Pictures show

1 & 2 Images from the intercostal thoracotomy surgery

3, 4 and 5 – Annotated CT scans showing the extent of Sheldon’s conditions 

The case

Sheldon, a seven-year-old Labrador, had a history of osteoarthritis and had been receiving nonsteroidal anti-inflammatory drug treatment (NSAID) for four years when he was first referred to us at Paragon Veterinary Referrals.

Investigations by the referring vet identified suspected cardiomegaly and anaemia, after his owners reported him being lethargic, reluctant to go for walks and off his food.

On presentation at Paragon, Sheldon was found to have a small amount of fluid around the heart and in his abdomen which, when tested, revealed septic peritonitis and septic pericardial effusion.

A CT scan was performed, where the omentum was seen within the pericardium, and a diagnosis of a pericardio-peritoneal diaphragmatic hernia (PPDH) was made.

Surgery was recommended as the cause of septic peritonitis in dogs is often due to rupture of the stomach or intestines.

An emergency exploratory coeliotomy was performed, where we identified a ruptured gastroduodenal ulcer, which was biopsied and repaired. The necrotic omentum was resected, and the hernia closed.

One week after surgery, Sheldon re-presented to us with recurrent pericardial effusion. This fluid accumulation causes a problem as pressure builds up in the sac, preventing the heart from working effectively, which can result in ascites and eventually the animal going into heart failure.

We drained this effusion on two occasions but when it happened for a third time, we recommended surgery to remove the sac.

We therefore performed an intercostal thoracotomy and a subtotal pericardiectomy. Sheldon recovered quickly from this and has had no further recurrence of fluid around the heart or chest.

This was a slightly unusual case as PPDH is congenital in cats and dogs. Sheldon has had his since birth with no adverse effects until recently.

Usually dogs recover well without requiring further treatment once the hernia is sealed but this was not the case with Sheldon.

We believe the fluid inflammation was secondary to ongoing inflammation in the pericardium, as there was no evidence of infection or neoplasia on multiple samples.

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