Recently, ACCES had the opportunity to work with the Seattle Humane Society to help a critically ill young dog. Tully, an approximately 2 year old, female Chihuahua was soon to be euthanized in an animal shelter in Los Angeles when the Seattle Humane Society agreed to care for her and find her a home. Tully arrived at the shelter in Bellevue emaciated, covered in fleas, and pregnant. Over the course of her first days in Seattle, Tully started having a hard time breathing until on the afternoon of Tuesday, June 14, it was clear that Tully’s condition was deteriorating. Hopeful that cause of Tully’s increased respiratory rate and effort was a fixable condition, the Humane Society referred Tully to ACCES for further diagnostic tests and care.
Tully was admitted by an emergency clinician, Dr. Julie March, and immediately radiographs were taken of Tully’s chest. The radiographs were diagnostic of a diaphragmatic hernia. The diaphragm is a musculotendinous partition that separates the chest from the abdomen. Loss of this separation allows the abdominal organs to enter the chest cavity and interfere with the lung’s ability to fill expand and ventilate normally.
The diaphragm is made up of a muscular portion that attaches to the ribs on both sides and a central tendinous region. The aorta, vena cava and other veins, esophagus, and lymphatic system pass through openings in the diaphragm. Hernias can be either congenital, in which one or both muscular portions of the diaphragm fails to develop or fails to fuse centrally, or traumatic, in which injury to the diaphragm can cause a tear in normally developed diaphragm. This is a common sequelae after dogs and cats get hit by cars.
Treatment of this condition requires surgery to repair or reconstruct the diaphragm. Complications can arise when the abdominal organs have been present in the thoracic cavity and have adhered to structures within the chest or to the chest wall. Or in congenital diaphragmatic hernias when abdominal organs develop within the chest and may not mechanically be reduced into the abdomen even with surgery.
Tully’s condition was complicated by the fact that she was pregnant. The puppies had mineralized skeletons but whether or not they were near term was yet unknown. A decision was made to take Tully to emergency surgery to relieve the lung compression and repair the diaphragm. Since Tully was pregnant, it was also decided to perform a cesarian section to try to save the puppies since they would be unlikely to survive a long anesthetic procedure.
Tully was quickly anesthetized and taken to surgery. Four puppies were retrieved and resuscitation of the puppies was initiated. Tully’s entire gastrointestinal tract, spleen, omentum and the majority of her liver had been pushed into her chest through a very large hole in the right side of her diaphragm. Her abdominal organs were replaced into her abdomen and closer inspection revealed the hernia to likely have been congenital. It was necessary to also approach the diaphragm from her chest to get adequate access for repair. By advancing the diaphragm and part of the abdomimal wall forward and towards the left side, it was possible to close the hole in Tully’s diaphragm.
Tully had a rough recovery from anesthesia and struggled to reinflate her lungs and breath normally. She was treated with oxygen therapy overnight and by morning was breathing more comfortably. Unfortunately, Tully’s puppies did not survive. After several days of further supportive care, Tully returned to the Seattle Humane Society where she was put into foster care. Tully appears to be adapting well to her new home. We hope she finds a fantastic new family soon.
 |
| Tully is now waiting for her forever home in foster care. |
 |
| Tully, fully recovered, is happy and healthy. |
No comments:
Post a Comment