Multiple referral teams collaborate to help a challenging case

Gingy, an 11-year-old cat, was referred to the Hospital’s Neurology Service with a suspected vertebral fracture with spinal cord injury following a dog attack. On exam, he had several penetrating puncture wounds affecting his abdomen and dorsum, as well as pelvic limb paresis with marked lumbar pain.

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Serious trauma

The Hospital’s Neurology and Emergency and Critical Care (ECC) teams worked together to assess the severity of Gingy’s injuries. The Diagnostic Imaging team conducted an emergency trauma CT, which identified a dorsally displaced fracture of L4 with subsequent cord compression. There was also loss of integrity of the abdominal wall in the location of the bite wounds. Given the concern for organ trauma, and presence of puncture wounds communicating with the abdomen, along with the need to repair the abdominal wall, an exploratory coeliotomy was advised; conservative management of the L4 fracture was deemed to be the most appropriate in light of the concurrent findings.

Renal avulsion

The Soft Tissue Surgery team identified that the right kidney had been completely avulsed from the dorsal abdominal wall. As the vasculature to this kidney was still intact, the right kidney was successfully sutured back into place. The penetrating wounds and traumatised tissues were also addressed.

Gingy recovered from surgery in our intensive care unit under the supervision of the ECC Service, with a multimodal analgesia plan developed by our Anaesthesia team. Secondary to the trauma, Gingy developed severe hypotension requiring the addition of vasopressors to maintain an adequate blood pressure. Owing to the widespread muscle damage, he became markedly hypoalbuminaemic and developed peripheral oedema, necessitating blood product administration. In addition to the trauma, severe hypotension and myoglobinuria, Gingy went on to develop an acute kidney injury, which made managing his fluid and medication needs challenging.

Specialist care

Gingy received around-the-clock care from our ECC nurses, who delivered ongoing assessments of his comfort levels and provided nutrition, medications and physiotherapy when suitable.

With this multi-disciplinary, Specialist approach and attentive nursing, Gingy made a steady recovery and was discharged 10 days later. We are delighted to report that Gingy is doing well and has recovered his kidney function and mobility.