{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:00:40Z","timestamp":1790593240902,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Animals"],"abstract":"<jats:p>Peritoneopericardial diaphragmatic hernia (PPDH) is a congenital anomaly allowing communication between the peritoneal and pericardial cavities. Surgical repair of large diaphragmatic defects can be challenging due to insufficient tissue for primary closure. A 2-year-old intact female White Miniature Schnauzer weighing 6.23 kg presented with a 1-month history of panting and exercise intolerance. Thoracic radiography, ultrasonography, echocardiography, and CT confirmed PPDH with herniation of the left medial and quadrate liver lobes into the pericardial sac. Surgical repair via midline celiotomy revealed a large defect (4.5 \u00d7 5 cm) involving approximately 70% of the central tendon. Primary closure was incomplete because only two simple interrupted sutures could be placed at the dorsal margin due to excessive tension, leaving a triangular residual defect larger than 3 \u00d7 3 cm at the ventral aspect, which was closed with a two-layer canine small intestinal submucosa (cSIS) patch applied over the residual defect. Reherniation occurred 42 days postoperatively at the margin between the diaphragm and the cSIS patch. At the second surgery, grossly observed tissue presumed to be newly formed self-tissue at the cSIS site enabled direct suture repair. No recurrence was observed during a 5-month follow-up, and a telephone interview with the owner 3 years after the second surgery confirmed that the dog remained free of clinical signs. This case suggests that cSIS may serve as a feasible reinforcement biomaterial for large diaphragmatic defects where primary closure alone is insufficient, although conclusions drawn from a single case remain preliminary, and surveillance for marginal reherniation is warranted.<\/jats:p>","DOI":"10.3390\/ani16193048","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:34Z","timestamp":1790589634000},"page":"3048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Repair of a Large Congenital Peritoneopericardial Diaphragmatic Hernia with Canine Small Intestinal Submucosa Patch Reinforcement in a Dog: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3767-5768","authenticated-orcid":false,"given":"Tae-Seong","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Yeon","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Han","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Ji","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8472-7723","authenticated-orcid":false,"given":"Chang-Min","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A-Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6237-9958","authenticated-orcid":false,"given":"Hwi-Yool","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6425-7716","authenticated-orcid":false,"given":"Jung-Moon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.12681\/jhvms.15638","article-title":"Peritoneopericardial diaphragmatic hernia in the dog and cat","volume":"67","author":"Nikiphorou","year":"2018","journal-title":"J. Hell. Vet. Med. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"398","DOI":"10.5326\/0460398","article-title":"Peritoneopericardial diaphragmatic hernia: A retrospective study of 31 cats and eight dogs","volume":"46","author":"Banz","year":"2010","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.2460\/javma.259.9.1009","article-title":"Relationships between congenital peritoneopericardial diaphragmatic hernia or congenital central diaphragmatic hernia and ductal plate malformations in dogs and cats","volume":"259","author":"Seibert","year":"2021","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2460\/javma.242.5.643","article-title":"Surgical and nonsurgical treatment of peritoneopericardial diaphragmatic hernia in dogs and cats: 58 cases (1999\u20132008)","volume":"242","author":"Burns","year":"2013","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/vsu.13360","article-title":"Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs","volume":"49","author":"Morgan","year":"2019","journal-title":"Vet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.22271\/veterinary.2021.v6.i4a.367","article-title":"Diagnosis and repair of peritoneopericardial diaphragmatic hernia (PPDH) in a Doberman dog: A first report from India","volume":"6","author":"Kumar","year":"2021","journal-title":"Int. J. Vet. Sci. Anim. Husb."},{"key":"ref_7","first-page":"1019","article-title":"Peritoneal pericardial diaphragmatic hernia with an incidental finding of suspected right ventricular wall aneurysms in a dog","volume":"65","author":"Fracka","year":"2024","journal-title":"Can. Vet. J."},{"key":"ref_8","first-page":"181","article-title":"Diagnostics of canine peritoneal-pericardial diaphragmatic hernia (PPDH)","volume":"65","author":"Komsta","year":"2009","journal-title":"Med. Weter."},{"key":"ref_9","first-page":"69","article-title":"Peritoneal-pericardial diaphragmatic hernia in a 6-year-old male intact pug dog","volume":"62","author":"Welch","year":"2021","journal-title":"Can. Vet. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.5326\/JAAHA-MS-6457","article-title":"Cholecystopexy and Pericardial Pseudocyst Removal in a Dog with a Congenital Peritoneopericardial Diaphragmatic Hernia","volume":"53","author":"Cabon","year":"2017","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2460\/javma.24.02.0098","article-title":"A ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog","volume":"262","author":"Hennet","year":"2024","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9977947","DOI":"10.1155\/crve\/9977947","article-title":"Congenital Peritoneopericardial Diaphragmatic Hernia in a Dog: Ventral Advancement Diaphragmatic Technique for Repair","volume":"2026","year":"2026","journal-title":"Case Rep. Vet. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1053\/jvet.2002.33596","article-title":"The use of porcine small intestinal submucosa as a biomaterial for perineal herniorrhaphy in the dog","volume":"31","author":"Stoll","year":"2002","journal-title":"Vet. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"327","DOI":"10.4142\/jvs.2012.13.3.327","article-title":"Use of canine small intestinal submucosa allograft for treating perineal hernias in two dogs","volume":"13","author":"Lee","year":"2012","journal-title":"J. Vet. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1089\/10763270050044416","article-title":"Galalpha(1,3)Gal epitope in porcine small intestinal submucosa","volume":"6","author":"McPherson","year":"2000","journal-title":"Tissue Eng."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Yen, C.-H., Tai, H.-C., Peng, S.-H., Yang, T.-S., and Tu, C.-F. (2020). The Scaffold Derived from GGTA1 and CMAH Gene Knockout Pigs Generated by Gene Editing Provoked Little Inflammatory Responses in a Humanized Pig Model. Res. Sq.","DOI":"10.21203\/rs.2.23159\/v1"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4142\/jvs.2013.14.2.175","article-title":"Evaluation of a canine small intestinal submucosal xenograft and polypropylene mesh as bioscaffolds in an abdominal full-thickness resection model of growing rats","volume":"14","author":"Lee","year":"2013","journal-title":"J. Vet. Sci."},{"key":"ref_18","first-page":"411","article-title":"Evaluation of the efficacy of freeze-dried bovine pericardium and acellular bovine skin in the treatment of diaphragmatic hernia in dogs","volume":"38","author":"Ibrahim","year":"2024","journal-title":"Al-Ma\u011falla\u1e97 Al-\u02bbir\u0101qiyya\u1e97 Li-L-\u02bbul\u016bm Al-bay\u1e6dariyya\u1e97\/Iraqi J. Vet. Sci."},{"key":"ref_19","first-page":"30","article-title":"Hernioplasty of induced diaphragmatic hernia in dogs via a comparative study between implantation of polypropylene mesh and latissmus dorsi muscle","volume":"5","author":"Jobory","year":"2012","journal-title":"Al-Anbar J. Vet. Sci."},{"key":"ref_20","first-page":"999","article-title":"Porcine small intestinal submucosa biomaterial graft for repair of a congenital pleuroperitoneal hernia in a kitten","volume":"65","author":"Freitas","year":"2024","journal-title":"Can. Vet. J."},{"key":"ref_21","first-page":"629","article-title":"Retrospective evaluation on the outcome of perineal herniorrhaphy augmented with porcine small intestinal submucosa in dogs and cats","volume":"61","author":"Swieton","year":"2020","journal-title":"Can. Vet. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jpedsurg.2005.11.068","article-title":"The whole truth: Comparative analysis of diaphragmatic hernia repair using 4-ply vs 8-ply small intestinal submucosa in a growing animal model","volume":"41","author":"Sandoval","year":"2006","journal-title":"J. Pediatr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5038","DOI":"10.1039\/C9TB00530G","article-title":"Small intestinal submucosa: Superiority, limitations and solutions, and its potential to address bottlenecks in tissue repair","volume":"7","author":"Cao","year":"2019","journal-title":"J. Mater. Chem. B"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"621","DOI":"10.2106\/00004623-200703000-00020","article-title":"Degradation and remodeling of small intestinal submucosa in canine Achilles tendon repair","volume":"89","author":"Gilbert","year":"2007","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.jfms.2009.06.003","article-title":"Reconstruction of a large diaphragmatic defect in a kitten using small intestinal submucosa (SIS)","volume":"11","author":"Andreoni","year":"2009","journal-title":"J. Feline Med. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/S1091-255X(02)00050-1","article-title":"Evaluation of porcine-derived small intestine submucosa as a biodegradable graft for gastrointestinal healing","volume":"7","author":"Gottfried","year":"2003","journal-title":"J. Gastrointest. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/(SICI)1097-4636(199908)46:2<203::AID-JBM9>3.0.CO;2-4","article-title":"Use of small intestinal submucosal implants for regeneration of large fascial defects: An experimental study in dogs","volume":"46","author":"Dejardin","year":"1999","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_28","first-page":"PI1-5","article-title":"A comparison of suture retention strengths for three biomaterials","volume":"10","author":"Obermiller","year":"2004","journal-title":"Med. Sci. Monit."}],"container-title":["Animals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2615\/16\/19\/3048\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:18:43Z","timestamp":1790590723000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2615\/16\/19\/3048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":28,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["ani16193048"],"URL":"https:\/\/doi.org\/10.3390\/ani16193048","relation":{},"ISSN":["2076-2615"],"issn-type":[{"value":"2076-2615","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}