Surgical findings and treatment
The cat was premedicated with atropine (0.05 mg/kg) and butorphanol tartrate (0.22 mg/kg) subcutaneously. Cefazolin (22 mg/kg
intravenously) was given prophylactically and was discontinued after surgery. Anesthesia was induced with ketamine hydrochloride
(6.6 mg/kg) and diazepam (0.33 mg/kg) given intravenously. The cat was maintained on isoflurane throughout surgery, and manual
ventilation was used to assist respiration during the procedure.
The cat was placed in dorsal recumbency, and a ventral midline celiotomy was performed. Parts of the right and left medial
liver lobes, the quadrate lobe, and the gallbladder were lying in the pericardial sac through a vertical rent about 5 cm in
length. This rent was in the central tendinous portion of the diaphragm (Figure 3). Manual manipulation of the liver within the pericardial sac revealed adhesions of the falciform ligament to the surface
of the herniated liver lobes, but none to the heart or pericardial sac. The adhesions were broken down, the liver lobes and
gallbladder were replaced into the abdominal cavity, and the rent was closed with 3-0 nylon suture in a Ford suture pattern.
Air was removed from the pericardial sac with a 20-ga catheter placed through the diaphragm (Figure 4). The catheter was removed, and the abdomen was closed routinely. Dexamethasone sodium phosphate (0.5 mg/kg intravenously)
was given because a portion of the liver was trapped in the pericardial sac and reperfusion injury was possible.
Recovery and follow-up
The cat received butorphanol (0.24 mg/kg subcutaneously) for postoperative analgesia. The cat began eating four hours after
surgery and recovered well. It was discharged to the referring veterinarian that evening. Oral butorphanol (0.3 mg/kg b.i.d.)
was given for pain relief for five days. No respiratory or cardiovascular problems were observed. The referring veterinarian
removed the skin staples in 12 days, and a complete blood count and serum chemistry profile revealed no abnormalities. Thoracic
radiographic findings obtained three months after surgery were normal. The cat gained weight and remains free of any clinical
signs six months after surgery.