About a month ago, the cat was showing an increased effort in breathing and radiographs revealed a peritoneal pericardial diaphragmatic hernia with lots of liver in the pericardial sac.

This is a congenital defect (from birth) resulting in abdominal contents being in the sac which surrounds the heart. It can cause difficulty breathing and other digestive problems. It is diagnosed on x-rays and ultrasound may also be helpful. 

First perform a midline abdominal exploratory on the cat. In this cat, you can immediately see the large peritoneal pericardial diaphragmatic hernia. The gall bladder has herniated through the opening, as well as some of the liver lobes.

The gall bladder can be grasped using atraumatic thumb forceps to pull the liver back into the abdominal cavity. 

Once all the hernia contents have been removed, you still have to break down some of the hepatic ligaments in order to be able to fully see inside the pericardial sac.

You’ll be able to clearly see the heart beating within the pericardial sac, along with some pericardial effusion. When you suction out some of the liquid, you must be very careful not to break down the pleura that separates the pericardial sac from the pleural space because if you do, then you must put in a chest tube.

Then close the hernia using a simple continuous suture pattern with 3-0 Prolene. You want to use something non-absorbable so that it’s going to be there for a while.

Following hernia repair, it’s really important to do a complete abdominal exploratory to check for strangulation of any organs that were present in the area.

DVM, MS, MACVSc, Diplomate ACVS, ACVS Founding Fellow of Surgical Oncology, Registered Specialist of Small Animal Surgery, Senior Staff Surgeon

Charles graduated from the University of Florida and did an internship at the Animal Medicine Center in New York City. He then did a residency in small animal surgery and Master’s program at Virginia Tech. Following that he did a one-year fellowship in Cardiac Surgery and Research at Auburn University and an 18 month Fellowship in Surgical Oncology at Colorado State University before he became an Assistant Professor of Orthopaedic Surgery also at Colorado State University.

Charles then started a busy referral surgical practice in Washington DC where he was also on the Board of Directors and the Program Chair for the DC Academy of Veterinary Medicine. In 2004, Charles moved to Australia and started Southpaws Specialty Surgery for Animals. He started with just one nurse and by the time he sold the practice in 2022, Southpaws was up to 170 staff over 2 hospitals. Charles set up the first radiation therapy unit for animals in Australia. He has published hundreds of articles, abstracts, book chapters and proceedings in topics related to the treatment of surgical diseases in animals. He is often invited to lecture at international conferences. Charles has 5 patents for devices used in the treatment of surgical diseases in animals.