Triple pelvic osteotomy for the treatment of pelvic canal stenosis in a cat

Ischiocavernosus Muscle Release for Urethral Obstruction Treatment after Pelvic Symphyseal Distraction Osteotomy in a Cat with Pelvic Stenosis

Symphyseal distraction osteotomy (SDO) with a polymethyl methacrylate (PMMA) spacer is an effective surgical treatment for cats with pelvic stenosis. This study reports the successful treatment of urethral obstruction due to ischiocavernosus muscle (IM) tension after SDO with a PMMA spacer. A 2-year-old castrated male Korean domestic shorthair feline had megacolon and pelvic canal stenosis. The ratio of the maximal diameter of the colon to the L5 length and the pelvic canal diameter ratio were 1.6 and 0.45, respectively. Pelvic SDO was performed with a PMMA spacer, leading to pelvic canal enlargement (pelvic canal diameter ratio: 0.73). Two days after surgery, dysuria was identified immediately after removing the preoperatively placed urinary catheter. Complete blood counts and serum biochemical profiles were within the reference intervals, and a positive contrast retrograde urethrogram confirmed urethral obstruction at the level of the membranous–pelvic urethra region. Increased tension of the IM leading to a narrowed urethra was suspected as the cause of urethral obstruction. After IM release at the level of origin on the ischium, the patient had an uneventful recovery with spontaneous urination. Muscle release resulted in excellent functional restoration, with no intraoperative or postoperative complications reported during the 12-month long-term follow-up. Therefore, SDO with IM release could be a feasible therapeutic option for severe pelvic stenosis without complications, such as urethral obstruction, in cats.

Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats

OBJECTIVE

 The aim of this study was to describe the technique and the clinical outcome of cats with obstipation as a result of pelvic canal narrowing, treated using an alternative triple pelvic osteotomy technique.

METHODS

 Five cats with obstipation as a result of pelvic canal narrowing due to pelvic fracture malunion or secondary hyperparathyroidism were treated by triple pelvic osteotomy. After performing the iliac osteotomy and medial partial cortical debridement (4/5 cases), the pelvic canal was widened by moving the caudal fragment of the ilium to the lateral aspect of the cranial fragment. The iliac fragments were fixed by a 2.7-mm lag screw (5/5 cases) and an additional 2 Kirschner wires 0.8 mm (1/5 cases).

RESULTS

 The radiographic examination immediately postoperatively and 8 weeks postoperatively showed a mean pelvic canal enlargement of 20% (range 7-38%). Minor complication occurred in one case; this resolved 15 days postoperatively without any treatment. Complications and recurrence of obstipation did not occur during the final follow-up, ranging between 5 months and 1 year in any of these cases.

CLINICAL SIGNIFICANCE

 The use of lag screw fixed triple pelvic osteotomy resulted in widening of the pelvic canal and led to a satisfactory outcome with no major complications. This technique is fast, requires no expensive implants and it is relatively straightforward. Further cases are required to determine the success and complication risk of the procedure.

Partial internal hemipelvectomy as rescue therapy in obstipation in four dogs: case report

ABSTRACT Multiple pelvic fractures can lead to narrowing of the pelvic canal and loss of life quality. Hemipelvectomy, characterized by removal of bone fragments from the pelvis, is considered a rescue therapy. This report describes the technique of caudal partial hemipelvectomy in four cases of obstipation secondary to traumatic pelvic canal narrowing in four dogs, with promising results. All patients had tenesmus and fecal retention. After the procedure, the patients presented immediate normochezia and support of the ipsilateral limb after 10 to 20 days, showing the feasibility of the technique in small animals, providing clinical improvement without walking alterations.

Symphyseal distraction-osteotomy using a novel spacer of spirally fashioned orthopaedic wire for the management of obstipation

Three domestic shorthair cats, one male and two females, 17.6±6.5 months old and 3.5±0.4 kg body weight, were admitted with a 6.6±1.1 (range 6–8) month history of recurrent bouts of obstipation. Defecatory difficulties had started within a month of conservatively managed pelvic fractures. Clinical and radiographic examination revealed severe colonic distension with faeces and a narrow pelvic canal caused by malunion of the pelvic fractures. A pelvic symphyseal distraction-osteotomy (SDO) technique was performed, using a novel metal spacer of spirally fashioned orthopaedic wire. Pelvic canal enlargement allowed the insertion of an index finger into the rectum. Following this, no further episodes of obstipation occurred during a follow-up period of 1–3 years. The SDO technique may be successful for the treatment of obstipation secondary to post-traumatic pelvic canal stenosis in the cat, if the colon motility is not already permanently affected.

Tension band stabilisation of acetabular physeal fractures in four kittens

The surgical repair of acetabular physeal fractures in four kittens using a screw and tension band technique is reported. This was an appropriate method for restoring articular congruency and improving pelvic alignment. All cases had an excellent outcome and full limb use following fracture repair. In kittens younger than 12 weeks, there is a possibility of premature fusion of the acetabular bone resulting in development of a deformed, shallow acetabulum and hip subluxation. However, surgery is still justified when there is pelvic canal narrowing to decrease the risk of future defecatory problems. Early implant removal in such young kittens may decrease the severity of deformity caused by premature physeal closure. In kittens of 16 weeks or older, the prognosis is good for normal acetabular development and implant removal is not necessary.

Surgical management of constipation

There are many recognised causes of constipation in the cat and the management of the condition depends on the clinician's ability to recognise the appropriate aetiology in each case. Most surgery therapies for constipation in the cat are related to the management of idiopathic megacolon, although causes such as pelvic outlet obstruction, complications of neutering surgery, perineal herniation, and malunion pelvic fractures may also require surgical intervention. Currently, the surgical management of megacolon consists of subtotal colectomy with the recommendation that the ileocolic junction be preserved. The procedure, in general, is associated with few life-threatening complications although the majority of individuals will experience a transient period of loose stool formation in the immediate post-operative period. In the majority of cases, the long-term outcome following subtotal colectomy is considered excellent.

Lumbosacral and pelvic injuries

Pelvic fractures are commonly observed in cats after automobile-induced trauma and frequently affect other organ systems. An organized systematic approach should be followed in the evaluation of pelvic fractures. Common pelvic fracture patterns observed in cats include pubic fractures in combination with unilateral ilial fractures, unilateral sacroiliac luxations, bilateral sacroiliac luxations, and contralateral ilial body fractures. Narrowing of the pelvic canal may preclude normal passage of feces and result in megacolon. Timely and precise surgical intervention is necessary so as to impart a favorable prognosis.