Management of a diaphragmatic hernia using self‐locking knots

Summary A 4‐year‐old Thoroughbred gelding was presented with a history of severe colic signs that were non‐responsive to non‐steroidal anti‐inflammatory drugs. During initial evaluation, distended small intestine was observed, together with continued colic signs and a serosanguinous abdominocentesis sample. It was therefore elected to perform an exploratory laparotomy to ascertain and resolve the source of colic. Intraoperatively, a 2 cm horizontal defect was located at the junction between the diaphragm and the left 12th rib, midway between the dorsal and ventral body walls. One metre of small intestine was entrapped within the thoracic cavity. The diaphragmatic defect was digitally extended to 6 cm to allow safe exteriorisation of the intestine. The resulting defect extended from just left of midline to the body wall; the defect was sutured closed using 4 M polyglactin 910 in a simple continuous pattern, utilising forwarder and Aberdeen self‐locking knots. Subsequently, the horse also underwent a jejunoileostomy. The horse progressed well post‐operatively, with the exception of an incisional infection. Repeat thoracic evaluation 2 weeks post‐operatively and again 6 months post‐operatively revealed no evidence of reoccurrence.