PMC5480630_01
Preoperative image showing substantial bruising of the ventral abdomen and the skin wound over the right caudal thorax. Cranial is to the left of the image
10.1177_2055116917714871-fig1.jpg
PMC5480630_01_10.1177_2055116917714871-fig1.jpg
fig1-2055116917714871
Two small (~0.5 cm diameter) full-thickness circular skin wounds were present on the right caudal thorax and left cranial flank (Figure 1).
Left lateral radiograph of the thorax depicting the presence of a mild caudoventrally located pleural effusion. The diaphragm appears intact. Several discrete mineral opacities can be seen in the caudoventral thorax and cranial abdomen
10.1177_2055116917714871-fig2.jpg
PMC5480630_01_10.1177_2055116917714871-fig2.jpg
fig2-2055116917714871
Thoracic radiographs identified a mild right-sided pneumothorax, increased soft tissue opacity in the right cranial and middle lung lobes, and a small volume of pleural effusion within the caudoventral aspect of the right thoracic cavity along with several discrete mineral opacities (Figures 2-4).
Right lateral radiograph of the thorax depicting mild pneumothorax. The diaphragm appears intact
10.1177_2055116917714871-fig3.jpg
PMC5480630_01_10.1177_2055116917714871-fig3.jpg
fig3-2055116917714871
Thoracic radiographs identified a mild right-sided pneumothorax, increased soft tissue opacity in the right cranial and middle lung lobes, and a small volume of pleural effusion within the caudoventral aspect of the right thoracic cavity along with several discrete mineral opacities (Figures 2-4).
Dorsoventral radiograph of the thorax showing increased soft tissue opacity of the right caudal and middle lung lobes and mild right-sided pneumothorax. Discrete mineral opacities are present in the caudal right thorax/cranial abdomen
10.1177_2055116917714871-fig4.jpg
PMC5480630_01_10.1177_2055116917714871-fig4.jpg
fig4-2055116917714871
Thoracic radiographs identified a mild right-sided pneumothorax, increased soft tissue opacity in the right cranial and middle lung lobes, and a small volume of pleural effusion within the caudoventral aspect of the right thoracic cavity along with several discrete mineral opacities (Figures 2-4).
Preoperative ultrasound image depicting the small-sized gall bladder surrounded by liver parenchyma
10.1177_2055116917714871-fig5.jpg
PMC5480630_01_10.1177_2055116917714871-fig5.jpg
fig5-2055116917714871
The gall bladder was visualised and appeared very small in size (Figure 5).
Preoperative image depicting the yellow-orange fluid draining from the right-sided thoracic skin wound
10.1177_2055116917714871-fig6.jpg
PMC5480630_01_10.1177_2055116917714871-fig6.jpg
fig6-2055116917714871
Following initial diagnostic investigations, a change in the character of the fluid from the right-sided thoracic wound from sanguinous to yellow-orange fluid was observed (Figure 6).
Intraoperative image demonstrating the bi-lobed gall bladder. Notice the yellow bile staining of the avulsed lobe (a closed DeBakey thumb forceps has been inserted into the avulsed gall bladder lobe). Cranial is to the left of the image
10.1177_2055116917714871-fig7.jpg
PMC5480630_01_10.1177_2055116917714871-fig7.jpg
fig7-2055116917714871
The gall bladder was identified as bi-lobed (both lobes shared a common cystic duct), with one lobe within the pleural space and one lobe remaining within the peritoneal space; avulsion of the single herniated lobe had resulted in leakage of bile into the right pleural cavity (Figure 7).
Intraoperative image depicting herniation of omental fat through a left-sided ventrolateral abdominal wall defect. Note the absence of gross signs of peritonitis. Cranial is to the left of the image
10.1177_2055116917714871-fig8.jpg
PMC5480630_01_10.1177_2055116917714871-fig8.jpg
fig8-2055116917714871
There was herniation of omental fat through a left-sided ventrolateral abdominal wall defect, caudal to the rib cage (Figure 8), and communicating with the skin wound on the left flank.