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 see. 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.
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 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 the rested for one month.
The following section contains graphic surgical pictures of the actual hernia repair we performed on Sundance.
Any pet that has been traumatized so severely that they have 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 white arrow shows the area of the hernia on the inside of the right rear leg. 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, so they are easily be damaged when trapped in an opening this size, especially since they had been there for approximately 5 days. In this picture our surgeon 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 Dr. P placed additional sutures besides 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.
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