Refractory Perioperative Hypotension and Hyperlactatemia after the Surgical Repair of a Traumatic Diaphragmatic Hernia in a Cat

Abstract

A 2-year-old intact female mixed-breed cat was referred for confirmation and treatment of a traumatic diaphragmatic hernia. Thoracic radiography revealed the prolapse of abdominal organs such as the gastrointestinal tract and liver into the thoracic cavity, and since the cardiac shadow was unclear, a diagnosis of traumatic diaphragmatic hernia was made and reduction of the herniated organs and closure of the diaphragm through a midline abdominal incision were thus performed. After completing the herniated organs reduction during surgery, the peristaltic movements of the intestinal tract and pulsation of the blood vessels were diminished, and the intestines appeared pale. Subsequently, acute hypotension and tachycardia occurred. Fluid boluses of crystalloids and colloids, dopamine, norepinephrine, vasopressin and whole blood were administered for the treatment of hypotension, with no improvement. Postoperatively, the serum lactate levels gradually increased, and hyperkalemia, hypoglycemia and hypercapnia occurred. Catecholamine-resistant circulation insufficiency persisted, and the cat died approximately 9 hours after surgery. Careful perioperative management is required because refractory perioperative hypotension, hyperlactatemia, hyperkalemia and hyperlactatemia may occur after reduction of a traumatic diaphragmatic hernia.