Pets that roam outdoors are prone
to numerous traumatic injuries. Fighting with other animals and
getting hit by a car 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. This needs to
be corrected because the blood supply to the intestines can be
compromised while entrapped in this abnormal location. This will cause
a segment of the intestines to die with subsequent loss of life
This page has
graphic surgery pictures. At the end of this page are autopsy (called
necropsy in animals) that are also graphic in nature and not suitable
for all viewers.
Diagnosis with Radiography
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
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
- 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?
Sundance was presented to us with
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
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.
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
following section contains
graphic surgical pictures of the actual hernia repair we performed on
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
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
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!
The following photos
are graphic in nature.
To give you a better understanding we
have some photos taken at necropsy of a diaphragmatic hernia on a pet
that did not make it.
This thin, broad, and very strong muscle is the diaphragm. The front
side of this muscle is facing the abdomen. On the other side of this
muscle is the thorax (chest). You can see the reddish colored liver at
the bottom of the picture.
This one has been torn at
This liver has gone through
a torn diaphragm and is now in the thorax.
The vertical white line on the left is where the diaphragm was.
To the right of this line is the thorax.
When you pull the liver away
you can see the heart and lungs
When abdominal organs are in
the thorax they take up space and prevent the lungs from expanding. The
lungs might also be bruised, called pulmonary contusion.
The darker areas of these lung lobes have pulmonary contusion.
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