CASE DESCRIPTION A 15-year-old spayed female mixed-breed dog was evaluated for a 7-week history of stranguria, pollakiuria, and intermittent urethral obstruction.
CLINICAL FINDINGS On initial evaluation, the patient had persistent stranguria with lack of urine production; after multiple unsuccessful attempts to urinate, a large volume of urine was produced. Prior to voiding the large volume, the urinary bladder was not palpable during examination. Abdominal ultrasonography confirmed caudal displacement of the urinary bladder, and the urethra and trigone could not be located ultrasonographically. Positive-contrast cystourethrography and CT confirmed caudal displacement of the urinary bladder and also revealed trigonal invagination and urethral kinking; dysuria was attributed to these findings.
TREATMENT AND OUTCOME Surgical repositioning of the lower urinary tract was performed. The urinary bladder was moved cranially and was fixed in place along the left lateral aspect of the body wall by cystopexy. After surgery, positive-contrast cystourethrography revealed a more cranial positioning of the urinary bladder and straightening of the urethra with no urethral kinking or trigonal invagination. Immediately after surgery, stranguria had resolved and the patient was able to void normally. Two years after surgery, the dog was reported to be urinating normally.
CLINICAL RELEVANCE Surgical correction of caudal urinary bladder displacement with cystopexy led to resolution of trigonal invagination, urethral kinking, and urethral obstruction in the dog of the present report. Trigonal invagination and urethral kinking, although uncommon findings, should be considered as possible causes of dysuria in dogs.
CASE DESCRIPTION 7 juvenile (< 12 months old) dogs with lung lobe torsion were evaluated.
CLINICAL FINDINGS All patients were male; breeds included Pug (n = 5), Chinese Shar-Pei (1), and Bullmastiff (1). Dyspnea and lethargy were the most common initial complaints, with a duration of clinical signs ranging from 1 to 10 days. A CBC showed leukocytosis and neutrophilia in all dogs. Anemia was present in 6 dogs, 2 of which received packed RBC transfusions. The diagnosis was made on the basis of results of thoracic radiography, CT, ultrasonography, or a combination of modalities. The left cranial lung lobe was most commonly affected (n = 4), followed by the right middle lung lobe (2) and the right cranial lung lobe (1).
TREATMENT AND OUTCOME A lateral intercostal thoracotomy with lobectomy of the affected lobe was performed in all patients. All dogs survived to be discharged between 1 and 2 days postoperatively. Six of 7 owners contacted for follow-up information 7 to 170 months after discharge reported satisfaction with the treatment and no apparent signs of recurrence of disease.
CLINICAL RELEVANCE The juvenile patients of this report were successfully treated surgically with no apparent complications. Clinicians should be aware of the possibility of lung lobe torsion when evaluating young dogs with clinical signs related to the respiratory system, including those with vague signs, to avoid undue delays in treatment.
Case Description—A 17-week-old spayed female Sphinx was evaluated after a 3-day history of inappetence, lethargy, and vomiting. Three weeks prior, the kitten had undergone routine elective ovariohysterectomy.
Clinical Findings—Abdominal ultrasonography revealed moderate hydronephrosis of the left kidney, and the left ureter was tortuous and dilated from the kidney to the level of the midureter, where it abruptly tapered. No discrete cause of obstruction could be identified. Clinicopathologic analyses revealed that the kitten was nonazotemic.
Treatment and Outcome—Exploratory laparotomy revealed that the distal portion of the left ureter was irregular with ill-defined margins and abundant scar tissue, likely secondary to iatrogenic ureteral ligation during the ovariohysterectomy (suture was not observed). Intraoperative antegrade pyelography confirmed complete left ureteral obstruction extending distally from the level of the midureter. A subcutaneous ureteral bypass device was placed to allow for renal decompression. No complications were encountered in the perioperative period, and the kitten recovered well after anesthesia. The kitten was discharged from the hospital 7 days after initial evaluation and continued to do well after surgery. At long-term follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation.
Clinical Relevance—A subcutaneous ureteral bypass device successfully allowed renal decompression in a kitten with iatrogenic ureteral ligation. A subcutaneous ureteral bypass device may be an alternative to historical surgical options in cases of unilateral ureteral obstruction and may result in a good long-term outcome.
An 11-month-old mixed-breed dog was evaluated because of a 2-day history of acute-onset, intermittent vocalization and collapse several days after ingesting metallic wire foreign material.
Physical examination findings were initially unremarkable. After a brief period of hospitalization, the patient acutely developed non-weight-bearing lameness with signs of severe pain localized to the left thoracic limb and inability or refusal to rise. Results of cervical, thoracic, and abdominal radiography revealed a linear metallic foreign body at the thoracic inlet and a single metallic foreign body in the cranial aspect of the abdomen. Neuropathic pain at the level of the left brachial plexus was suspected. Results of a subsequent CT scan were consistent with a metallic foreign body in the left axilla with associated abscess formation and neuritis and an additional metallic foreign body within the omental fat near the pyloroduodenal junction.
TREATMENT AND OUTCOME
Intraoperative fluoroscopy was used to facilitate localization and surgical removal of the axillary foreign body. The intra-abdominal foreign body was removed laparoscopically. Complete resolution of clinical signs was observed before discharge from the hospital the following day. On telephone follow-up 8 months after surgery, the owners reported the patient had no signs of lameness or complications.
Migrating metallic foreign bodies may be identified as incidental findings with the potential to cause harm in the future or may be a cause for severe clinical signs. Migrating foreign bodies should be considered as a differential diagnosis for patients reported to have acute collapse or lameness and consistent clinical history.
Case Description—An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb.
Clinical Findings—On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM).
Treatment and Outcome—Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed.
Clinical Relevance—Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog.
Objective—To determine clinical characteristics of primary bacterial peritonitis (infection of the peritoneal cavity with no identifiable intraperitoneal source of infection) and compare characteristics of primary and secondary peritonitis in dogs and cats.
Design—Retrospective case series.
Animals—24 (primary peritonitis) and 60 (secondary peritonitis) client-owned dogs and cats.
Procedures—Data from medical records of dogs and cats with primary and secondary peritonitis were reviewed for descriptive information regarding primary peritonitis and for comparison between the 2 forms of peritonitis.
Results—15 dogs and 9 cats met inclusion criteria for primary peritonitis, and 49 dogs and 11 cats met inclusion criteria for secondary peritonitis. The most common historical findings in dogs and cats with primary and secondary peritonitis were lethargy, vomiting, and anorexia. Dogs with secondary peritonitis more often developed peritoneal exudates than those with primary peritonitis, and dogs with primary peritonitis were more often infected with gram-positive bacteria than those with secondary peritonitis. No difference in outcome was detected between all animals with primary versus secondary peritonitis; however, dogs with secondary peritonitis treated with surgery were more commonly discharged than those with primary peritonitis treated with surgery.
Conclusions and Clinical Relevance—Differences in primary and secondary peritonitis related to historical, physical examination, and clinical laboratory findings; bacteriologic findings; peritoneal effusion characteristics; and outcome were detected. However, larger case numbers are needed before alternative recommendations, such as avoidance of surgery, can be made.
During the same week, 3 sequential patients (a 10-year-old 8.7-kg spayed female poodle cross [dog 1], 13-year-old 2.6-kg spayed female domestic longhair cat, and 13-year-old 9.0-kg castrated male mixed-breed dog [dog 2]) underwent CT-angiography (day 0) and transarterial embolization (day 1) for nonresectable hepatocellular carcinoma (n = 2) or prostatic carcinoma (1).
Contrast-induced nephropathy (CIN) was suspected in all animals on the basis of higher serum creatinine concentrations after contrast medium administration (exposure), compared with baseline concentrations before exposure, consistent with CIN definitions. The total dose of contrast medium was < 3 mL/kg for each exposure. For all 3 patients, creatinine concentration peaked at a median of 3 days (range, 2 to 3 days) after the first exposure (day 0), and the median absolute and relative increases in creatinine concentration after exposure (vs baseline concentrations before exposure) were 2.9 mg/dL (range, 2.2 to 3.7 mg/dL) and 410% (range, 260 to 720%), respectively.
TREATMENT AND OUTCOME
The patients received individually tailored supportive care for acute kidney injury. Serum creatinine concentrations began to improve at a median of 4 days (range, 3 to 4 days) and returned to within reference limits at a median of 7 days (range, 3 to 13 days) following initial exposure.
CIN should be considered as a potential complication following IV administration of contrast medium. Short-term outcome following CIN can be excellent with supportive care.
Objective—To describe a technique and evaluate the outcome of thoracoscopic thoracic duct ligation (TDL) and subphrenic pericardiectomy (SPP) for treatment of idiopathic chylothorax (IC) in dogs.
Design—Retrospective case series.
Animals—6 client-owned dogs.
Procedures—Medical records of dogs with a diagnosis of IC that were subsequently treated by thoracoscopic TDL and SPP and that had not undergone previous surgical treatment were reviewed. Thoracoscopic TDL was performed via a 3-portal technique with the patient in lateral recumbency. Subphrenic pericardiectomy was subsequently performed via a 3-portal technique with the patient in dorsal recumbency. If visualization during SPP was suboptimal, 1-lung ventilation was used to ensure that pericardial resection was close to the phrenic nerves bilaterally but without risk of iatrogenic nerve injury.
Results—All TDL and SPP procedures were completed successfully in a median surgical time of 177 minutes (range, 135 to 210 minutes). All 6 dogs showed resolution of clinical signs of chylothorax with no recurrence during a median follow-up period of 39 months (range, 19 to 60 months). Final postoperative thoracic radiographic evaluation was performed at a median of 14.5 months (range, 7 to 25 months). Complete resolution of pleural effusion occurred in all but 1 dog. In 1 dog, a small volume of pleural effusion was persistent at a 7-month postoperative radiographic follow-up but was not associated with clinical signs and did not require thoracocentesis at any time during the dog's 25-month follow-up period.
Conclusions and Clinical Relevance—From this limited series of patients, results suggested that a minimally invasive TDL-SPP combined surgical technique for management of IC in dogs may be associated with a similarly successful outcome as has been reported for open surgical TDL-SPP.
Objective—To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure.
Design—Retrospective case series.
Animals—25 client-owned dogs (n = 22) and cats (3).
Procedures—Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope.
Results—SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered.
Conclusions and Clinical Relevance—Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.
Case Description—An 11-year-old castrated male Vizsla was evaluated for excision of a cranial mediastinal mass.
Clinical Findings—The dog had a 1-month history of a cough that had recently increased in frequency. On physical examination, the dog had a grade 2/6 left systolic heart murmur and multiple subcutaneous masses. A soft tissue mass was observed in the cranioventral aspect of the thorax on radiographs. Results of a CT scan revealed a well-defined, 2.8 × 3.2 × 3.9-cm soft tissue mass in the cranial mediastinum.
Treatment and Outcome—The dog underwent video-assisted thoracoscopic removal of the mediastinal mass and recovered routinely. Histologic examination of excised tissues revealed malignant thymoma. Approximately 6.5 months after surgery, the dog was evaluated because of polyuria, polydipsia, decreased appetite, and vomiting. On physical examination, masses were found in both axillary regions. Results of serum biochemical analysis indicated hypercalcemia. Thoracic ultrasonography revealed pulmonary metastases and a large mass in the right caudoventral region of the thorax. The dog received supportive care and medical treatment for hypercalcemia, but clinical signs recurred. Euthanasia was elected; necropsy and histologic examination revealed thymic carcinoma.
Conclusions and Clinical Relevance—Descriptions of the development of portal site metastasis in canine patients are rare. In this patient, portal site metastasis developed rapidly after thoracoscopic resection of a malignant thymic mass and was associated with hypercalcemia. As use of thoracoscopic procedures increases in veterinary medicine, it will be important to monitor the development of major complications such as those in the patient of this report. (J Am Vet Med Assoc 2015;247:793–800)