4470 El Camino Real

Los Altos, California 94022

Veterinarian Always on Duty

Severe Trauma post hit by car

Hidden Injuries

"Chama," a two year old neutered male beagle, was presented one Sunday night to the Adobe Emergency Service after being hit by a car. He was in shock, not putting any weight on his right hind leg, and had bloody urine dripping from his penis. After he was stabilized with intravenous fluids, x-rays were taken to determine if there were any internal injuries. His chest film looked normal, but his bladder showed a possible partial tear in the wall. He also had multiple pelvic fractures and a dislocated hip. He was kept on fluids overnight, treated for shock, and given pain medication and antibiotics.

Two days later, Chama was taken to surgery. He had his pelvic fractures wired and the hip put back in the socket. A dye was instilled into his urinary bladder to verify that it was not ruptured. Two days later Chama was discharged. A few days later, though still limping on his hind leg, he was doing very well.

But three days later he presented in a depressed and dehydrated state. He had been vomiting for two days and was not eating. On examination, he had pain on abdominal palpation and was still painful in his pelvic region. Blood was taken for analysis and revealed that he had acute traumatic pancreatitis, an inflammation of the pancreas that causes severe abdominal pain and consequent vomiting. Chest x-rays were taken because no lung sounds were heard. The films showed fluid in the chest cavity. Chama was readmitted for fluid therapy and monitoring.

The next day his chest x-ray was repeated and now showed a mass effect present on the right side near the diaphragm that was obscured by fluid the previous day. We were concerned about an abscess, a collapsed lung, or a diaphragmatic hernia (a tear in the muscular separation between the chest cavity and the abdomen). An ultrasound examination was performed. A collapsed lung was found but the diaphragm's attachment to the body wall could not be located (indicating it was probably torn). His intestine appeared to be in the chest cavity. To confirm the presence of intestine in the chest cavity, Chama was given some barium to swallow. This chalk-like material allows us to see the location of the stomach and intestines. The barium verified that Chama did indeed have intestine in his chest. Though his chest x-rays had been normal the night of the accident, we assume the injury had produced a partial tear and weakening of the diaphragm at one spot. When he began vomiting from the pancreatitis, the added stress on his diaphragm resulted in completing the tear.

Poor Chama was again taken to surgery and a three inch tear in the diaphragm was found on the right side where it should be attached to the body wall. A section of small intestine, a liver lobe, and the right kidney were prolapsed through the rent and into the chest cavity. The organs were gently retracted and returned to their normal positions within the abdomen and the tear was closed.

Chama had an uneventful recovery and never looked back. He recovered quickly from all his injuries and pancreatitis.

This case illustrates how helpful imaging techniques are in evaluating trauma patients. Since not everything is evident on x-rays or ultrasound, the barium and other types of contrast or dyes can be very useful in aiding us in visualizing what is going on inside the animal's body. This case also makes the point that not all damage sustained at the time of injury is immediately evident, and problems may not be noted for days afterward.

Species: Dog

Diagnosis: Multiple Injuries

Doctor: Nancy Clifton

Back to Case Presentations