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Hepatic encephalopathy associated with extensive hepatic diaphragmatic herniation in an adult horse.
Abstract: Diaphragmatic hernia in horses is a rare condition, most commonly presenting with signs of colic and, less frequently, respiratory compromise. Hepatic herniation through a diaphragmatic defect with secondary hepatic failure and encephalopathy has rarely been documented in horses. Methods: A 5-year-old Mangalarga Marchador stallion was evaluated for progressive neurological deterioration, including obtundation, head pressing, ataxia, and circling. Serum biochemistry revealed severe hepatobiliary dysfunction, characterised by increased gamma-glutamyl transferase and alkaline phosphatase activities, hyperbilirubinaemia and hypertriglyceridaemia. The horse died within 12 h of admission. Post-mortem examination revealed a chronic pleuroperitoneal diaphragmatic defect with herniation of the left lateral, left medial, and quadrate hepatic lobes into the thoracic cavity. The herniated portion showed severe atrophy, haemorrhagic necrosis, cholestasis, and ductular proliferation, while the non-herniated hepatic mass exhibited bridging fibrosis and nodular regenerative remodelling. Histopathological examination of the brain confirmed the presence of Alzheimer type II astrocytes in the cerebral cortical grey matter, consistent with hepatic encephalopathy. Conclusions: This case documents an unusual manifestation of equine diaphragmatic hernia in which extensive chronic hepatic incarceration resulted in severe hepatobiliary dysfunction and hepatic encephalopathy. The findings suggest that diaphragmatic hernia with hepatic involvement should be considered in the differential diagnosis of horses presenting with severe hepatopathy and neurological signs compatible with hepatic encephalopathy, particularly when classical signs of colic are absent.
© 2026. The Author(s).
Publication Date: 2026-07-31 PubMed ID: 42542553PubMed Central: 2957032DOI: 10.1186/s12917-026-05752-wGoogle Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
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Hepatic encephalopathy due to extensive liver herniation through a diaphragmatic defect was identified in an adult horse, causing severe liver dysfunction and neurological symptoms. This rare complication of diaphragmatic hernia highlights the importance of considering liver involvement in horses with neurological and liver-related signs.
Background and Significance
- Diaphragmatic hernia in horses is a rare condition, typically presenting as colic or respiratory issues due to abdominal organs moving into the chest cavity through a defect in the diaphragm.
- Hepatic (liver) herniation specifically through a diaphragmatic defect is even rarer in horses and is usually not associated with liver failure or hepatic encephalopathy.
- Hepatic encephalopathy involves brain dysfunction caused by severe liver disease, often related to accumulation of toxins normally cleared by the liver.
Case Presentation
- A 5-year-old male Mangalarga Marchador horse showed progressive neurological decline, including decreased alertness, head pressing, uncoordinated movements (ataxia), and repetitive circling.
- Laboratory tests revealed severe hepatobiliary dysfunction:
- Elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) – enzymes indicative of liver injury or cholestasis.
- High bilirubin (hyperbilirubinaemia) suggesting impaired bile processing or liver failure.
- Increased triglycerides (hypertriglyceridaemia), often correlated with liver dysfunction.
- The horse died within 12 hours of hospital admission due to rapid deterioration.
Post-Mortem Findings
- A chronic diaphragmatic defect was found, creating a communication between the pleural (chest) and peritoneal (abdominal) cavities.
- The left lateral, left medial, and quadrate lobes of the liver were herniated into the thoracic cavity through this defect.
- The herniated liver tissue exhibited:
- Severe atrophy indicating prolonged compression or reduced blood supply.
- Haemorrhagic necrosis, or tissue death with bleeding.
- Cholestasis, which is bile stagnation due to impaired flow.
- Ductular proliferation, a reaction to bile duct injury or obstruction.
- The non-herniated portion of the liver showed bridging fibrosis (scarring connecting different areas of the liver) and nodular regenerative remodeling, indicative of chronic liver disease.
- Brain histology revealed Alzheimer type II astrocytes in the cortex, a hallmark cellular change seen in hepatic encephalopathy—which confirms brain dysfunction due to liver failure.
Conclusions and Clinical Implications
- This case highlights a rare but severe sequela of equine diaphragmatic hernia involving chronic incarceration and damage of liver lobes.
- The extensive liver damage caused severe hepatobiliary dysfunction, leading to hepatic encephalopathy with neurological signs.
- Horses with diaphragmatic hernia typically present with colic signs; however, in this case, classical colic signs were absent, and the prominent clinical features were neurological.
- Therefore, veterinarians should consider the possibility of diaphragmatic hernia with hepatic involvement in horses displaying severe liver dysfunction and neurological signs consistent with hepatic encephalopathy, even when colic is not apparent.
- This awareness might aid earlier diagnosis and better understanding of similar presentations in equine practice.
Cite This Article
APA
Linhares MT, de Sousa IV, de Castro Eloy LR, de Oliveira Neto JM, Quillas LJA, Ubiali DG, Carvalho LRRA, Lucena RB.
(2026).
Hepatic encephalopathy associated with extensive hepatic diaphragmatic herniation in an adult horse.
BMC Vet Res, 22(1), 453.
https://doi.org/10.1186/s12917-026-05752-w Publication
Researcher Affiliations
- PatoBiology Laboratory, Universidade Federal da Paraíba, Areia, Paraíba, 58397-000, Brazil.
- PatoBiology Laboratory, Universidade Federal da Paraíba, Areia, Paraíba, 58397-000, Brazil.
- PatoBiology Laboratory, Universidade Federal da Paraíba, Areia, Paraíba, 58397-000, Brazil.
- PatoBiology Laboratory, Universidade Federal da Paraíba, Areia, Paraíba, 58397-000, Brazil.
- Section of Anatomic Pathology, Institute of Veterinary Medicine, Universidade Federal Rural do Rio de Janeiro, Rio de Janeiro, Seropédica, Brazil.
- Section of Anatomic Pathology, Institute of Veterinary Medicine, Universidade Federal Rural do Rio de Janeiro, Rio de Janeiro, Seropédica, Brazil.
- Department of Physiology and Pharmacology, Karolinska Institutet, 5B, Solnavägen 9, Stockholm, S-171 77, Sweden. lucas.carvalho@ki.se.
- PatoBiology Laboratory, Universidade Federal da Paraíba, Areia, Paraíba, 58397-000, Brazil.
Conflict of Interest Statement
Declarations. Ethics approval and consent to participate: This study was conducted using necropsy records and archived tissue samples from a horse submitted for post-mortem examination at a veterinary pathology service. No experimental procedures or interventions were performed on live animals for this study. All procedures followed institutional guidelines for the use of animal biological material for research purposes. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
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