PROGNOSIS OF DIAPHRAGMATIC HERNIA. 



567 



in the lungs, and in short no absolute diagnosis can be founded on 

 clinical examination. The character and course of the symptoms 

 and the absence of fever, though never pathognomonic, are perhaps 

 the most reliable guides, though an exploratory puncture with 

 Dieulafoy's aspirator may settle the diagnosis. Should the displaced 

 viscus be penetrated, and fluid mixed with ingesta be drawn off, 

 no doubt can then remain as to the conditon. 



Prognosis is always unfavourable and treatment unavailable, 

 because even though reposition could be effected by performing 

 laparotomy, the condition would probably recur, it being impossible 

 to close the diaphragmatic opening. 



Fig. 402. — Diaphragmatic hernia. E, Epiploon; I G, loop of small intestine ; 

 C F, floating colon ; R, spleen P, lung ; Pe, pericardium. 



Schrader saw an uncommon complication in the horse. The 7th rib 

 was broken and a fragment had perforated the diaphragm, producing an 

 opening through which portions of bowel, omentum, and spleen had passed 

 into the thorax, and making their way through the thoracic wall and under 

 the skin, had produced a hernia as large as a man's head just below the left 

 elbow. The horse lived for several years, but finally died in consequence 

 of the hernia becoming strangulated. 



A case of diaphragmatic hernia is described in Cadiot and Dollar's 

 "Clinical Veterinary Medicine and Surgery," and the condition is fully 

 treated on pp. 44 et seq. of the same work. The case referred to is here 

 illustrated (Fig. 402). The rent in the diaphragm had probably existed 

 for many months, judging from the condition of its edges, but at first had 

 only given passage to a few loops of small intestine and epiploon. Seven 

 days before death the horse showed colic, but apparently recovered. 

 Twelve hours before death, however, it had violent pain, which continued 

 until the end. The gastric and splenic hernias were probably produced 

 at that time ; soon after becoming herniated the stomach ruptured. 



