Hiatal Hernia in Cats

There are two types of hernias that are classified depending on how the contents inside the hernia are secured. A true hernia allows for movement of the internal contents by means of a peritoneum, or hernial sac. A false hernia has no sac, meaning that contents may be trapped from going back into the abdomen. Contents that are strangulated receive no or limited blood flow, which can kill tissue. Untreated hernias may lead to further health issues. Veterinary attention is required to fix a herniation.

Due to an abnormal weakness or opening in the diaphragm, either from genetic defect or injury, organs in the abdomen may protrude through the muscular tissue into the chest cavity. This condition is referred to as a hiatal hernia. Often, part of the stomach will push through the diaphragm, although other organs may also herniate. Congenital hiatal hernias are rare in cats, with hernias from injury being more common. If the hernia is from a birth defect, it may come and go, which is then termed a sliding hernia. 

In very mild hiatal hernia cases, the cat may show no symptoms. If the hernia has resulted from injury, other injuries may be present on the cat and will cause further symptoms. All symptoms to watch for include:

• Drooling
• Vomiting (may vomit blood)
• Coughing
• Loss of appetite
• Discomfort
• Weight loss
• Dysphagia (trouble swallowing)
• Dyspnea (labored breathing)
• Rapid breathing
• Exercise intolerance

If the hernia results from a genetic defect, the issue may be passed down from the parents. Also, the mother cat may have been exposed to harmful toxins during pregnancy which hindered the proper development of the kittens. Cats carrying this defect from birth should not be bred. All known causes of hiatal hernia are listed below. 

• Congenital weakness of the abdomen (a true hernia)
• Injury from severe trauma (a false hernia)
• Disease or substance ingestion causing excess vomiting

If symptoms arise in a kitten, most likely a birth defect is to blame. Your veterinarian will perform a complete physical examination of the kitten to see if any other defects or problems are present. If the hernia has resulted due to injury, the cat will be fully assessed to locate all injuries present. Life-threatening issues will be addressed first, and once the cat is stable, the hernia will be dealt with. Sometimes hernias may result from excessive vomiting, in which case the cat may also be dehydrated. 

A thoracic X-ray may show the presence of gas-filled tissue in the cat’s upper abdomen. An internal organ may also show as having an absence of border. Dye may be used to make the organ borders more visible on the X-ray images. Fluoroscopy (or a video X-ray) may be used to gain more visual information about the herniated area. 

An endoscope (a flexible tube with a light and camera on it) may be inserted into the digestive tract to get internal images of the herniation. When the upper digestive tract is being examined, this is called a gastroscopy. These visual exams can also reveal the presence of a foreign body causing internal complications. If pneumonia has developed from the hernia’s effect on the lungs, bacterial infection should be tested for. 

Certain cases of hiatal hernia may require no treatment, while severe cases merit emergency care. The type and cause of the hernia will factor in the urgency of treatment needed. 

Surgical Anatomical Restoration 

When a hernia is causing serious damage to body tissue (especially in instances of false hernia), surgically repairing the abdominal wall and restoring the organ location may be necessary. The cat will require general anesthetic. Incision size varies depending on location, and whether videoendoscopy (a flexible tube with a camera on it) can be used to perform the surgery. The surgeon will attempt to use existing tissue where possible to make the repair. Sutures may be used to reinforce the abdominal wall. Affected organs may need to be attached to the abdominal wall to prevent sliding. 

Medication 

Various medications may be prescribed to assist with digestion. Other medications can improve the strength of the sphincter to prevent further digestion issues. 

Dietary Modifications 

In mild cases of hiatal hernia, your vet may develop a diet specific to the cat's needs. Often this will include frequent small meal portions with foods low in fat. Probiotics and antacids may be used to ease digestive problems.

Antibiotics 

If pneumonia has developed in the cat’s lungs from hernia complications, the corresponding antibiotic will be prescribed to remove harmful bacteria from the body. Antibiotics may also be prescribed post-surgery to keep infection from forming in the incision. Prescriptions often last one to four weeks.

When surgery has been performed on your cat, certain at-home care measures need to be taken. You will have to monitor the incision site daily for any signs of infection, including bleeding and swelling. If infection does develop, this can lead to serious damage. The success of the procedure has much to do with the skill of the surgeon. Complications may arise from using weak tissue to repair the abdominal wall. The esophagus may be gradually destroyed if too much pressure has forced stomach acid into it over a period of time.

If the cat makes a full recovery from surgery, the prognosis is quite good. A follow-up appointment will be needed to assess how the cat’s internal organs have healed from the procedure. Aspirational pneumonia may develop in cats who have hernial complications. Obesity and anything else that puts pressure on the cat's abdomen may cause the hernia to recur. Keeping the cat on an appropriate diet will greatly reduce the chance of recurrence.