockage that was not following the text book. The next step the vet called an internist. We met with the internist, who did a quick history, then proceeded with the ultrasound. At first beginning in the abdomen, his small intestine was enlarged, 8cm, but not to surprising since we thought we were still dealing with an impaction. Then as she moved forward following the small intestine, she found where his intestine had moved into his diaphragm. All four vets in the room, got that look on their face when you know something is very bad. The internist could not determine when it had happened, if it had been a chronic condition that got exacerbated by the colic, if the intestine just slipped through a hole that had been there already. Lots of questions unanswered. The fact that his vitals had been normal all week, and that he did not have extreme pain until the gastric tube is telling in my opinion. He had small bouts of pain with a small amount of food and water, then with a larger volume he got very painful. Perhaps the intestine had already displaced, but could handle small amounts of food and water. Then with the large amount the intestine expanded and caused the intense pain. Lots of questions unanswered, I would like to think we did everything right for the colic. The displacement was not on anybody's radar, since his vitals had remained normal, right up until his last painful episode, at which time his heart rate jumped up. By the time the displacement was found it was clearly to late to do anything, expect end his suffering and let him go in peace. Up until the colic had begun he had been acting normal, eating normally, exercised 4-5 times a week with no symptoms of having anything wrong.

Diaphragmatic Hernia Average Cost

From 525 quotes ranging from $6,000 - $12,000

Average Cost

$8,000

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