Titus Undergoes Surgery
Titus is a 6 month old cat that has had several homes during his young life. The problem seems to be that Titus has trouble with his bowel movements – they have been soft off and on and he doesn’t always make it to the litter box.
Under the foster care of Hope for Life Animal Rescue and the Drs. at Pet Care Veterinary Hospital a work up was done to try and figure out the cause of his problem. On June18 radiographs taken by Dr Poutous revealed an obvious problem in Titus’s thorax or chest area. (arrow) There was a mass effect from the diaphragm (a thin muscle that internally separates the chest from the abdomen and aids in breathing) to the heart. Dr. Fox performed a quick ultrasound analysis and it looked as if this mass was the liver. Based on these findings a diagnosis of diaphragmatic hernia was suspected. This hernia is a rent or tear in the thin diaphragm muscle that allows spillage of tissue from the abdomen into the thorax where it takes up space and compromises the heart and lung.
The following day Dr. Poutous did a barium contrast study on Titus where liquid barium, a substance that shows up white on a x-ray, is given orally followed by serial x-rays to observe how it outlines and travels through the intestinal tract. This study confirmed the diaphragmatic hernia and surgical repair was discussed with Hope for Life. The procedure would be risky as we did not know how long the hernia had been present; they can occur secondary to blunt trauma or congenital and present from birth. The Drs. were concerned about the presence of adhesions- bands of connective tissue that the body produces in its attempt to heal things. These adhesions can tightly adhere to surrounding tissue and when broken down can create bleeding problems. Was the heart or major blood vessels involved with these adhesions? We weren’t going to be sure until going in surgically.
Hope for life gave the OK and a surgical team was put together consisting of surgeons Drs. Fisher and Poutous, Licensed Veterinary Technician, Shannon Mullen, and surgical assistant, Lizzie Cleary. Anesthesia is particularly tricky on these cases as once the abdomen is opened, outside air leaks into the thoracic cavity through the hernia tear and the mechanisms controlling normal breathing are disrupted. Shannon, our anesthetist, not only had to breathe for Titus during the procedure, but also had to monitor his vital signs for any trouble associated with the rigors of anesthesia and surgery.
During surgery it was found that three fourths of the liver was stuck through the hernia tear and the Drs. slowly and carefully broke down existing adhesions and pulled the liver back into the abdomen. Luckily the adhesions were not too severe and they were not attached to any vital structures.
Once all of the liver was back in its normal position, Dr. Poutous sutured close the tear in the diaphragm as Dr. Fisher assisted by holding tissues in place. Air that had leaked into the chest was removed and within minutes Titus was breathing again without assistance.
The abdomen was closed to complete the procedure and Titus spent several days at Pet Care on pain killers and nutritional/fluid support. Once eating and feeling well Titus was returned to his loving foster home for follow up care.
