Multiple acquired portosystemic shunts in a cat secondary to chronic diaphragmatic rupture

A cat with a chronic diaphragmatic rupture presented with neurological signs, including twitching and focal seizures. Blood ammonia level was markedly elevated and therefore neurological signs were thought to be related to hepatic encephalopathy. Exploratory laparotomy revealed that the left lateral and medial liver lobes were herniated into the thorax and multiple acquired portosystemic shunts (MAPSS) were present. The hernia was reduced and the diaphragm repaired. Neurological signs gradually resolved following surgery and 1 year postoperatively the cat was clinically normal, was not on any medication and had no evidence of hepatic dysfunction