Introduction Cat's that roam outdoors are prone
to numerous traumatic injuries. Fighting with other animals and
getting hit by cars are some of the more common injuries we
encounter. This page shows a surgical procedure to correct an
abdominal hernia in a cat that was hit by a car. In this situation the hernia was
caused by a blow to the abdomen by the car. The blow was strong
enough to tear a large hole in the abdominal muscles that surround
the abdomen. The small intestine went through this hole and was
trapped between the muscle and the underside of the skin.
Presentation
Sundance was presented to us with
a history
of being gone for 5 days and lethargy. Most cats that are hit by a
car are in a state of shock and can die if not treated with
intravenous
fluids. Sundance is lucky
he survived being hit by a car without any shock therapy.
Our exam revealed a swollen and
bruised area just under the skin in the right inguinal area, which
made us suspicious of a hernia. Bruising is very common in such small
animals that have been hit be a car, so it does not necessarily mean
there is an abdominal hernia. To help us determine if there
indeed was a hernia we took a radiograph. Radiographs are taken for
numerous reasons on every pet that is hit by a car. These pets can
have trauma to the chest, broken ribs, herniation of abdominal
contents into the chest, and ruptured internal organs like the
urinary bladder. The radiograph helps us determine if any of these
problems exist. In this case, the radiograph helped verify that
Sundance had an abdominal hernia. He also had a fractured pelvis
which would heal on its own if he was confined and rested for one
month. In addition to an abdominal
hernia which you will learn more about soon, animals that are hit by
cars also can get a diaphragmatic hernia. In this hernia the
abdominal organs like liver or stomach have literally torn through
the diaphragm (muscle of respiration) and are sitting in the chest.
Needless to say, these are serious injuries.
The
structures are marked in this normal radiograph or a
cat's chest. The arrows are pointing to a normal
diaphragm. The lungs are all the dark areas. Use them for
comparison to the abnormal radiograph that
follows.
This
is the radiograph appearance of a cat with a diaphragmatic
hernia. Several abnormalities are
apparent:
- The windpipe
is pushed upwards to the top of the
chest
- The lungs
are not black throughout the whole
chest
- The
diaphgram is not visualized from top to
bottom
- The heart
seems huge because the liver and stomach are
pushing up against it from below
This dog
has 2 fractured ribs at the arrows. Can you see
them?
This
view of the same chest might help a little. The fractures
could easily be missed in the above view, verifying how
important it can be to take 2 views.
This
is a radiograph of cat with a fractured pelvis that is more
severe than the one Sundance has. Do you see the fracture on
both sides?
Surgery
Any pet that has been traumatized so severely
that it has a hernia has an added anesthetic risk. We take special
precautions to minimize this risk.
In most hernia's we make an incision directly
over the hernia and proceed to make the repair. In this case the hernia area
had extensive swelling due to the fact that it had been present for several
days before we saw Sundance. Also, the herniated area was near the area where
we routinely make an incision to enter the abdomen for an ovariohysterectomy
(spay). In this case it was decided
to make an incision directly in the center of the body like a spay surgery,
and repair the hernia through this incision.
The following section contains
graphic surgical pictures of the actual hernia repair we performed on
Sundance.
The
white arrow shows the area of the hernia on the inside of
the right rear leg. This is called the inguinal area. It
is difficult to visualize the swelling from this
view.
This
second arrow in the middle of the body shows the location
of our incision into the abdomen.
The
incision directly in the middle of the body was much
longer than our typical spay incision. You can see our
surgeon starting the incision.
We dissect
through the tissue under the skin (called the subcutaneous tissue)
until we encounter the rectus sheath, an area where the abdominal
muscles come together. This area is very tough, and is used to
hold the abdominal muscles together when we sew our patient back
together.
The rectus sheath can be seen here
as the large white glistening area between Dr.
P's finger. A horizontal
incision is made directly through this layer in order to enter the
abdomen and find the hernia.
The
tear in the abdominal muscles was 4 inches long. It can
be visualized here as the horizontal opening towards the
bottom of this picture, just under Dr. P's finger. a
large segment of the small intestines was found caught in
this hole, and was gently removed just prior to this
picture.
Intestines
do not belong in this area, and are easily damaged when
trapped in an opening this size, especially for
approximately 5 days in this case. In this picture Dr. P
is carefully checking them to make sure their blood
supply in intact.
A special suture is used to sew the
herniated muscle opening shut. It will provide the strength needed to
hold the muscle together until healing is complete. Eventually the suture
will dissolve. You can view the partial closure of the opening in this
picture as Dr. P sutures the muscle from right to left in the picture.
The
muscle closure is now complete. The hernia was so large
that additional sutures were placed over this layer for
added strength.
The
intestines were not the only abdominal organ trapped in
the hole in the muscle. In this picture our surgeon is
trimming off a piece of omental tissue that is discolored
at the tip. The omentum is tissue that naturally resides
in the abdomen. When an abdominal organ is traumatized,
as the intestines were in Sundance's case, the omentum
migrates to this area and covers the injured tissue to
help in the repair process.
It is important to check all the abdominal
organs for injury. After the unhealthy omental tissue seen above was
trimmed, Dr. P methodically went through all the abdominal organs and
checked for injury. Here he has exposed the urinary bladder and is looking
for any signs of problem.
Sundance
had no other abdominal organ trauma so his rectus sheath
and skin were sutured back together. Here is the 7 inch
incision in his abdomen after it has been sutured closed.
These sutures will be removed in 7-10 days.
At this point in the procedure Sundance was
given a pain
injection and monitored carefully
by our nursing
team. He went home the next day and
eventually made a full recovery. He was lucky this time, and certainly used
up more than one of his nine lives!
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