Abstract
<title>Abstract</title> <p> <bold>Background</bold> peritonealpericardial diaphragmatic hernia (PPDH) and congenital portosystemic shunt (PSS) are uncommon congenital disorders in cats that arise from distinct developmental abnormalities. Although both conditions have been well describing individually, their concurrent occurrence has rarely been documented. This report describes the diagnostic interventions, staged surgical management, and outcome of a cat affected by both anomalies. <bold>Case presentation</bold> A 3-year-old neutered male Persian cat was presented with a history of persistent vomiting, diarrhea, anorexia, lethargy, ataxia and intermittent head pressing. Physical examination revealed depression, mild dehydration, pale mucous membranes, and episodes of disorientation. Clinicopathologic abnormalities include mild microcytic non-regenerative anemia, markedly decreased blood urea nitrogen, mild increases in hepatic enzyme activities, and severe fasting hyperammonemia, raising suspicion of a PSS. During diagnostic imaging, abdominal ultrasonography unexpectedly identified herniation of hepatic tissue and gallbladder into the pericardial sac. Following stabilization, surgical correction of the diaphragmatic defect was performed. Because the clinical and laboratory abnormalities could not be explained by PPDH alone, further investigation was pursued after recovery from surgery. Computed tomography angiography (CTA) identified a congenital left gastero-phrenic extrahepatic shunt. After a period of medical stabilization, surgical attenuation of the shunt was achieved using cellophane banding. Clinical signs progressively resolved following surgery, and clinicopathologic abnormalities returned within reference intervals. At the 6-month follow-up examination, the case remained clinically normal with no recurrence of neurologic or gastrointestinal signs. <bold>Conclusions</bold> This case highlights rare concurrent occurrence of PPDH and congenital PSS in a cat. The finding emphasize that identification of one congenital anomaly should no exclude the possibility of additional developmental defects. The case emphasizes the value of through diagnostic investigation and a staged diagnostic and therapeutic approach for the recognition and successful management of coexisting congenital disorders. </p>