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Israel Journal of Veterinary Medicine  Vol. 69 (3)  September 2014 Narayanan, M. K. 146
INTRODUCTION
Diaphragmatic hernia (DH) is the passage of abdominal
viscera into the thoracic cavity through a congenital or ac-
quired opening in the diaphragm. DH may be congenital or
acquired. Congenital diaphragmatic hernias are seldom diag-
nosed or recognized compared to traumatic hernias. Despite
of etiology, DH is a surgical emergency and the condition
has been reported in dogs, cats, horses, pigs, calves, cattle and
bufaloes (1, 2, 3, 4, 5, 6, 7). However the condition was not
yet reported in small ruminants like sheep and goat. DH was
previously reported in a goat as an incidental postmortem
fnding (8). Te animals presented with DH may gradually
become lethargic and indisposed and often the owners may
not agree to pursue treatment and rather opt for euthanasia.
At times, treatment may be chosen considering the genetic
value of the animal. Te post-operative survival rates after
repair of DH was found to be good in large animals as well as
small animals (9, 10, 11). However mortality is not infrequent
particularly in animals presented with adverse respiratory
complications and concurrent injuries (2, 3, 12). Te present
case of DH with fractured rib was managed successfully and
is believed to be the frst description in a goat kid or any
small ruminant.
CASE HISTORY
A three month old male kid (Capra hircus) weighing 6 ki-
lograms was presented to the Teaching Veterinary Clinical
Complex (College of Veterinary and Animal Sciences, Kerala
Veterinary and Animal Sciences University) immediately
after an automobile accident. Te animal was dull and de-
pressed and an extensive soft difuse swelling was noticed
along the right ventro-lateral thorax. Te abdomen was
found to be defated.
Te kid showed tachypnea (30 breaths/min) and mild
dyspnea when excited. Te rectal temperature (39.6°C) and
heart rate (78 beats/min.) were within normal range. Te
pulse was strong and regular. Te conjunctival mucous mem-
branes were pale pink and the capillary refll time was <2
Diaphragmatic Hernia in a Kid – First Case Reported
Narayanan, M. K.,
1
Sarangom, S. B.,
1
* Devanand, C. B.,
1
Antonia, N. A.,
1
Jinu, J.,
1
Gadhaf, K. P.,
1
Syam, K. V.
2
and Anoop, S.
1
1
Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal
Sciences University, Mannuthy, Trissur, Kerala, India – 680 651.
2
Teaching Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences
University, Mannuthy, Trissur, Kerala, India – 680 651.
* Corresponding Author: Sherin B. Sarangom, MVSc., Teaching Assistant, Department of Veterinary Surgery and Radiology, College of Veterinary and Animal
Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Trissur, Kerala, India – 680651. Tel: +91 9447310472 Email: sbs04vet@gmail.com
ABSTRACT
A three month old male kid (Capra hircus) was presented to the clinic with an extensive soft difuse
swelling on the right ventro-lateral thorax due to an automobile accident. By clinical, radiographic and
ultrasonographic examination, diaphragmatic herniation of abdominal organs into the thoracic cavity was
diagnosed. Herniorrhaphy was performed and intra-operatively, ribs 9-11 were found fractured below the
costochondral junction. Postoperative medication and monitoring led to an uneventful recovery. To the best
knowledge of the authors this is the frst report of a successful diaphragmatic herniorrhaphy in a goat kid
or any small ruminant.
Keywords: Diaphragmatic hernia, Kid Goat, Radiography, Diaphragmatic silhouette.
Case Reports
Israel Journal of Veterinary Medicine  Vol. 69 (3)  September 2014 147 Diaphragmatic Hernia in a Kid
seconds. Te respiratory movements of the right chest were
found to be decreased compared to the left side. On aus-
cultation of the left side of chest, normal heart sounds and
increased lung sounds were heard but on the right side of
chest, the sounds were mufed along with intestinal sounds.
No signs of pain or discomfort were noticed anywhere on the
body except at the area of swelling. Te margin of the ribs
could not be positively felt along the region of swelling. Signs
of any sprain, fracture or dislocation could not be detected
on orthopedic examination.
Te lateral radiograph of the thorax revealed an incom-
plete diaphragmatic silhouette with gas flled gastro-intes-
tinal organs in the thoracic cavity. Dorsoventral radiograph
confrmed herniation through the right side of the dia-
phragm. Only the caudal portion of the left lung was prop-
erly flled with air. Ultrasonographic evaluation identifed
forestomachs, spleen, small intestine, liver and gall bladder
in the thoracic cavity that has herniated through the rent on
the right ventrolateral diaphragm at the musculotendinous
junction. Te complete hematology and serum biochemis-
try revealed no abnormalities. Hemogram revealed negative
status for blood protozoa and/or ricketssial infections, and
hematological values were within normal range.
TREATMENT
Te herniorrhaphy was attempted on the same day under
general anesthesia along with local infltration analgesia as
the cardiopulmonary function of the animal was generally
stable. Te kid was premedicated with diazepam (Calmpose,
Ranbaxy laboratories Limited, Baddi, Himachal Pradesh,
India) at the rate of 0.2 mg/kg body weight intravenously.
Preoperatively, ceftriaxone (Intas Pharmaceuticals Ltd.,
Ahmedabad, Gujarat, India) 100 mg and ketoprofen
(Neoprofen, Pfzer Animal Health India Limited, Haridwar,
Uttarakhand, India) at the rate of 3.3 mg/kg body weight
were administered intravenously. Anesthesia was induced
with intravenous ketamine (Aneket, Neon Laboratories
Limited, Tane, Maharashtra, India), administered at the
rate of 5 mg/kg body weight and was maintained with iso-
furane (Forane, Abbott Laboratories Ltd., Queen Borough,
Kent, United Kingdom) and oxygen. Te jugular vein was
catheterized for perioperative administration of intravenous
Ringer’s Lactate (RL, Parenteral drugs (India) Limited,
Indore, Madhya Pradesh, India) at the rate of 10 mL/kg/
hr. Four mL of 2% lignocaine hydrochloride (Lignocaine
Hydrochloride Injection 2%, A.P.J. Laboratories Ltd.,
Sirmour, Himachal Pradesh, India) was linearly infltrated
along the proposed site of incision. An additional 5 mg ket-
amine was given intravenously.
Te kid was positioned in supine position and a transab-
dominal approach was resorted to with a concentric incision
of 7.5 cm in length caudal to xiphoid and parallel to costal
arch on right cranial quadrant of ventral abdomen. Once the
abdominal cavity was opened, the hernia was confrmed and
the herniated contents included the forestomachs, omen-
tum, spleen, small intestine, liver and gall bladder. An 8 cm
long tear was noticed along the right side of diaphragm at
the musculotendinous junction. Intra-operatively, ribs 9-11
were found fractured below the costo-chondral junction.
Figure 1: Kid presented after accident with a swelling on the lateral thorax. Figure 2: Lateral radiograph showing incomplete diaphragmatic silhouette.
Case Reports
Israel Journal of Veterinary Medicine  Vol. 69 (3)  September 2014 Narayanan, M. K. 148
Adhesions, fbrin deposition and congestion were not ob-
served on the herniated viscera.
Te abdominal organs were gently repositioned and the
diaphragm was sutured in simple continuous sutures pat-
tern using 2-0 USP polyglactin 910 (Relyon Glactin, MCo
Hospital Aids Pvt. Ltd., Hubli, Karnataka, India). An ad-
ditional layer of sutures were applied in a simple interrupted
manner using 2-0 USP polypropylene (Prolene, Johnson
and Johnson Limited, Aurangabad, Uttar Pradesh, India).
Towards the ventral side, the diaphragm was fxed onto
the manubrium sterni and the thoracic wall using 2-0 USP
polyglactin 910. Te lungs were hyperinfated before the ap-
plication of the fnal suture on the diaphragm. A butterfy
needle connected to a syringe was used to reestablish the
negative pressure inside the right thorax. Te rib fracture
was not treated and was left as such. Te muscles and sub-
cutaneous tissues were opposed using 2-0 USP polyglactin
910 in simple continuous suture pattern followed by skin
using polyamide (Ethilon, Johnson and Johnson Limited,
Aurangabad, Uttar Pradesh, India). A cotton gauze stent was
also fxed over the suture line. Postoperatively, ceftriaxone
and ketoprofen were administered intravenously. Lateral
thoracic and abdominal radiograph showed re-established
diaphragmatic silhouette along with repositioned abdominal
organs. Confnement and rest was advised to enable healing
of fractured ribs.
Upon observation on second post-operative day, the kid
was bright and alert. Te animal started sucking dam’s milk.
Toracic auscultation showed normal lung sounds on both
sides of the chest. Mild subcutaneous emphysema was no-
ticed anterior to the suture line dorsally that resolved by the
third post-operative day. Based on the perioperative surgical
evaluation and the postoperative clinical response, the prog-
nosis was assessed to be good. Post-operative antibiotics and
analgesics were administered for 7 additional days. Te skin
sutures were removed on the 10
th
post-operative day. Post-
operative complications were not noticed since then and the
animal had an uneventful recovery.
DISCUSSION
Traumatic diaphragmatic hernias are infrequent in animals.
It may be caused by mechanical factors like trauma due to
automobile accidents as in the present case, penetrating in-
juries, pregnancy, act of parturition and falls (13, 14, 15).
Immediate recognition and diagnosis of the condition is
necessary in order to plan the treatment strategies.
Te usual presentation of DH includes a wide range of
clinical signs depending on the size and the location of the
hernia and the amount and the type of viscera involved (14,
15). DH should be suspected if any animal is presented with
dyspnea, bilateral asymmetric lung sounds and intestinal
sounds on thoracic auscultation especially immediately af-
ter a traumatic incident (4, 14, 15, 16). In the present case,
the clinical signs were nonspecifc and hence the condition
had to be diferentially diagnosed from edema and infam-
matory swelling due to trauma, subcutaneous emphysema,
ventral abdominal hernia, pneumocele, unilateral pneumo-
thorax, pneumonia and pleural efusion. Toracic radiographs
are helpful in diagnosing the condition and the ultrasono-
Figure 3: Dorso-ventral radiograph showing herniation through the right
hemi-diaphragm
Figure 4: Post-operative lateral radiograph showing re-established
diaphragmatic silhouette
Case Reports
Israel Journal of Veterinary Medicine  Vol. 69 (3)  September 2014 149 Diaphragmatic Hernia in a Kid
graphic evaluation enable to confrm the diagnosis (4, 6, 15,
17). Diagnostic tools like contrast radiography may provide
an additional picture regarding the extent of hollow organs
involved in the herniation (6, 9, 12, 15). Invariably, reticulum,
omentum, omasum, abomasum, liver, gall bladder, spleen and
intestinal loops have been reported to have herniated in cattle
and bufaloes (4, 9, 12, 14). Exploratory laparotomy and tho-
racic laparoscopy could also be considered for the diagnosis
of DH (3, 11, 14).
Te repair of DH required preoperative, perioperative
and postoperative considerations. Te preoperative stabiliza-
tion of the animal, the antibiotic and analgesic therapy, the
possible anesthetic complications like hypoventilation and
hypoxia due to atelectatic lung and the stabilization of car-
dio-pulmonary function prior to surgery have to be invigilat-
ed (4, 11, 17). Te general anesthetic and local analgesic drug
combination was comparatively safe and provided efective
anesthesia and analgesia for performing herniorrhaphy. As
the animal was presented shortly after trauma and immedi-
ate surgical intervention was attempted, adhesions and fbrin
deposition were not set in. Also, the absence of any strangu-
lated viscera provided a favorable prognosis. Te duration of
illness, size and location of the diaphragmatic tear and the
amount of compromised viscera play a signifcant role in the
prognosis of DH (11, 12, 18, 19). Tere was no evidence of
shock and hence tachypnea can be attributed to be the result
of a reduced lung capacity due to pulmonary compression or
conscious pain perception at the injured site of diaphragm
(19). Te anticipated complication was associated with rib
fracture and the possible fail chest (2, 20). Moreover, the re-
pair of fractured rib below the level of costochondral junction
was not attempted. Te fxation of the repaired diaphragm
on to the manubrium sterni and ventro-lateral thoracic wall
considerably reduced the tension on the fractured rib. Te
extent of the tear on the diaphragm was in the range of an
opposable length. Te transabdominal approach made the
repair convenient and easy. An additional prosthetic mesh
with a bio-absorbable layer has to be considered for the clo-
sure of large or less pliable congenital and traumatic rents and
to reduce the tension on the repaired diaphragm (11). Te
negative pressure was successfully reestablished and hence
thoracic drain was not placed.
Te early presentation, rapid diagnosis, immediate surgi-
cal intervention, favorable response to anesthetic and analge-
sic drug combination, intra-operative monitoring, minimal
intra-operative complication, skill of the surgeon and assis-
tants, postoperative medication and monitoring in addition
to the appreciable mind-set of the owner led to an unevent-
ful recovery of the animal. Also it was the fractured ribs got
stabilized by rest and confnement. According to the best of
the authors’ knowledge, this is the frst report of successful
diaphragmatic herniorrhaphy in a kid.
ACKNOWLEDGEMENT
Te authors thank the Dean, College of Veterinary and Animal
Sciences, Mannuthy, Trissur, Kerala, India for providing nec-
essary facilities for the study. Te help and support rendered by
the Senior Veterinary Surgeon and Veterinary Surgeon of the
District Veterinary Centre, Trissur, Kerala, India is also deeply
acknowledged.
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