ABSTRACT
Peritoneopericardial diaphragmatic hernia (PPDH) is a communication between the abdomen and the pericardial sac generated by congenital anomalies triggered during diaphragmatic and pericardial development. This report aimed to present the case of an adult, mixed-breed cat, affected by PPDH, focusing on the period from diagnosis to successful surgical correction. The patient had a capricious appetite and weight loss for about four months and started, at the end of this period, a state of apathy. On abdominal ultrasound, the gallbladder (GB) was close to the heart, suggesting diaphragmatic discontinuity. On thoracic radiography, there were changes suggestive of PPDH, pericardial efusion or cardiomegaly with probable dilated cardiomyopathy. Based on these findings, an echocardiogram was performed, highlighting the hepatic lobe and GB internally to the pericardium, causing cardiac compression, although without severe cardiac changes. During surgery, a diaphragmatic defect of 4 cm in diameter was observed with the congested right medial hepatic lobe and hyperemic GB in the pericardial sac. The defect was sutured using the sultan pattern in separate stitches and polyamide threads. The feline returned to feeding with greater interest soon after the surgery, and after 15 days it was fed with dry food and had normal behavior. PPDH can be diagnosed in healthy adult cats, even if there are no apparent respiratory, gastrointestinal, or cardiac signs. The echocardiogram is relevant in the definitive diagnosis, in addition to excluding differential diagnoses, and simple surgical treatment with polyamide thread and sultan suture is successful.
A hérnia periotônio-pericárdica diafragmática (HPPD) comunica o abdome e o saco pericárdico, é gerada por anomalias congênitas deflagradas no desenvolvimento diafragmático e pericárdico. O objetivo deste relato é apresentar o caso de uma gata adulta, mestiça, acometida por HPPD, destacando do diagnóstico à correção cirúrgica bem sucedida. A paciente exibia apetite caprichoso e emagrecimento há cerca de 4 meses, iniciando ao final deste período, apatia. Na ultrassonografia abdominal a vesícula biliar (VB) estava próxima ao coração sugerindo ruptura diafragmática. Na radiografia torácica evidenciou-se alterações sugestivas de HPPD ou cardiomegalia com provável miocardiopatia dilatada. Devido tais achados realizou-se ecocardiograma destacando o lobo hepático e a VB no pericárdio comprimindo o coração sem comprometer sua função. Na cirurgia observou-se defeito diafragmático (4 cm), passagem do lobo hepático medial direito e da VB para o pericárdio. Suturou-se o defeito com padrão sultan e fio poliamida 3.0. A felina voltou a se alimentar com maior interesse logo após a cirurgia. A HPPD pode ser diagnosticada em felinos adultos saudáveis, mesmo que não haja sinais respiratórios, gastrointestinais ou cardíacos aparentes. O ecocardiograma é relevante no diagnóstico definitivo, além de excluir diagnósticos diferenciais, sendo o simples tratamento cirúrgico com fio poliamida e sutura sultan bem sucedido.
