Effect of hospitalisation on the rate of surgical site infection in dogs with Penrose drains

OBJECTIVES

The aim of this study is to retrospectively report complication and infection rates associated with the use of Penrose drains in a large population of dogs; and to compare complication and infection rates of dogs hospitalised for maintenance of their Penrose drains with those that were discharged home with their drains in place.

MATERIALS AND METHODS

We performed a retrospective search of medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound in one institution. Our population was sub-divided into dogs discharged home with a drain in place; dogs discharged only after drain removal; and dogs recovered part of the time in hospital and part at home (with the drain in situ). Postoperative complications were graded using the Clavien-Dindo scale.

RESULTS

Two hundred and eight dogs were included. The overall complication rate was 40.9% (85/208), with most complications considered minor. The overall infection rate was 16.9% (35/207). Dogs discharged home with the drain in situ <24 hours after surgery (n=136) had similar complication (39.0%) and infection (16.2%) rates to dogs kept hospitalised for drain care (n=50, 42.9%, 18.4%) and dogs kept hospitalised for >24 hours but discharged with the drain in situ (n=18, 50.0%, 22.2%).

CLINICAL SIGNIFICANCE

Our study results show no significant influence on the complication or infection rates between dogs that were hospitalised for drain care and those discharged home with drains in situ within 24 hours of surgery.

Evaluation of complications and long-term outcomes associated with 101 dogs and cats discharged with and without subcutaneous active closed-suction drains (2014-2022)

OBJECTIVE

To retrospectively evaluate complications reported in dogs and cats with a closed suction subcutaneous drain that were either managed completely in hospital (Group ND) or discharged home for ongoing outpatient care (Group D).

ANIMALS

101 client-owned animals involving 94 dogs and 7 cats with a subcutaneous closed suction drain placed during a surgical procedure.

PROCEDURES

Electronic medical records (January 2014 to December 2022) were reviewed. Signalment, reason for drain placement, surgical procedure, location and duration of drain placement, drain discharge status, antimicrobial usage, culture and sensitivity results, and intraoperative and postoperative complications were recorded. Associations among variables were evaluated.

RESULTS

There were 77 animals in Group D and 24 animals in Group ND. Majority (n = 21/26) of complications were classified as minor and were all from Group D. Length of hospitalization in Group D (1 day) was significantly shorter than Group ND (3.25 days). Duration of drain placement was significantly longer in Group D (5.6 days) than Group ND (3.1 days). There were no associations between drain location, drain duration, or surgical site contamination with risk of complications.

CLINICAL RELEVANCE

There is a higher risk of complications associated with discharging an animal from hospital (37%) with a subcutaneous closed suction drain than removing it prior to discharge (4%). These complications, however, were primarily minor and easily managed. Discharging an otherwise stable animal to home with a subcutaneous closed suction drain may be feasible to decrease duration of hospitalization, cost to the owner, and stress for the animal.

Influence of 4 drain configurations on fluid dispersal and retrieval in an instillation model

OBJECTIVE

To describe and compare the pattern of fluid dispersal and retrieval in a novel instillation therapy system.

STUDY DESIGN

In vitro experimental study.

METHODS

A 10 cm² square model was constructed using plastic sheeting secured to plexiglass, with a wound infusion catheter and Jackson-Pratt (JP) active suction drain positioned in 4 configurations: parallel, perpendicular, diagonal, and opposite. Fluid was instilled using the wound infusion catheter, allowed to dwell for 10 min, and retrieved using the JP drain. Two surface area calculations were made using imaging software: coloration with diluted methylene blue (MB) on photos, and filling with diluted contrast on fluoroscopic images. Fluid retrieval was recorded. Statistical analysis was performed using a mixed-effects linear model (p < .05).

RESULTS

Configuration influenced fluid dispersion within the model (p = .0001); the diagonal configuration had the greatest surface area coverage (mean ± SD; 94.5 ± 2.4%) and the parallel configuration had the lowest surface area coverage (60.2 ± 2.9%). A dwell period increased fluid dispersal by an average of 4.0 ± 0.8% (p < .0001). Fluid retrieval exceeded 16.7 ± 1.5 mL (83.5 ± 7.5% volume instilled) for all configurations and was 0.5 ± 0.1 mL (2.5 ± 0.5% volume instilled) greater for MB than contrast agent (p < .0001).

CONCLUSION

Perpendicular or diagonal configurations and low-viscosity fluid maximized fluid dispersion and retrieval.

CLINICAL SIGNIFICANCE

Wound instillation therapy involves delivering lavage fluid or medications to a closed wound space. This is feasible using a wound-infusion catheter and active suction drain. Configuration should be considered to optimize fluid dispersal and retrieval when planning instillation therapy.

Percutaneous transhepatic cholecystostomy drainage in a dog with extrahepatic biliary obstruction secondary to pancreatitis

CASE DESCRIPTION

An 8-year-old 36.3-kg (79.9-lb) spayed female Rottweiler was evaluated because of anorexia and vomiting.

CLINICAL FINDINGS

Extrahepatic biliary obstruction (EHBO) secondary to pancreatitis was suspected on the basis of results from serum biochemical analyses, CT, and cytologic examination.

TREATMENT AND OUTCOME

Only marginal improvement was observed after 24 hours of traditional medical management; therefore, novel continual biliary drainage was achieved with ultrasonographically and fluoroscopically guided placement of a percutaneous transhepatic cholecystostomy drainage (PCD) catheter. Within 24 hours after PCD catheter placement, the dog was eating regularly, had increased intestinal peristaltic sounds on abdominal auscultation, no longer required nasogastric tube feeding, and had decreased serum total bilirubin concentration (7.7 mg/dL, compared with 23.1 mg/dL preoperatively). Bile recycling was performed by administering the drained bile back to the patient through a nasogastric tube. The PCD remained in place for 5 weeks and was successfully removed after follow-up cholangiography confirmed bile duct patency.

CLINICAL RELEVANCE

Transhepatic PCD catheter placement provided fast resolution of EHBO secondary to pancreatitis in the dog of the present report. We believe that this minimally invasive, interventional procedure has the potential to decrease morbidity and death in select patients, compared with traditional surgical options, and that additional research is warranted regarding clinical use, safety, and long-term results of this procedure in veterinary patients, particularly those that have transient causes of EHBO, are too unstable to undergo more invasive biliary diversion techniques, or have biliary diseases that could benefit from palliation alone.

Technical Note: Coccygeal vein catheterization for sampling of reproductive tract-derived products from the uterine-ovarian drainage

Blood sample collection from the caudal vena cava at the site of uterine-ovarian drainage provides a more exact evaluation of the concentration and pattern of secretion of uterine or ovarian secreted products for studies of reproductive processes in cyclic and pregnant cattle compared with samples collected from general circulation. This paper describes a thorough and updated procedure for cannulating the coccygeal vein into the caudal vena cava for the collection of serial blood samples at or near the site of uterine-ovarian drainage. Concentrations of progesterone were quantified in cows of different reproductive tract sizes with an active corpus luteum to assess the distance for proper catheter placement compared with circulating concentrations collected from the jugular vein. This procedure has a low risk for side effects, can be used effectively in pregnant animals with no major consequence to the viability of the pregnancy, and provides means for frequent collections up to 12 d.

Isolation and Characterization of Equine Uterine Extracellular Vesicles: A Comparative Methodological Study

Extracellular vesicles (EVs) have been identified in the uterine fluid in different species and have been pointed as key players in the embryo-maternal dialogue, maternal recognition of pregnancy and establishment of pregnancy. However, little is known about the uterine EVs in the mare. Therefore, the present study aimed at characterizing EVs from uterine lavage of cyclic mares by comparing five EVs isolation methods and the combination of them: (1) ultracentrifugation (UC); (2) concentration of lavage volume by Centricon ultrafiltration (CE); (3) the use of CE with different washing steps (phosphate-buffered saline with or without trehalose); (4) size-exclusion chromatography with iZON-qEV columns, and (5) a combination of the methods with best results based on EVs yield, purity, and protein cargo profiles. Transmission electron microscopy and Western blotting confirmed the isolation of EVs by all methods but with quantitative and qualitative differences. Mass spectrometry provided differences in protein profiles between methods, number of identified proteins, and protein classes. Our results indicate that the combination of CE/trehalose/iZON/UC is an optimal method to isolate equine uterine EVs with good yield and purity that can be applied in future studies to determine the role of equine uterine EVs in embryo-maternal interactions.

Use of platelet-rich plasma for the treatment of prostatic cysts in dogs

Abnormalities of the canine prostate gland, in particular, benign hyperplasia and cysts, are frequent in dogs over 5 years of age. Treatment strategies for dogs with prostatic cysts include ultrasound-guided percutaneous drainage with alcohol sclerotherapy, reduction surgery, and omentalization. The aim of this study was to evaluate the use of platelet-rich plasma (PRP) for the treatment of prostatic cysts in dogs. Ten mixed breed adult male dogs were included in the study. Percutaneous drainage was performed prior to ultrasound-guided PRP injection with a 21G spinal needle. The PRP dose contained half of the solution drained from the cyst. Follow-ups were performed 6, 12, 24, and 60 d after treatment. Ten prostatic cysts were successfully treated with PRP after the ultrasound-guided drainage of the cystic cavities. No side effects were observed during the procedures. After the introduction of PRP, cysts detected by ultrasound appeared hypoechoic. On the sixth day, the hypoechoic appearance was maintained and margins were still identifiable. At 24-day and 60-day follow-ups, cysts were no longer detectable by ultrasound. One of the ten dogs had to be euthanized because of the presence of a malignant mesenchymal neoplasm of the oral cavity (fibroblastic sarcoma) and histological examination of serial sections of the prostate gland was performed. Histologic evaluation 1 year after treatment showed a regression of the cystic lesion injected with PRP. The therapy, which uses PRP injection in combination with ultrasound-guided drainage, can be considered a safe and effective strategy for the treatment of prostatic cysts in dogs.

Sialoendoscopy as a treatment for an obstructed mandibular salivary duct in a horse

A 14-year-old Quarter Horse was examined for a draining tract of 8 months' duration on the right mandible that was non-responsive to antibiotic therapy and surgical therapy. Further investigation and subsequent treatment with sialoendoscopy and ultrasonography were performed to relieve an obstruction of plant awns in the mandibular salivary duct.

Multiple liver abscesses in a dog secondary to the liver fluke Metorchis conjunctus treated by percutaneous transhepatic drainage and alcoholization

A 1-year-old German shepherd × husky cross dog was diagnosed with multiple liver abscesses and severe cholangitis secondary to the liver fluke Metorchis conjunctus. The dog was successfully treated with 2 percutaneous transhepatic drainage and alcoholization procedures, and a prolonged course of antibiotics and praziquantel.

Streptococcus equi subsp zooepidemicus pleuropneumonia and peritonitis in a dromedary camel (Camelus dromedarius) calf in North America

CASE DESCRIPTION

A 12-week-old female dromedary camel (Camelus dromedarius) calf was evaluated because of acute (< 24 hours) inappetence and lethargy. The calf was being bottle-fed because of maternal rejection.

CLINICAL FINDINGS

Physical examination revealed decreased bronchovesicular sounds and absent borborygmi. The rectal temperature was 38.9°C (102.0°F). A CBC indicated leukopenia with a degenerative left shift suggestive of a systemic infection. Results of abdominal and thoracic ultrasonography showed severe bicavitary effusion, peripheral lung consolidation, and intestinal hypomotility. Pleural and peritoneal fluid analysis confirmed a diagnosis of septic pleuritis and peritonitis. Results of aerobic bacterial culture of venous blood, peritoneal fluid, and pleural fluid samples indicated Streptococcus equi subsp zooepidemicus septicemia as the etiology for the polyserositis (ie, alpaca fever).

TREATMENT AND OUTCOME

Treatment with IV broad-spectrum antimicrobials, an NSAID, and pleural drainage was initiated. Clinical signs of pleuropneumonia, peritonitis, and systemic infection improved rapidly 24 hours after initiation of medical treatment. The calf was discharged from the hospital after 11 days, and antimicrobial treatment continued for 2 weeks after discharge. At follow-up approximately 4 weeks after hospital discharge (6 weeks after the initial examination), there were no clinical signs suggestive of relapse or any reported complications.

CLINICAL RELEVANCE

S equi subsp zooepidemicus may cause polyserositis in Old World camelids (eg, dromedary camels) with signs similar to those seen in New World camelids (eg, alpaca and llama). The rapid response to medical treatment for the patient described suggested that S equi subsp zooepidemicus-induced polyserositis (alpaca fever) in dromedary camels may respond favorably to appropriate treatment. Reducing stress, reducing overcrowding, and separate housing of equids and camelids are suggested. Further studies are needed to better assess the epidemiology of alpaca fever in dromedary camels in North America.

Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse

CASE DESCRIPTION

A 4-year-old Arabian-cross mare was examined because of a 48-hour history of pyrexia, lethargy, and signs of abdominal discomfort.

CLINICAL FINDINGS

On initial evaluation, the horse was in good body condition, but febrile, tachycardic, tachypneic, and icteric and had signs of colic. Findings on CBC and serum biochemical analysis indicated marked systemic inflammation and hepatocellular damage. Serial abdominal ultrasonographic examinations revealed progressive, localized hepatic parenchymal abnormalities in the left ventral aspect of the abdomen in proximity to the left liver lobes, and eventual identification of an irregularly marginated, hyperechoic walled region of heterogenous echogenicity consistent with an encapsulated hepatic abscess.

TREATMENT AND OUTCOME

Medical treatment was initiated with administration of doxycycline and flunixin meglumine. After 7 days, the horse's clinical signs and hematologic values improved. After 14 days, the horse was discharged from the hospital and prescribed continuation of doxycycline treatment for 14 days. One week following hospital discharge, the horse was reevaluated for recurrent signs of colic and pyrexia. The horse was sedated, and the region overlying the caudal aspect of the seventh rib was desensitized with an inverted L nerve block by local infiltration with 2% lidocaine. While the horse was standing and sedated, drainage of an encapsulated intra-abdominal abscess was followed by rib resection and removal of a portion of necrotic left lateral liver lobe. The development of a pneumothorax following rib resection represented the only major surgical complication. Twelve months later, the horse was clinically normal and had returned to its previous level of performance.

CLINICAL RELEVANCE

Rib resection in standing sedated horses, together with appropriate medical management, should be considered an option for removal of well-encapsulated cranially located intra-abdominal abscesses that are adherent to the ventrolateral aspect of the body wall in horses.

[Septic peritonitis: treatment and prognosis]

Septic peritonitis is an inflammatory condition of the peritoneum that has a wide variety of clinical courses. The etiology and pathophysiology of this condition and its diagnosis in small animals are reviewed in a companion article. This article addresses the treatment of septic peritonitis and prognosis in small animals.

Septic peritonitis

Bacterial septic peritonitis is a serious condition that requires immediate treatment. The pathogenesis is complex, and the list of diagnostic differentials is extensive. The keys to successful treatment are early recognition of the condition and elimination of the causative organism. Multiple options for draining the peritoneal cavity exist, and further studies are necessary to establish specific, evidence-based guidelines. The prognosis is generally guarded in dogs and cats. Much depends on whether the patient develops concurrent sepsis, systemic inflammatory response syndrome, or multiple organ dysfunction syndrome.

Intracranial empyema: literature review and two novel cases in cats

OBJECTIVES

To review the literature on intracranial empyema and report two new cases in cats.

METHODS

Literature review and case reports.

RESULTS

Intracranial empyema has been rarely reported in small animals. In two novel cases in cats, the route of infection was postulated to be local extension from a retrobulbar abscess of odontogenic origin in one case and direct inoculation from a penetrating bite wound to the skull, confirmed at post-mortem examination, in the other. On magnetic resonance imaging of the first case, there was a contrast-enhancing large extra-axial fluid collection overlying the right cerebral hemisphere, consistent with subdural empyema. Infection was caused by an Actinomyces spp. This is the first report of successful treatment of intracranial empyema by craniotomy, drainage and antibiotics.

CLINICAL SIGNIFICANCE

Intracranial empyema is a neurosurgical emergency. Favourable outcomes may be achieved with surgical decompression, antimicrobial therapy and intensive care.

Diagnosis and successful treatment of a caudal lingual abscess in a geriatric dog

A 13-year-old, intact male, golden retriever was presented for glossomegaly. A diagnosis of a caudal lingual abscess was made by fine needle aspiration under general anesthesia. The dog showed marked clinical improvement following abscess drainage. Lingual abscesses should be included as a differential diagnosis in any dog with an unexplained acute glossomegaly.

Use of vascular access ports with intrathoracic drains for treatment of pleural effusion in three dogs

CASE DESCRIPTION

3 dogs (9 to 12 years old) were evaluated because of recurrent pleural effusion that was refractory to treatment of the underlying cause.

CLINICAL FINDINGS

Dogs were evaluated because of cough, dyspnea, tachypnea, or lethargy or a combination of these clinical signs. Radiography, ultrasonography, or thoracocentesis were used to confirm the presence of pleural fluid in each dog. A neoplastic cause of pleural effusion was confirmed in 2 dogs. In 1 dog, fasciitis of the mediastinum and the left parietal pleura was diagnosed, with no evidence of neoplasia.

TREATMENT AND OUTCOME

Each dog was anesthestized, and thoracotomy was performed with manual perforation of the mediastinum. Permanent, subcutaneously placed vascular access ports were attached to intrathoracic, Jackson-Pratt drain tubing for repeated drainage of pleural fluid. Drains were used successfully in the 3 dogs for periods of 6 weeks, 11 weeks, and > 3 years.

CLINICAL RELEVANCE

Findings suggest that subcutaneous vascular access ports attached to intrathoracic drain tubing may be an effective way to remove recurrent pleural effusion in dogs.

Ultrasound-Assisted Drainage and Alcoholization of Hepatic and Renal Cysts: 22 Cases

Twenty-two dogs and cats with symptomatic renal or hepatic cysts that had undergone ultrasound-assisted drainage and alcoholization were retrospectively evaluated. Common presenting complaints were anorexia, reluctance to move, and vomiting. Abdominal pain was observed in all cases. Systemic hypertension was identified in four dogs and four cats with renal cysts. Cyst drainage and alcoholization were achieved without complications in 19 animals, and all clinical signs resolved after the procedure. In three cases, transient bleeding was observed during alcoholization, and the procedure was interrupted. Blood pressure normalized in the four dogs with renal cysts, but it remained elevated in the four cats.

"Lumpy jaw" in exotic hoof stock: a histopathologic interpretation with a treatment proposal

"Lumpy jaw" of artiodactyls and macropods, although often considered a manifestation of actinomycosis, is actually an osteomyelitis, perhaps commencing with a dental root abscess or trauma to the jaw. Anaerobes may be cultured from the lesions, and vegetable matter may be impacted in them. It is a chronic disease and difficult to treat. Successful treatment may include draining the abscess, cleaning the cavity with saline and antibiotics, flushing with a combination of hydrogen peroxide-sodium hypochlorite and Betadine, and apicoectomy and endodontic filling when active inflammation has subsided.

Successful medical treatment of 15 dogs with pyothorax

OBJECTIVES

To review the success of non-surgical management, which included antibiotics and a single thoracocentesis, in 15 dogs presenting with pyothorax.

METHODS

Sixteen dogs were selected retrospectively from case files at the Veterinary Cardiorespiratory Centre.

RESULTS

One dog was diagnosed with a mass suspected to be a pulmonary abscess on ultrasound examination and was referred for surgery. Fifteen dogs were treated medically. Springer spaniels were the most commonly presented breed (six cases) followed by Labrador retrievers (three cases). Under sedation or general anaesthesia, thoracocentesis was performed unilaterally and as much purulent effusion as possible was removed. Lavage of the thorax was not undertaken. In most dogs, antibiotic treatment was ampicillin at a mean dose of 33 mg/kg administered three times daily and 25 mg/kg metronidazole administered twice daily. Antibiotics were provided for a minimum of six weeks. All dogs recovered completely and did not show relapse on prolonged follow-up. This included one dog, which had very widespread pleural adhesions and minimal effusion.

CLINICAL SIGNIFICANCE

In dogs that do not have evidence of pulmonary masses or consolidations and no evidence of granular pleural effusion, medical therapy may be curative even in chronic cases of pyothorax with pleural adhesions.

Factors influencing the short-term outcome following thoracic surgery in 98 dogs

OBJECTIVES

To evaluate the factors influencing the short-term (<14 days) outcome of thoracic surgery in dogs.

METHODS

A retrospective review of 98 dogs undergoing thoracotomy over a five-year period was undertaken.

RESULTS

A pre-operative diagnosis was achieved in 69 per cent of cases. Intrathoraic neoplasia had the lowest pre-operative diagnosis rate (5.5 per cent). Mortality rates of 21 per cent were recorded and were significantly higher for intrathoracic neoplasia (50 per cent) and significantly lower for persistent ductus arteriosus (7.4 per cent) and vascular ring anomaly (0 per cent). Median sternotomy was the preferred approach for pyothorax (85 per cent) and penetrating thoracic injuries (66 per cent). Intercostal thoracotomy was the preferred approach for all other diseases. Postoperative complications occurred in 39 per cent of cases. Wound complications were more common for pyothorax (45 per cent) and following median sternotomy (71 per cent). Thoracic drains were placed in 77 per cent of cases and complications were recorded in 23 per cent. Pyothorax and chylothorax had thoracic drains maintained for significantly longer periods of time. Longer thoracic drain duration was correlated significantly with increased complication rates.

CLINICAL SIGNIFICANCE

The short-term outcome following thoracic surgery is influenced by diagnosis. The thoracic approach is determined by intrathoracic disease, but may influence outcome by affecting the incidence of postoperative wound complications. The risk of thoracic drain complications increases with drain duration, which is influenced by the underlying disease. Drains should be maintained for the minimal amount of time possible.

Initial wound management

A wounded patient can be presented to the veterinary surgeon under a number of circumstances. The wound could result from external trauma,such as vehicle trauma or an animal fight, or it could have been created by surgical intervention, such as the removal of a mass. A wound could also be secondary to a failed initial attempt at wound closure. No matter what the cause, initial wound management often follows similar pathways. A successful wound closure and healing outcome is often dependent on adherence to basic principles of wound assessment, appropriate care, and reassessment. This article covers the approach to and specific options for the initial stages of wound management.

Treatment for pancreatic abscesses via omentalization with abdominal closure versus open peritoneal drainage in dogs: 15 cases (1994–2004)

OBJECTIVE

To compare survival rate, duration of hospitalization, and complications in dogs with pancreatic abscesses treated with omentalization with abdominal closure versus open peritoneal drainage and evaluate a pancreatitis severity score for potential prognostic value.

DESIGN

Retrospective case series.

ANIMALS

15 dogs with pancreatic abscesses.

PROCEDURE

Data regarding species, breed, age, initial clinical signs, CBC, serum biochemical abnormalities, pancreatitis severity score, anatomic location of the abscess, intraoperative bacteriologic culture results, treatment modality, postoperative complications, outcome (dismissed alive from the hospital, died in the postoperative period, or euthanized at surgery), and duration of hospitalization were evaluated.

RESULTS

6 dogs survived, 6 dogs died or were euthanized after surgery, and 3 were euthanized during surgery. Five of 8 dogs treated with omentalization and abdominal closure survived, and 1 of 4 dogs treated with open peritoneal drainage survived. In several dogs, treatment required additional surgical procedures, which did not appear to affect outcome. Postoperative complications were similar among survivors and nonsurvivors. Mean duration of hospitalization for dogs treated with omentalization and abdominal closure was less than that of dogs treated with open peritoneal drainage. Neither pancreatitis severity score nor any individual components of the score were associated with outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Omentalization is a viable treatment option for pancreatic abscess in dogs. Furthermore, shorter hospitalization and better survival outcomes may make omentalization preferred over open peritoneal drainage.

Therapeutic percutaneous ultrasound-guided cholecystocentesis in three dogs with extrahepatic biliary obstruction and pancreatitis

Three dogs were examined because of acute pancreatitis. In all 3, distension of the gallbladder was seen ultrasonographically, and extrahepatic biliary tract obstruction (EHBO) was diagnosed on the basis of ultrasonographic findings and serum biochemical abnormalities (i.e., high serum bilirubin and cholesterol concentrations and increased hepatic enzyme activities). In all 3 dogs, percutaneous ultrasound-guided cholecystocentesis (PUCC) was used to decompress the gallbladder, with cholecystocentesis performed multiple times in 1 dog. Serum bilirubin concentration was substantially decreased following the procedure in all 3 dogs. Two of the 3 dogs did not require surgery to resolve the obstruction. In the third dog, an exploratory laparotomy was performed because of concerns about development of abdominal effusion following the procedure. Bile staining of the mesenteric fat was seen during the laparotomy, but no defect in the gallbladder wall could be identified. In most dogs with EHBO secondary to pancreatitis, the obstruction resolves spontaneously as the acute pancreatitis improves so that surgery is not required. In those few dogs in which EHBO does not resolve or in which EHBO results in complications, therapeutic PUCC may be useful in relieving gallbladder distension.

Cisterna Chyli Ablation with Thoracic Duct Ligation for Chylothorax: Results in Eight Dogs

OBJECTIVE

To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs.

STUDY DESIGN

Retrospective study.

ANIMALS

Eight dogs with chylothorax.

METHODS

TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners.

RESULTS

Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA.

CONCLUSION

CCA and TDL resolved chylothorax in most dogs (88%).

CLINICAL RELEVANCE

CCA combined with TDL may improve the outcome of chylothorax in dogs.

Percutaneous Drainage and Alcoholization of Hepatic Abscesses in Five Dogs and a Cat

Hepatic abscesses are rare and difficult to diagnose in dogs and cats. Ultrasonographic examination is essential to thoroughly examine hepatic abnormalities, and it may also help in the localization of hepatic abscesses. In this retrospective study, five dogs and one cat with focal hepatic lesions compatible with a hepatic abscess were treated with percutaneous ultrasound-assisted drainage and alcoholization using 95% ethanol. The procedure was performed rapidly under injectable anesthesia and provided excellent results in all animals. No complications or relapses were noted for 120 days following the procedure. The technique of percutaneous ultrasound-assisted drainage and alcoholization of hepatic abscesses in the dog and cat is also described.

The Effect of Cisterna Chyli Ablation Combined with Thoracic Duct Ligation on Abdominal Lymphatic Drainage

OBJECTIVE

To evaluate the effect of cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) on abdominal lymphatic drainage in normal dogs.

STUDY DESIGN

Experimental study.

ANIMALS

Nine female beagle dogs.

METHODS

TDL was performed in 3 dogs and was combined with CCA (CCA-TDL) and local omentalization in 6 dogs. Contrast lymphangiography was attempted in all dogs immediately before and after TDL. Dogs were reanesthetized at 31-37 days for lymphatic studies by new methylene blue (NMB) injection into a mesenteric lymph node and by contrast lymphangiography.

RESULTS

In 6 CCA-TDL dogs, 2 had direct shunting of contrast from the lymphatic system into major abdominal veins, 3 had contrast material that dissipated into abdominal vessels within the mesenteric root, and 1 had shunting into the azygous vein. NMB was not observed within the omental pedicle after CCA-TDL. Chylous drainage was by the azygous vein in all 3 TDL dogs.

CONCLUSIONS

CCA-TDL disrupted chylous drainage to the thoracic duct and resulted in direct intraabdominal lymphaticovenous anastomoses identified by shunting of lymphatic flow directly into the abdominal vasculature in 5 of 6 CCA-TDL dogs. Omentalization of the cisternal ablation site was not beneficial in augmenting extrathoracic lymphatic drainage and is not recommended with CCA-TDL.

CLINICAL RELEVANCE

CCA-TDL represents a novel approach to surgical redirection of chylous drainage to the venous circulation outside of the thorax and may be useful in the treatment of spontaneous chylothorax in the dog.

Infection with Corynebacterium pseudotuberculosis in five alpacas

Among the population of an alpaca breeding farm, 5 alpacas (22 days to 14 months old) developed focal swellings in the subcutaneous tissues of the head or neck. Infection with Corynebacterium pseudotuberculosis was confirmed on the basis of results of microbial culture of abscess material and a serum hemolysis inhibition assay to detect C. pseudotuberculosis toxin. The dams of the affected alpacas were seronegative for C. pseudotuberculosis toxin. The affected alpacas underwent surgical excision of the abscesses and were isolated from herdmates for 90 days; treatment was successful, and no other alpacas in the herd became infected. Common risk factors for sources of infection in the affected alpacas included housing in a maternity barn and a pasture. Also, the infection potentially originated from new alpacas introduced into the herd during the preceding 3 months. Infection with C. pseudotuberculosis should be considered as a differential diagnosis for camelids with peripheral lymphadenopathy or abscesses in subcutaneous tissues.

[Subperitoneal cyst in a Friesian mare]

The case of a 5-year-old Friesian mare with a mass in her abdomen and a gait irregularity of the left hind limb is discussed. At rectal ultrasonogrphic examination the mass appeared to be a thin-walled, anechogenic cavity in the left abdomen. By means of laparoscopy the mass could be visualized as a smooth structure, covered by peritoneum and fat. Under laparoscopic guidance the mass was punctured and fluid was aspirated. Cytological and bacteriological findings of the fluid were indicative of a cyst. After drainage of the cyst the locomotion disorder of the left hind limb disappeared. It is concluded that this horse suffered from a subperitoneal cyst, a rare disorder in humans and never previously described in horses. The case emphasizes the value of laparoscopy in the diagnosis and treatment of (intra)abdominal masses and further clearly shows that in the differential diagnosis of locomotion disorders not only structures related to the locomotion system should be taken into account.

Pericarditis and pleuritis caused by Corynebacterium pseudotuberculosis in a horse

A 13-year-old Oldenburg mare was evaluated for lethargy and signs of mild colic. Pericardial tamponade caused by fibrinoeffusive pericarditis was diagnosed. Cytologic and biochemical evaluation of pericardial fluid was consistent with a septic effusion. Corynebacterium pseudotuberculosis, the cause of pigeon fever, was identified by bacteriologic culture of pericardial fluid. Drainage and lavage of the pericardial sac, local (intrapericardial) and systemic antimicrobial treatment, and subsequent corticosteroid treatment resulted in a successful outcome in this horse. To the authors' knowledge, this is the first report of pericarditis associated with C pseudotuberculosis in a horse.

Omentalization of a nonresectable uterine stump abscess in a dog

One month after ovariohysterectomy, a 2-year-old spayed female Golden Retriever was evaluated because of an extensive uterine stump abscess. Clinical signs included intermittent vomiting, signs of depression, lethargy, and pollakiuria. The dog underwent abdominal surgery; the greatly enlarged uterine stump was tightly adhered to the dorsal surface of the bladder, encompassing the distal portions of the ureters and the bladder's neurovascular supply. En bloc resection of the uterine stump was not considered an acceptable treatment option because of the risk of surgical damage to and subsequent devitalization of the bladder or ureters, urinary incontinence, or urinary tract obstruction. Therefore, the diseased uterine tissue that extended cranial to the bladder was resected, and the remaining abscess cavity was lavaged and packed with omentum. The dog recovered fully from the procedure. The omentum is an effective physiologic drain; its extensive vascular and lymphatic networks absorb fluid and actively promote elimination of infection. Omentalization appears to be an option for surgical management of nonresectable uterine stump abscesses in dogs.

Treatment of peritonitis

In summary, peritonitis in the horse is a potentially life-threatening disease that must be treated promptly and aggressively. Therapy should be aimed at reducing systemic shock and hypovolemia, correction of the primary cause, antibiotic and anti-inflammatory therapy, and abdominal drainage and lavage. The prognosis depends on the ability to diagnose and treat the underlying cause and prevent the development of complications. Mortality rates can be as high as 59.7%, with horses developing postoperative peritonitis having a 56% mortality rate. Long-term complications like adhesion formation or internal abscesses may further reduce the survival rate. The prognosis is best determined by an early and quick response to aggressive treatment.

Steroid injection therapy in a feline solitary bone cyst

A nine months old Japanese domestic cat with a solitary bone cyst, which is a benign tumor-like lesion and is particularly uncommon in feline practice was referred. Radiographic examination revealed an expansive radiolucency in the distal metaphysis of the right ulna and pathologic fracture. The histological examination demonstrated immature osteogenesis consisting of osteoblasts surrounded by connective tissue. We applied drainage and instillation of steroid solution into the cystic cavity. Clinical signs, including lameness and pain, disappeared three weeks after the therapy started. Fourteen months after the therapy, the cystic lesion of bone was remodeling successfully without re-developing. We conclude that our procedure was useful treatment in this case.

Ultrasound-guided percutaneous drainage as the primary treatment for prostatic abscesses and cysts in dogs

Thirteen dogs with prostatic abscesses and cysts were treated using percutaneous ultrasound-guided drainage. Eight dogs were diagnosed with prostatic abscesses and five with cysts on the basis of cytopathological examination and bacterial culture of the prostatic fluid. Antibiotic therapy, based on culture and sensitivity results, was administered for a minimum of 4 weeks. Intact dogs were castrated after initial drainage. Repeat ultrasonography of the prostate was performed every 1 to 6 weeks, and any residual cavitary lesions were drained and fluid analysis repeated. The median number of drainage procedures required to completely resolve the lesions was two (range, one to four). No complications were observed after drainage, and clinical signs resolved in all dogs. None of the dogs developed clinical signs of recurrent abscesses or cysts in the follow-up period (median, 36 months; range, 10 to 50 months). Ultrasound-guided, percutaneous drainage of prostatic abscesses and cysts appears to be a useful alternative to surgical treatment in select dogs.

Risk factors, prognostic indicators, and outcome of pyothorax in cats: 80 cases (1986-1999)

OBJECTIVE

To identify risk factors associated with development of pyothorax in cats, assess survival rates for cats that are treated, determine prognostic indicators, and determine recurrence rates.

DESIGN

Retrospective study.

ANIMALS

80 cats with pyothorax and 212 control cats.

PROCEDURE

History; month of evaluation; physical examination findings; results of hematologic, serum biochemical, and retrovirus testing; radiographic findings; outcome; recurrence rate; and necropsy findings were recorded. For control cats, age, sex, breed, indoor versus outdoor status, vaccination history, and single- versus multi-cat household status were recorded.

RESULTS

Cats from multi-cat households were 3.8 times as likely (95% confidence interval, 1.9 to 8.2) to develop pyothorax, compared with cats from single-cat households. Indoor or outdoor status was not a risk factor. Cats with pyothorax were significantly younger (mean, 3.83 +/- 3.43 years) than controls (mean, 5.62 +/- 5.27 years). Nonsurvivors had significantly lower heart rates than survivors. Hypersalivation was significantly more common in nonsurvivors (11/39; 26.8%) than survivors (1/39; 3%). Overall, 48.8% (39/80) of cats survived. When cats that were euthanatized without treatment were excluded from analyses, the survival rate was 66.1% (39/59). Pyothorax recurred in 1 of 17 cats for which follow-up information was obtained.

CONCLUSIONS AND CLINICAL RELEVANCE

Cats with pyothorax that received treatment had a fair to good prognosis, with low recurrence rates in survivors. Hypersalivation and low heart rate were associated with worse clinical outcome. Cats with pyothorax were likely to come from multi-cat households.

Hyponatremia and hyperkalemia associated with chylous pleural and peritoneal effusion in a cat

A 6-year-old, castrated male shorthair was evaluated for chylous effusion in the thorax and abdomen. An underlying disease process was not determined. The cat developed hyponatremia and hyperkalemia, which was attributed to the mechanical drainage of pleural fluid and to the decreased urinary excretion of potassium.

Open peritoneal drainage versus primary closure for the treatment of septic peritonitis in dogs and cats: 42 cases (1993-1999)

OBJECTIVE

To determine survival rates in dogs and cats with septic peritonitis treated with open peritoneal drainage (OPD) versus primary closure (PC) after laparotomy.

STUDY DESIGN

Retrospective analysis of medical records from Colorado State University Veterinary Teaching Hospital from 1993 to 1999.

SAMPLE POPULATION

Thirty-six dogs and 6 cats with septic peritonitis documented by cytological examination or microbiological culture of abdominal fluid.

METHODS

Medical records of dogs and cats with septic peritonitis treated by OPD or PC were reviewed. Age, weight, species, white blood cell (WBC) count, band neutrophil count, platelet count, serum glucose concentration, heart rate, body temperature, duration of hospitalization, and clinical outcome were recorded for each animal. Differences in treatments administered between the OPD and PC groups as well as the underlying cause of septic peritonitis were determined.

RESULTS

There was no significant difference in survival between animals in the OPD versus PC groups (P =.26) with an overall survival rate of 71%. White blood cell count, band neutrophil count, platelet count, serum glucose and total bilirubin concentrations, heart rate, age, and weight were not significantly different between groups (P >.05). A significantly greater number of animals in the OPD group received plasma (P =.009), blood (P =.037), and a jejunostomy tube (P =.02) than animals in the PC group. There was a significant difference in the number of days spent in critical care unit with a mean of 6.0 +/- 4.1 days for the OPD group and 3.5 +/- 2.3 days for the PC group (P =.02).

CONCLUSIONS

Open peritoneal drainage for the management of septic peritonitis in dogs and cats is an acceptable alternative to PC.

Omentalization of cystic sublumbar lymph node metastases for long-term palliation of tenesmus and dysuria in a dog with anal sac adenocarcinoma

A 13-year-old castrated male Bassett Hound was examined because of a 2-week history of severe constipation and tenesmus. Radiography revealed a large cystic mass in the caudal portion of the abdomen that was compressing the urethra and obstructing the pelvic canal. A small perianal mass was also noticed in the region of the left anal sac. Exploratory surgery was performed, but the mass was deemed unresectable. Instead, the mass was incised, drained, and omentalized in an attempt to establish continuous drainage after surgery. Cytologic evaluation of the perianal mass was consistent with a diagnosis of anal sac adenocarcinoma. Histologic evaluation of the abdominal mass revealed it was a lymph node effaced by adenocarcinoma. Despite the poor prognosis for anal sac adenocarcinoma with metastatic spread to the sublumbar lymph nodes, tenesmus and dysuria in this dog remained palliated until the dog's death 18 months after surgery. Omentalization was successful in providing a continuous method of fluid drainage for this cystopapillary abdominal tumor.

Pericardial effusion in a mixed breed dog

A 7-year-old, spayed female mixed breed dog was evaluated for labored breathing, lethargy, and a distended abdomen. Pericardial effusion was diagnosed after radiographic and echocardiographic interpretation. Treatment consisted of thoracocentesis and a single pericardiocentesis. Follow-up examinations indicate that the dog's condition has remained stable.