Congenital Esophageal Hiatal Hernia in the Chinese Shar‐Pei Dog

Abstract

Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and J u l y 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radiographic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs. AN ESOPHAGEAL hiatal hernia is a protrusion of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity. It is a relatively uncommon condition affecting both dogs and cats. Two types of esophageal hiatal hernia have been recognized in the dog and cat: 1) sliding hiatal hernia, in which the abdominal segment of the esophagus and parts of the stomach are displaced cranially through the esophageal hiatus,'-'* and 2) paraesophageal hiatal hernia, in which the abdominal segment of the esophagus and lower esophageal sphincter remain in a fixed position but a portion of the stomach herniates into the mediastinum alongside the thoracic es~phagus.'~ In dogs and cats, sliding hiatal hernia is the most common form.The clinical signs associated with hiatal hernia are vanable and range in severity from infrequent episodes of mild anorexia, hypersalivation, and regurgitation to vomiting, hematemesis, and dyspnea. '-I2 Cardiac arrest can occur when large hernias interfere with cardiopulmonary function. Medical therapies have traditionally been directed toward treatment of presumed reflux esophagitis but usually fail to resolve the clinical signs. Surgical stabilization of the normal anatomy by reduction in the size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic gastropexy has yielded good to excellent results. I Most sliding esophageal hiatal herniae have been reported in animals less...

Gastroesophageal junction of Anatolian shepherd dog; a study by topographic anatomy, scanning electron and light microscopy

“…The topographical anatomy and interrelationships of this area have received description by Dyce et al (1987). Although a distinct abdominal esophagus has been described in the human (Bonibeck et al 1966; Morson et al 1990), there was no anatomical study found to substantiate that in the canine (O'Sullivan et al 1982;Ellison et al 1987;Prymak et al 1989;Callan et al 1993;Van Sluijs 1993;Waldron and Leib 1993). Waterman and Hashim (1991) were demonstrated the position of the lower esophageal sphincter 4-5 cm cranial to the costal border of the diaphragm.…”

Hiatal hernia controversies ‐ a review of pathophysiology and treatment options

“…While changes have recently been advocated in both medical and surgical treatments, 2,11,13 controversy still exists over when to employ medical and/or surgical treatment and which procedure to use. [1][2][3]9,14 The aim of this article is to review the aetiology and pathophysiology of HH in animals, with the inclusion of relevant information from the human literature. A discussion of currently available medical and surgical treatments follows, with indications for each.…”

Combined surgical and endoscopic approach for the reduction of a congenital hiatal hernia in a cat: a case report

“…Different techniques have been proposed to avoid gastro-oesophageal reflux (Leonardi et al 1977), but the Nissen fundoplication is the most frequent technique performed (Bright et al 1990;Sivacolundhu et al 2002). In the case reported here the Nissen fundoplication could be indicated but, with reference to the literature, we decided not to perform it (Callan et al 1993;White 1993;Lorinson and Bright 1998;Sivacolundhu et al 2002), to avoid the severe complications reported: dysphagia, inability to belch, "gas bloat" and recurrence of stomach herniation with possible strangulation (Gaskell et al 1974;Callan et al 1993).…”

“…Congenital hiatal hernia, as other congenital malformations (Pisoni et al 2012;Tremolada et al 2013) is an uncommon abnormality in dogs and rare in cats, but various reports are available in the literature (Gaskell et al 1974;Teunissen et al 1978;Peterson 1983;Ellison et al 1987;Miles et al 1988;Prymak et al 1989;Bright et al 1990;Williams 1990;Brinkley 1990;White 1993;Callan et al 1993;Auger and Riley1997;Hardie et al 1998;Lorinson and Bright 1998;Sivacolundhu et al 2002;Rahal et al 2003;Kirkby et al 2005;Owen et al 2005;Ardnt et al 2006;Baig et al 2006;Keeley et al 2008;DeSandre-Robinson et al 2011), most of which are congenital, such as, apparently, the case described in the present report. Despite the several cases reported, the pathogenesis is not completely understood and, similarly, the therapeutic protocol has not been standardised.…”

“…Plane radiographs can also not be diagnostic if the gastric protrusion is not permanent (Hunt and Johnson 2003). Different surgical techniques are described to resolve HH: antireflux procedures, hiatal plication, oesophagopexy and incisional left-side or tube gastropexy (Ellison et al 1987;Prymak et al 1989;Bright et al 1990;Williams 1990;Callan et al 1993;White 1993;Lorinson and Bright;. No specific guidelines about treatment protocols are present in the literature, particularly about which type of surgical procedure gives greater success in relation to the different types of HH.…”