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Welcome to June's case of the month! This month, like last month, involves the chest, but for a completely different reason. |
NO GUTS, NO...WHAT?
HISTORY
Jammer was a 6-year-old black lab who came to us because she'd just lost all of her energy. For a couple of days she hadn't eaten well, and had stopped completely on the day she was brought to us. She also normally loved to chase sticks and run around, but acted like she was having trouble breathing after only a couple of minutes playing.
PHYSICAL FINDINGS
On examination, Jammer was pale and having obvious difficulty breathing. Her belly appeared bloated, and showed evidenc of free fluid. Listening to her chest, it was difficult to hear her lungs, and what could be heard suggested some fluid in the lungs as well. We soon took some x-rays:
X-RAY RESULTS
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A lot of things appear in the chest that don't belong there. Our main concern was that the areas with question marks were intestinal loops. Here's another view, a little farther back:
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TREATMENT
Jammer required surgery to repair the damage to her diaphragm. Because of the damage to her diaphragm, it was necessary for us to breathe for her throughout the 3-hour procedure. On examination during surgery, her diaphram was found to have a tear about 2 1/2 inches long. She had a large amount of fluid in her abdomen from abnormal pressure on her liver. Her entire small intestine, pancreas, much of her large intestine, and one kidney had managed to work their way into her chest. There wasn't much room left for her lungs and heart! Fortunately, the displaced organs had not been damaged, and had not damaged anything by being in the chest. We returned them to their normal positions, and closed the hole in the diaphragm. We then evacuated all of the air from her chest (the inside of the chest is normally a vaccuum, which is required in order for us to breathe), and inserted a chest tube to allow us to remove any leftover air or fluid after surgery. Here's what her chest looked like when we were done:
We kept Jammer in the hospital for a couple of days after surgery for observation. We removed some fluid and air that accumulated in her chest the morning after surgery, and then were able to remove the chest tube. Remarkably, she was able to get up and asked to go outside a couple of hours after surgery, and was eating by the next morning.
DISCUSSION
Diaphragmatic hernias are uncommon, and have 2 causes:
In Jammer's case, the cause was most likely an injury that her owners hadn't witnessed. We think she probably was grazed by a car, with no visible external effects. We never detected any bruising or swelling, and even internally she had no signs of injury other than the hernia.
That's all for now. See you next month!
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