3 years on borrowed time!

ip27978 Jasmine GilbertJasmine is a delightful 6-year-old Tortoisehell cat who enjoys a life of luxury with her owner Miss Gilbert.

Early in January she appeared to lose her normal ‘joie de vivre’, so Miss Gilbert took her to Vets Now, who provide out-of-hours emergency cover for Wigmore.  Their vets examined her, but were unable to make a diagnosis so gave her some supportive treatment and referred her back to us for further investigation.

Whilst Jasmine was certainly ‘not right’, her symptoms remained vague.  Andrew and Duncan, with a combined 50 years veterinary experience, were initially baffled.  BLOOD TESTS DID NOT HELP. Despite continuing to eat, she had not passed any faeces for almost a week so Duncan advised exploratory surgery to open up her abdomen for a thorough internal examination.  As soon as he made the incision into her tummy, Duncan recognised that something was very odd indeed - neither her small or large intestines were where they should have been!

Further exploration was needed so the incision was enlarged and Duncan went searching for those missing abdominal organs and found them in Jasmine’s chest!  Duncan discovered a tear in her diaphragm, the sheet of muscle that separates the abdomen from the chest and is largely responsible for breathing.  Her intestines had passed through this tear and were sitting in her chest next to her lungs.  Amazingly they had still been functioning normally and filling up with faeces, but this meant there was no way the intestines could fit back through the tear and so they had become very swollen.  By enlarging the tear in the diaphragm, Duncan was able to manipulate the intestines back into the abdomen and inspect them fully.  They had suffered some damage due to stretching, but Duncan was happy that there was no serious problems and he was able to successfully patch this up.

He then repaired the diaphragmatic tear and after a final check Jasmine’s incision was sewn up and she went into recovery.  Access to operate on the diaphragm can be very awkward and fiddly and the repair is prone to break down as the diaphragm muscle is already badly damaged.

A further severe risk with surgery into the chest or into the abdomen when the diaphragm is ruptured, is that the near vacuum in the chest which allows the lungs to expand is lost and the pet has to be artificially ventilated to breathe.  AND AFTER SURGERY IS COMPLETED AIR HAS TO BE SUCKED OUT OF THE CHEST TO ALLOW SPONTANEOUS BREATHING - ALWAYS A WORRYING TIME WAITING FOR IT TO RE-START.

Jasmine post opAmazingly within less than an hour Jasmine was sitting up, had passed some faeces and was already looking more comfortable - a testament to her incredible toughness.  She continued to make a good recovery and is now completely back to normal.

But the mystery was still not completely solved!  Tears in the diaphragm only occur in cats as a result of major trauma, most commonly when they are hit by a car.  Jasmine had absolutely no signs of any trauma at all, no scuffed nails, no cuts or grazes and most significantly no bruising either externally or internally.  ALSO THE DIAPHRAGMATIC TEAR DID NOT LOOK RECENT TO DUNCAN.  So how had the tear been caused?  A further check through her medical records showed that she came to us in December 2013 after possibly being hit by a car.  At the time she was thoroughly checked over but showed no signs of any major problems and was given treatment after which she very quickly made a full recovery.  She has enjoyed good health ever since.

It is clear now that the diaphragm must have sustained a tear then.  This injury can be life threatening and a severe emergency especially if enough of the abdominal contents PASS INTO THE CHEST TO COLLAPSE THE LUNGS.  In this case it seems just the intestines very recently moved through the tear into the chest cavity, resulting in the onset of Jasmine becoming unwell.  But quite why this happened now, more than 3 years since the accident still remains a mystery!

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