Congenital Peritoneopericardial Hernia (PPDH)

 PPDH is a common congenital anomaly in dogs and cats. It is an abnormal development of the transverse septum resulting in a gap in the ventral diaphragm, through which the abdominal contents can advance into the pericardial. This tends to be present at birth.

Z, a 3 year old schnauzer, was seen over the years for on and off digestive signs (vomiting, not eating). He was diagnosed in the past with a PPDH, but due to the lack of clinical signs associated with this at the time, it was considered that there is no need to intervene surgically. Lately, the digestive clinical signs were happening more often and the length of time for the dog to recover was longer. He was passed onto our medicine department and our colleagues, after multiple tests and imaging performed on Z, decided that the most likely cause for the recurrent digestive signs was the PPDH. The owner was aware that the small intestine of Z was not in the abdomen but in the pericardium, which is a sheet of tissue around the heart. This can lead to obstruction and other serious life-threatening complications in some cases.

The owner of Z became worried at the prospect of big surgery. The case was taken over by the surgical team and the procedure was explained in detail. The plan was to anaesthetise Z and enter the abdomen through the midline. Once in the abdomen the hernia would be assessed and the abdominal organs would be replaced into their proper place and the hernia would be closed. Most of these surgeries are straight forward but intra-surgical complications can occur due to adherences in between the heart and the abdominal organs, or, in-between the abdominal organs and the diaphragm. After the discussion with the surgery team, the owner of Z decided to go ahead with the surgery. 

Z had an uneventful general anaesthetic and the surgery went according to plan. He had a small hernia through which intestines and the omentum advanced into the pericardium and were now next to the heart. The intestines and the fat were retrieved with minimal resistance and the herniation in the diaphragm was closed. The air was drained from the pericardium and the abdomen was closed. 

Z made a fast recovery without any complications and was discharged after a night in the hospital. 

No more gastrointestinal signs were noted after the surgery and Z is a happy dog with an even happier owner.

Blue arrows pointing at intestines in the pericardium around the heart