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Case Description—An 11-year-old castrated male mixed-breed dog was examined for a 3-month history of hematochezia and tenesmus. Abdominal ultrasonography and rectal examination prior to referral had revealed a colorectal polyp, diagnosed as a benign colorectal polypoid adenoma after histologic examination of tissue samples. The patient was referred for treatment.
Clinical Findings—A 2-cm-diameter sessile polypoid mass was located approximately 6 cm orad to the anus in the right dorsolateral region of the descending colon just caudal to the pubis. There was no evidence of metastasis on thoracic radiography or abdominal ultrasonography. Results of a CBC and serum biochemical analysis were within reference limits.
Treatment and Outcome—Endoscopic mucosal resection (EMR) and snare electrocautery were used to resect the mass and a definitive histopathologic diagnosis of a sessile colorectal polypoid adenoma was made. A 9.9-mm gastroduodenoscope was used during colonoscopy to inspect the mass. To aid in EMR, a 25-gauge endoscopic injection needle was used to infuse sterile saline (0.9% NaCl) solution under the base of the polyp, into the submucosa to elevate the mucosa from the muscularis layer beneath the polyp prior to polypectomy. This was necessary because of the sessile, rather than pedunculated, base of the mass. The entire polyp was successfully removed with endoscopic guidance. The clinical signs of hematochezia and tenesmus resolved immediately, and serial rectal examinations were performed over the following 36 months with no palpable evidence of recurrence.
Clinical Relevance—The patient described in the present report underwent successful colonic EMR and snare polypectomy with no known evidence of mass recurrence during the following 36 months, suggesting that this minimally invasive procedure may be a valuable treatment option for sessile polyps. The advantage of this technique was that elevation of the mucosa via injection of saline solution improved visibility of the polyp and helped to separate the polyp base from the deeper submucosal colorectal tissue, making complete resection possible.
CASE DESCRIPTION 3 cats were referred for evaluation of chronic urinary incontinence.
CLINICAL FINDINGS A presumptive diagnosis of urethral sphincter mechanism incompetence (USMI) was made in all 3 cats. Preoperatively, incontinence was mild in 1 cat (incontinence during sleep) and moderate to severe (incontinence while awake and at rest) in 2. Structural abnormalities noted during cystoscopy included urethrovestibular junction stenosis (n = 1), vaginal stenosis (1), short urethra (1), and intrapelvic bladder (1).
TREATMENT AND OUTCOME All 3 cats were treated by means of implantation of an inflatable silicone hydraulic occluder (HO) via a ventral midline celiotomy. Immediately prior to HO implantation, patients underwent cystoscopy to detect any anatomic abnormalities and confirm the absence of ureteral ectopia. Following surgery, all 3 patients attained complete continence, needing 0 or 1 inflation of the device. Complications included cystoscopy-associated urethral tear (n = 1), constipation (1), stranguria (1), hematuria (2), and urinary tract infection (2). Device explantation was performed 14 weeks after surgery in 1 cat because of postoperative constipation. Constipation persisted and urinary incontinence recurred but was markedly improved following device removal in this cat (leakage of urine only when sleeping at follow-up 29 months after surgery [26 months after device explantation]). At the time of last follow-up, 2 of the 3 cats remained fully continent approximately 3 and 6 years after device implantation.
CLINICAL RELEVANCE Findings suggested that implantation of an HO may be a safe and effective long-term treatment for some cats with USMI. Further studies are necessary to evaluate the potential for treatment-related complications and the long-term outcome.
Case Description—An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting.
Clinical Findings—Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct.
Treatment and Outcome—Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery.
Clinical Relevance—Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.
A 5-year-old spayed female Maltese mixed-breed dog was referred for evaluation because of severe urinary incontinence refractory to medical management.
Physical examination revealed constant dribbling of urine and urine scalding. Culture of a urine sample yielded methicillin-resistant Staphylococcus pseudintermedius and Proteus mirabilis. Abdominal ultrasonographic examination revealed absence of the left kidney, a small, nondistended urinary bladder, and diffuse hepatopathy. Urinary incontinence persisted despite appropriate antimicrobial treatment. Cystourethroscopy and vaginoscopy were subsequently performed and revealed a hypoplastic bladder and a vesicovaginal fistula with urinary leakage through the vaginal diverticulum; no left ureterovesicular junction was identified, consistent with suspected left renal aplasia.
TREATMENT AND OUTCOME
Exploratory laparotomy was performed, and the cranial aspect of the vagina was circumferentially ligated immediately caudal to the fistula. The urinary incontinence resolved immediately after surgery, and lower urinary tract signs improved over the next 2 weeks. Moderate urinary incontinence recurred approximately 6 months later, and a urinary tract infection with Escherichia coli was subsequently identified and treated; clinical signs resolved ≤ 48 hours after treatment was initiated.
To the author's knowledge, vesicovaginal fistulas in dogs have not been previously described and should be considered a differential diagnosis for persistent urinary incontinence and recurrent urinary tract infections in female dogs. Vaginoscopy in addition to cystourethroscopy was required to identify the abnormality in this patient. Because multiple concurrent anomalies can be present, both procedures should be performed in female dogs with these clinical signs, even if an abnormality is identified cystoscopically.
Objective—To evaluate the technical, short-term, and long-term outcomes in cats with benign ureteral obstructions treated by means of double-pigtail ureteral stent placement.
Design—Retrospective case series.
Animals—69 cats (79 ureters).
Procedures—The diagnosis of benign ureteral obstruction was made via abdominal ultrasonography, radiography, and ureteropyelography. Ureteral stent placement was attempted endoscopically, surgically, or both, with fluoroscopic guidance. The medical records were reviewed for pre-, intra-, and postoperative data; complications; and outcome.
Results—69 cats (79 ureters) had stent placement attempted for various causes: ureterolithiasis (56/79 [71%]), stricture (10/79 [13%]), both ureterolithiasis and stricture (12/79 [15%]), or a purulent plug (1/79 [1%]). Stent placement was successful in 75 of 79 ureters (95%). Median number of stones per ureter was 4 (range, 0 to > 50), and 67 of 79 (85%) had concurrent nephrolithiasis. Preoperative azotemia was present in 95% (66/69) of cats (median creatinine concentration, 5.3 mg/dL [range, 1.1 to 25.8 mg/dL]), and 71% (49/69) remained azotemic (median, 2.1 mg/dL [range, 1.0 to 11.8 mg/dL]) after successful surgery. Procedure-related, postoperative (< 7 days), short-term (7 to 30 days), and long-term (> 30 days) complications occurred in 8.7% (6/69; 7/79 ureters), 9.1% (6/66), 9.8% (6/61), and 33% (20/60) of cats, respectively; most of these complications were minor and associated with intermittent dysuria or the need for ureteral stent exchange. The perioperative mortality rate was 7.5% (5/69), and no deaths were procedure related. The median survival time was 498 days (range, 2 to > 1,278 days). For patients with a renal cause of death, median survival time was > 1,262 days, with only 14 of 66 cats (21%) dying of chronic kidney disease. Nineteen (27%) cats needed a stent exchange (stricture in-growth [n = 10], migration , ureteritis , dysuria , pyelonephritis , or reflux ). No patient died of the procedure or recurrent ureteral obstruction.
Conclusions and Clinical Relevance—Results of the present study indicated that ureteral stenting is an effective treatment for benign ureteral obstructions in cats regardless of obstructive location, cause, or stone number. The perioperative morbidity and mortality rates were lower than those reported with traditional ureteral surgery. The short- and long-term complications were typically minor but may necessitate stent exchange or use of an alternative device, particularly with ureteral strictures. The prognosis for feline ureteral obstructions after ureteral stenting could be considered good when the procedure is performed by trained specialists.
Case Description—Two adult male castrated cats were evaluated because of a history of constipation, tenesmus, or intermittent vomiting.
Clinical Findings—Radiography and ultrasonography revealed luminal narrowing in the colon of 1 cat and a colonic mass in the other. A histopathologic diagnosis of colonic adenocarcinoma was made in both cats.
Treatment and Outcome—Under fluoroscopic guidance, a self-expanding metallic stent was advanced over a wire and across the area of colonic stenosis and deployed. One cat had progressive weight loss but maintained a normal appetite, energy, and a high quality of life. Fecal continence was maintained, and tenesmus was rarely observed. The cat was euthanized because of tumor metastasis 274 days after the colonic stent was placed. The other cat retained fecal continence, and the owners reported subjective improvement in the severity of tenesmus, compared with that prior to stent placement. The cat was euthanized 19 days after stent placement because of perceived decreased quality of life.
Clinical Relevance—The use of self-expanding metallic stents for alleviation of colonic obstruction secondary to adenocarcinoma in cats appears to be effective. This technique provides a simple, quick, nonsurgical option for palliation in cats with advanced metastatic or systemic disease in which surgical resection may not be possible or warranted.
Objective—To describe the clinical characteristics, treatment, complications, and outcome of dogs and cats treated surgically for major abdominal evisceration.
Design—Retrospective case series.
Animals—8 dogs and 4 cats.
Procedures—Medical records from January 1998 through March 2008 were reviewed to identify animals that underwent surgery for major abdominal evisceration. Data regarding cause of evisceration, signalment, physiologic variables, and hematologic variables were collected. Details of treatment, duration of hospitalization, and outcome were recorded. Linear regression analysis was performed to evaluate the association of signalment, physiologic variables, and hematologic variables on the number of days of hospitalization.
Results—Major abdominal evisceration was secondary to a traumatic event in 4 animals and to postsurgical dehiscence in 8 animals. All animals had evisceration of the intestines and gross contamination with dirt, leaves, or litter. Two animals eviscerated the spleen, and 1 animal had a perforated colon and was leaking feces into the peritoneal cavity. All animals underwent exploratory abdominal surgery. Surgical procedures performed included resection of compromised intestine, body wall repair, diaphragmatic hernia repair, nephrectomy, splenectomy, and primary colonic repair. All animals survived to discharge from the hospital. Median duration of hospitalization was 4 days (range, 1 to 7 days). Factors associated with an increase in duration of hospitalization included evisceration secondary to trauma, high lactate concentration at time of admission, and small body size.
Conclusions and Clinical Relevance—Despite the dramatic appearance of major abdominal evisceration in cats and dogs, prompt and aggressive medical and surgical intervention can provide a favorable outcome.
Objective—To evaluate the outcome following urethral stent placement for the palliative treatment of obstructive carcinoma of the urethra in dogs.
Design—Retrospective case series.
Animals—42 dogs with obstructive carcinoma of the urethra.
Procedures—Medical records for dogs in which a self-expanding metallic stent (SEMS) was used for the treatment of obstructive carcinoma of the urethra were reviewed. Signalment, diagnostic findings, clinical signs before and after SEMS placement, and patient outcome were analyzed. Fluoroscopic images were evaluated to determine the effects of stent size, obstruction length, tumor length, and urethral length and width on the incidence of incontinence or stranguria.
Results—Resolution of urinary tract obstruction was achieved in 41 of 42 (97.6%) dogs. After SEMS placement, 6 of 23 male and 5 of 19 female dogs developed severe incontinence, and 1 of 23 male and 1 of 17 female dogs developed stranguria. Stent length, diameter, and location were not associated with incidence of incontinence or stranguria. Median survival time after SEMS placement was 78 days (range, 7 to 536 days). Treatment with NSAIDs before and chemotherapeutics after SEMS placement increased median survival time to 251 days (range, 8 to 536 days).
Conclusions and Clinical Relevance—Urethral SEMS placement was an effective palliative treatment for dogs with obstructive carcinoma of the urethra; however, severe incontinence subsequently developed in 11 of 42 (26%) treated dogs. Adjunctive treatment of affected dogs with NSAIDs and chemotherapeutics significantly increased the median survival time.