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Ruptured diaphragm

In my first year as a qualified vet there were so many new experiences.

Sadly, it was fairly common to have cats rushed to us, who had misjudged the moment to cross the road.

These would have potentially suffered both visible external and invisible internal injuries.

A common internal injury following a road traffic collision in a cat is a ruptured diaphragm.

The diaphragm is the thin muscle that divides the belly from the chest. With the ribcage, the diaphragm creates the breathing. But it is relatively easily torn, especially following a blow to the belly. The consequence is that some abdominal organs such as the liver, spleen, stomach or intestines can be squeezed through the tear in the diaphragm, and get stuck in the chest.

This results in an immediate compression of the lungs, making it difficult to breathe, and all kinds of problems with the other organs, if not correctly resolved within days.

Luckily, my first ruptured diaphragm repair was for a cat with an enormous tear. This makes it easier to diagnose and repair.

I knew one of my main challenges was to ensure my anaesthetist continued to create the breathing movements for my patient once I opened its belly, as this would result in the loss of the natural vacuum within the chest which creates the normal lung expansion.

And so, with artificial respiration in place, I opened the abdomen. I gently retracted the organs out of the chest. There was a satisfying sensation of completion when the last lobe of liver gently arrived back into its regular place, and I had a clear view through the hole in the diaphragm into the chest.

And what I saw made me draw breath. I was looking at the most amazing sight. The perfect salmon pink lungs were slowly inflating and deflating in time to my colleague’s hand movements, and its little heart apex, rhythmically beating, was pumping blood and showing my patient was still alive.

I experienced a moment of genuine wonder at such a view.

It was terrifying and exhilarating in equal parts to have such a visible reminder that this little pet’s life was literally in our hands. 

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