Hiatal hernia

A hiatal hernia results from an abnormal or stretched phreni- coesophageal ligament, which allows herniation of the ab­dominal esophagus, the gastroesophageal junction, parts of the stomach, and/or other abdominal organs into the thoracic cavity via the hiatus.

Figure 3.12:

Radiograph of a dog with intermittent vomiting and regurgitation. Lateral thoracic radiograph of a 4-year-old castrated male Beagle with intermittent bouts of vom­iting and regurgitation.

Figure 3.13:

Hiatal hernia. Barium contrast study of the same dog as shown in Figure 3.12 delineating the hiatal hernia.

nias can occur in cats, but are uncommon overall.^76,77 Para­esophageal hiatal hernias are rare. Hiatal hernias can be ac­quired due to trauma.

The most common clinical signs of hiatal hernias are a result of GER and include occasional or persistent regurgitation, vomiting, dysphagia, dyspnea, and/or ptyalism.^75-77 However, some animals with mild disease may be asymptomatic.⁷⁴ The diagnosis may be evident from survey thoracic radiographs. A soft-tissue opacity may be noted in the caudodorsal thorax, in the area of the esophagus (Figure 3.12). Distal esophageal dila­tion may also be seen. A hiatal hernia is often a dynamic con­dition so that multiple radiographic exposures may be neces­sary to yield a diagnosis.In some cases,contrast videofluoroscopy may be needed to confirm the diagnosis (Figure 3.13). The condition is more difficult to diagnose via endoscopy.

Figure 3.14:

Gastroesophageal intussusception. Lateral thoracic radiograph of a 4-month-old male Labrador Retriever showing a soft tissue mass effect in the area of the distal esophagus. The puppy was diagnosed at endoscopy and surgery with a gastro­esophageal intussusception.

Surgical correction is usually required for animals with con­genital disease.^74-77 Those with acquired disease may respond to medical management consisting of small frequent meals, H₂ receptor antagonists, prokinetic agents, and/or sucralfate suspension.^74,77

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