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 MEET
SOME OF OUR PATIENTS: “Ringo"
Like his Beatle namesake, Ringo was a bit of a Starr!
A very handsome 2 year old black & white cat with a gloriously
friendly temperament -as the Scottish saying goes, a real “sook”.
He was an infrequent visitor to the Clinic; boosters and the
occasional cat fight made up the majority of his treatments
but all that was about to change. Like most cats, Ringo had
a routine he adhered to, going out and returning home at about
the same time each day. However, one night, he wasn’t waiting
to be let in as normal. As the hours passed his owner became
more and more concerned until, in the early hours, she found
him at the bottom of the steps leading to the front door, seemingly
unable to climb them. As Ringo's owner went to pick him up,
it was obvious he was in a lot of pain so a call was made to
our Emergency Service. On examination at the surgery, various
injuries were uncovered.
 As
well as a bleeding nose, the tip of his tongue was injured;
it looked like his face had probably been scraped along the
road as a car hit him. His picture shows the damage to his tongue
and just inside the roof of his mouth. despite these looking
unpleasant, they were relatively slight injuries. Far more worrying
was that his abdomen felt empty whilst between his back legs
there was a large swelling which definitely shouldn’t have been
there. Ringo’s gums were quite pale, pointing to him suffering
from shock; this alone is enough to be fatal, regardless of
whatever other injuries are present, and he was in a lot of
pain. The vet strongly suspected that he had indeed been struck
by a car, the force of which had torn a large hole in his abdominal
muscles. All the internal abdominal organs are kept in place
by a sheet of muscle, which, at one end attaches itself to the
pelvis. It was here that the hole was, and as a result, most
of his intestines had escaped to directly under the skin between
his back legs. However, this was, at this point, not a priority;
Ringo required treatment for shock, to stabilise him as major
surgery would be required to literally piece him back together.
Accordingly, he was put on an intravenous drip and given antibiotics
and painkillers to make him more comfortable before being transferred
from our emergency clinic back to The Cat Clinic. By 10am, Ringo
was starting to look a bit more comfortable and, more importantly,
his gums were turning more pink, showing that he was coming
out of shock. It would be necessary to repair the rupture as
soon as the vet felt he could withstand an anaesthetic, as there
is a very high risk that some of the intestine could get trapped
in the hole, cutting off the blood supply leading to major problems.
The worry with injuries to this area is that the muscle could
be ripped so badly away from the bone of the pelvis, that there
literally isn’t enough to sew back again. Also, there is a major
worry that structures such as the bladder may have been ruptured;
having urine actually sloshing around in the abdomen isn’t going
to do anyone any good. With normal anatomy, it often is possible
to feel whether there is an intact bladder - Ringo’s anatomy
was anything but normal! It was with some trepidation then that
he was taken into the operating theatre for exploratory surgery.
 As
his picture shows, Ringo had extensive bruising on his abdomen
when we clipped his fur. We went ahead with surgery. Things
at first glance were better than we expected. Certainly, there
was a large hole in the muscle but the bladder was intact (although
very bruised) as were the other vital structures and major blood
vessels. However, there was an area of intestine that had suffered
severe damage and had to be removed. A very delicate surgical
procedure (enterectomy followed by an end-to-end anastomosis)
had to be performed to remove the damaged section and rejoin
the two ends together.
Once the vet was happy with that repair an attempt could be
made to repair the ruptured muscle. As feared on first presentation,
the muscle had been extensively torn; in fact this repair took
longer to affect than the delicate surgery required for the
anastomosis! However, after several hours in theatre, a very
sore and bruised Ringo was put back into his recovery kennel.
 His
owner had brought him in in his own soft bed and so it was with
a visible sense of relief that Ringo retreated into his kennel.
The next few days would be crucial for his complete recovery.
The main worry post-operatively was that whatever had hit Ringo
had caused crushing injuries to blood vessels causing a disruption
of the blood supply to vital areas. This damage wouldn’t become
apparent until a few days after the accident - we could already
see that there had been some damage to vessels and that was
why we performed the enterectomy, but at that stage it was impossible
to tell just how extensive it was. Only time would tell if the
blood was getting through okay to this area.
Twenty-four hours after the operation, Ringo was still looking
a bit sorry for himself but seemed quite bright considering
all he had been through. The vet was cautiously optimistic but
warned the owner that it was still too early to say he would
make a full recovery. Meanwhile, he was quite enjoying the fuss
and attention in his comfy bed. Every day he seemed a little
brighter and his op-site felt fine on palpation and so it was
a very relieved owner that came to collect him and nurse him
at home. By this stage, he was eating very small amounts of
very soft foods but understandably, his appetite wasn’t quite
what it had been before.
Six days after his operation, Ringo was brought in for a checkup.
Unfortunately it was apparent that not all was well. He had
been very quiet overnight, had no appetite and he was looking
pale again. On palpation of his tummy, the vet could feel a
large swelling at the op-site. A certain amount of swelling
is to be expected as the body starts to heal itself, but this
was larger than that and there was more of an expected “ouch”
from Ringo when this spot was touched.
There was no alternative than to go back in and have a look.
The biggest fear was that the initial repair had broken down
and that the contents of the intestine were leaking into the
abdominal cavity - a life-threatening complication. A very depressed
looking cat was taken away from a very worried owner and into
theatre again. A second exploratory operation actually revealed
that the repair of both the muscle rupture and intestine were
intact, but the problem was that the blood supply to the membranous
covering of the intestine (omentum) had been damaged in the
accident, causing an area to die off and this was the lump the
vet could feel. It wasn’t possible to see this damage at the
time of the accident; it’s rather like tying a piece of string
tightly around your finger. The blood stops reaching the part
past the string immediately but the tissues take several days
to die off. The dead piece of tissue was removed and a drainage
tube sutured in place.
Ringo was hospitalised for several days so we could flush out
his wound and check that this time there were going to be no
more complications. Every day that went by revealed a happier
and happier Ringo. Daily his appetite improved, as did his purring.
The next crucial step was to make sure that food was passing
through him okay - one of the few times as a nurse, you are
keen to see a full litter-tray! On the fourth day he duly obliged
and couldn’t quite understand the fuss and elation over a dirty
litter tray. The drainage tube was removed and a very happy
owner arrived to collect him.
He was sent home with oral antibiotics and instructions to
keep in daily touch with the Clinic by phone. Ringo never looked
back - every day he ate more and got brighter and brighter until
we were able to sign him off. However, I don’t think he ever
felt quite the same attachment to his nice comfy bed again!
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