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Kitten with abdominal wall rupture (arrows) and herniated bowel identified by ultrasonography. This otherwise healthy kitten presented for evaluation of a traumatic abdominal rupture. There was no evidence of damage to the abdominal viscera but it was considered an emergency due to the large amount of viscera present within the hernia and an inability to reduce it, suggesting a very small rupture.

Large dorsal hernia (arrowed) following rupture of the left cranial abdominal wall viewed from within the abdomen. (The patient’s head is to the left.) This hernia could only be properly evaluated with an exploratory laparotomy, followed by dissection dorsally between the ventral skin incision and the body wall, revealing its true extent.

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Kitten being prepared for hernia repair. A jugular catheter (optional; usually performed in specialist centres only) has been inserted to allow fluid administration intraoperatively due to the kitten’s small size; alternatively, the intraosseous route (using the trochanteric fossa of the proximal femur) can be used if cephalic vein cannulation is not possible.

The right (at top) linea alba is being retracted using atraumatic Babcock forceps. DeBakey forceps are being used to manipulate the delicate muscle of the rupture in the abdominal wall and a ribbon (malleable) retractor is being used to gently retract the viscera. (The kitten’s head is to the right.)

Rupture closed with single interrupted sutures.

Large dorsal hernia. The linea alba incision is dorsal and the surgeon has slipped their fingers down along the outside of the abdominal wall and in through the traumatic defect in the body wall. This rupture should be repaired in layers. The internal layer (transversus abdominus muscle) should be sutured to the ventral muscles of the spine without impinging on the retroperitoneal structures such as the ureter. The internal and external abdominal oblique muscles should be sutured to the lateral epaxial (spinal) muscles and the lumbar fascia.

Basic surgical kit. A = towel clamps; B = Brown–Adson thumb forceps; C = needle-holders; D = No. 3 scalpel handle; E = No. 15 scalpel blade; F = No. 10 scalpel blade; G = mosquito forceps; H = Metzenbaum scissors; I = Mayo scissors; J = Blunt–sharp suture scissors; K = gauze surgical swabs.

Rupture of the bladder in a cat with feline idiopathic cystitis. The blue catheter is a cystostomy tube that had been placed following the original episode of obstruction, before bladder rupture occurred (the cystostomy tube did not prevent rupture in this case, due to its occlusion). The three stay sutures are visible. The apex of the bladder is towards the top of the photograph and the rupture has occurred on the ventral aspect of the bladder. Debris within the bladder is consistent with urinary crystal formation, and fibrinous inflammation of the bladder mucosa.

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The mucosa everts when the bladder wall is excised Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

Incorrect way to hold bladder for suturing. Grasping the cut edge directly across the everted mucosa would cause it to evert again once the sutures were placed and tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

The cut edge should therefore be grasped at right angles. The forceps are then rotated to ensure that mucosal eversion is reduced, prior to placing the sutures, so that there is no eversion of mucosa when the suture is tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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