Evaluation of peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity for detection of septic peritonitis in horses

OBJECTIVE: To determine whether peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity can be used to differentiate horses with septic peritonitis from those with nonseptic peritonitis. DESIGN: Prospective study. ANIMALS: 46 horses, including 10 healthy horses, 15 horses with septic peritonitis, and 21 horses with nonseptic peritonitis. PROCEDURE: Peritoneal fluid and blood samples were analyzed for pH, glucose concentration, and lactate dehydrogenase activity. Complete blood cell counts were performed, and peritoneal fluid samples were submitted for bacterial culture. RESULTS: Horses with septic peritonitis had significantly lower peritoneal fluid pH and glucose concentrations than horses with nonseptic peritonitis and healthy horses. Compared with other tests, serum-to-peritoneal fluid glucose concentration differences > 50 mg/dl had the highest diagnostic use for detection of septic peritonitis. Peritoneal fluid pH < 7.3, glucose concentration < 30 mg/dl, and fibrinogen concentration > 200 mg/dl were also highly indicative of septic peritonitis. CLINICAL IMPLICATIONS: Peritoneal fluid pH and glucose concentration can be used to assist in the identification of horses with septic peritonitis. These measurements can provide an early indication of sepsis, especially if cytologic evaluation of peritoneal fluid is unavailable or results are equivocal and peritoneal fluid bacterial culture results are pending.     

Gastrointestinal tract perforations caused by ingestion of multiple magnets in a dog

Objective – To describe a case of gastrointestinal tract perforation, septic peritonitis and coagulopathy caused by ingestion of multiple magnets in a dog. Case Summary – An 8‐month‐old castrated male Rottweiler, weighing 30.5 kg was presented for evaluation of vomiting and weakness. Abdominal radiography and abdominal ultrasonographic examination identified a metallic foreign object within the gastric lumen, presence of free peritoneal gas, and peritoneal effusion. Septic peritonitis was diagnosed by abdominal fluid analysis. Exploratory celiotomy revealed the presence of an omental abscess, and gastric and colonic perforations. Four magnetic foreign objects were found within the lumen of the perforated stomach. Surgical management including removal of the magnets, abscess debridement and excision, perforation repair, and abdominal drainage combined with intensive medical therapy resulted in complete recovery of this dog. New or Unique Information Provided – This report describes in detail the case management of a dog that developed both gastric and colonic perforations and severe morbidity secondary to ingesting multiple magnets.     

Disseminated candidiasis secondary to fungal and bacterial peritonitis in a young dog

Objective – To describe a severe case of bacterial sepsis and disseminated candidiasis in a previously healthy dog.
Case Summary – Fungal sepsis was identified in a 2-year-old dog following intestinal dehiscence 4 days after abdominal surgery. Septic peritonitis was identified at admission and evidence of dehiscence at the previous enterotomy site was found during an exploratory laparotomy. Both gram-positive cocci and Candida albicans were cultured from the abdominal cavity. Candida sp. was also subsequently cultured from a central venous catheter. Euthanasia was performed due to failure to respond to therapy. Fungal organisms, morphologically consistent with Candida spp., were found in the lungs and kidney on postmortem histopathologic examination indicating disseminated candidiasis.
New or Unique Information Provided – Candida peritonitis is a well-recognized entity in humans and contributes to morbidity and mortality in critically ill patients. Abdominal surgery, intestinal perforation, presence of central venous catheters, and administration of broad-spectrum antibiotics are all considered to be suspected risk factors. This report describes the first known case of systemic candidiasis occurring secondary to Candida peritonitis and bacterial sepsis in a critically ill dog.     

Evaluation of postceliotomy peritoneal drain fluid volume, cytology, and blood-to-peritoneal fluid lactate and glucose differences in normal dogs

Objective: To describe peritoneal drain fluid volume, fluid cytology, and blood‐to‐peritoneal fluid lactate and glucose concentration differences after exploratory celiotomy in normal dogs. Study Design: Prospective study. Animals: Healthy Beagle dogs (n=10). Methods: After exploratory celiotomy, a peritoneal drain was placed, and peritoneal fluid was recorded every 6 hours for 7 days. Fluid was submitted for cytologic examination, and fluid and blood glucose and lactate concentrations were recorded every 12 hours. On day 7, drains were removed and drain tips submitted for aerobic bacterial culture. Results: Mean peritoneal fluid volume decreased from 2.8 mL/kg/day (day 1) to 0.6 mL/kg/day (day 7). All dogs had degenerate neutrophils in peritoneal fluid throughout the 7 days. Four dogs developed contaminated drains. Blood‐to‐peritoneal glucose concentration differences>20 mg/dL occurred after day 4. By day 7, 5 of 7 dogs with patent drains had blood‐to‐peritoneal lactate concentration differences70% of dogs had differences consistent with septic peritonitis each day. Postoperative blood‐to‐peritoneal fluid glucose and lactate difference may not be reliable indicators of septic peritonitis when evaluating abdominal fluid collected with closed suction drains.     

Uveitis associated with septic peritonitis in a cat

Objective – To report a case of bilateral uveitis believed to be a consequence of septic peritonitis in a 19‐month‐old cat. Case Summary – Bilateral anterior uveitis with suspicion of extension to the posterior segment was documented in a previously healthy young cat during hospitalization for severe septic peritonitis. Based on medical history and other findings uveitis was believed to result from concurrent abdominal sepsis, due either to metastatic seeding of bacterial organisms or to effects of bacterial toxins and inflammatory mediators on the blood‐aqueous barrier. The cat was surgically and medically managed, and made a full recovery with respect to both his ocular and his abdominal disease. New or Unique Information Provided – Ocular complications secondary to systemic sepsis are well documented in people but seldom reported in the veterinary literature. To the authors' knowledge this is the first report of uveitis linked to septic peritonitis in any veterinary species and the first to report sepsis‐related uveitis in a cat. Ocular inflammatory disease in the context of critical illness deserves attention as a potential significant source of morbidity. The development of ocular inflammatory disease may serve as a sentinel lesion for systemic sepsis and other life‐threatening conditions.     

Neospora caninum associated with septic peritonitis in an adult dog

A 7-year-old, male neutered Rhodesian Ridgeback dog was referred to the University of California-Davis Veterinary Medical Teaching Hospital with a 4-month history of peritonitis and episodic abdominal discomfort, lethargy, and weakness. Marked abdominal distension with a prominent fluid wave was noted on physical examination. Cytologic analysis of the abdominal fluid indicated a septic exudate with mixed bacteria and many protozoal zoites. Differentials for the identity of the protozoal zoites included Toxoplasma gondii, Sarcocystis neurona, and Neospora caninum. Indirect latex agglutination antigen testing, standard indirect fluorescent antibody testing, and PCR analysis were performed to identify the zoites. The dog's serum antibody titer for N caninum tachyzoites was 1:20,480, known polysera to N caninum reacted against zoites in the abdominal fluid, and PCR analysis of the abdominal fluid was positive for the presence of a known gene of N caninum. Based on the morphologic, immunologic, and molecular findings, the zoites were identified as N caninum. It remains unclear how the tachyzoites gained access to the peritoneal cavity. To the authors' knowledge, there are no reports of free N caninum in abdominal fluid of any species.     

Comparison of peritoneal fluid and peripheral blood pH,bicarbonate, glucose,and lactate concentration as a diagnostic tool for septic peritonitis in dogs and cats

OBJECTIVE: To establish a reliable diagnostic tool for septic peritonitis in dogs and cats using pH, bicarbonate, lactate, and glucose concentrations in peritoneal fluid and venous blood. STUDY DESIGN: Prospective clinical study. ANIMALS: Eighteen dogs and 12 cats with peritoneal effusion. METHODS: pH, bicarbonate, electrolyte, lactate, and glucose concentrations were measured on 1- to 2-mL samples of venous blood and peritoneal fluid collected at admission. The concentration difference between blood and peritoneal fluid for pH, bicarbonate, glucose, and lactate concentrations were calculated by subtracting the peritoneal fluid concentration from the blood concentration. Peritoneal fluid was submitted for cytologic examination and bacterial culture. Peritonitis was classified as septic or nonseptic based on cytology and bacterial culture results. RESULTS: In dogs, with septic effusion, peritoneal fluid glucose concentration was always lower than the blood glucose concentration. A blood-to-fluid glucose (BFG) difference > 20 mg/dL was 100% sensitive and 100% specific for the diagnosis of septic peritoneal effusion in dogs. In 7 dogs in which it was evaluated, a blood-to-fluid lactate (BFL) difference < -2.0 mmol/L was also 100% sensitive and specific for a diagnosis of septic peritoneal effusion. In cats, the BFG difference was 86% sensitive and 100% specific for a diagnosis of septic peritonitis. In dogs and cats, the BFG difference was more accurate for a diagnosis of septic peritonitis than peritoneal fluid glucose concentration alone. CONCLUSIONS: A concentration difference > 20 mg/dL between blood and peritoneal fluid glucose concentration provides a rapid and reliable means to differentiate a septic peritoneal effusion from a nonseptic peritoneal effusion in dogs and cats. CLINICAL RELEVANCE: The difference between blood and peritoneal fluid glucose concentrations should be used as a more reliable diagnostic indicator of septic peritoneal effusion than peritoneal fluid glucose concentration alone.     

Naproxen-associated duodenal ulcer complicated by perforation and bacteria- and barium sulfate-induced peritonitis in a dog

Signs of abdominal pain and frequent vomiting developed in a 4-year-old dog that had been given naproxen sodium for 3 weeks. The examination included an upper gastrointestinal contrast study, using barium sulfate (BaSO4). Nine hours after barium administration, a duodenal ulcer perforated, leaking duodenal contents and BaSO4 into the peritoneal cavity. The ulcer was surgically resected, and the BaSO4 was manually removed, using saline solution-soaked gauze sponges. Treatment included peritoneal drainage and lavage every 6 hours. Recovery was without complications and the dog has not had any detectable long-term effects from peritonitis induced by BaSO4.     

Evaluation of serum NT-pCNP as a diagnostic and prognostic biomarker for sepsis in dogs

Background: There is a need for diagnostic biomarkers that can rapidly differentiate dogs with sepsis from dogs with noninfectious forms of systemic inflammatory response syndrome (NSIRS). Objectives: To compare serum NT‐pCNP concentrations among dogs with various forms of sepsis, NSIRS, and healthy controls and to evaluate the use of serum NT‐pCNP for the diagnosis of various forms of sepsis in dogs. Animals: One hundred and twelve dogs including 63 critically ill dogs (sepsis n = 29; NSIRS n = 34) and 49 healthy control dogs. Methods: Prospective clinical investigation. Serum samples were collected for NT‐pCNP measurement from dogs with sepsis or NSIRS within 24 hours of intensive care unit admission or at the time of presentation for healthy dogs. Dogs with sepsis were subclassified based on the anatomic region of infection. Serum NT‐pCNP concentrations were compared among sepsis, NSIRS and healthy groups as well as among sepsis subgroups. The area under the curve (AUC), sensitivity, and specificity for identifying dogs with sepsis were determined. Results: Using a cut‐off value of 10.1 pmol/L, AUC, sensitivity, and specificity of NT‐pCNP for differentiating dogs with sepsis from dogs with NSIRS or healthy control dogs were 0.71 (95% CI, 0.58–0.85), 65.5% (45.7–82.1%), and 89.2% (80.4–94.9%), respectively. Serum NT‐pCNP had poor sensitivity for peritoneal sources of sepsis; AUC [0.92 (0.81–1.0)], sensitivity [94% (71–100%)], and specificity [89% (80–95%)] improved when these dogs were excluded. Serum NT‐pCNP concentration was not associated with survival in the sepsis group. Conclusions and Clinical Importance: Serum NT‐pCNP is a promising diagnostic biomarker for sepsis but is a poor indicator of septic peritonitis.     

Diagnostic Accuracy of D‐Dimer and Other Peritoneal Fluid Analysis Measurements in Dairy Cows with Peritonitis

Background: Peritoneal fluid analysis in cattle traditionally includes the classic parameters despite the fact that they have only moderate diagnostic accuracy and often fail to identify the pathogenesis or etiological factors. Therefore additional parameters recently have been established to improve diagnostic precision. In a recent study, reference ranges for several of these parameters have been proposed in dairy cows. Hypothesis/Objectives: The aim of this observational study was to assess the diagnostic value of D‐Dimer and other measurements of peritoneal fluid analysis in dairy cows with peritonitis. Animals: The study included 110 Holstein‐Friesian cows grouped into cows with peritonitis (n = 47) and cows without peritonitis (n = 63). Methods: Peritoneal fluid was obtained by abdominocentesis. Total protein, albumin, glucose, cholesterol, fibrinogen, l ‐lactate, D‐Dimer, lactate dehydrogenase (LDH), alkaline phosphatase, creatine phosphokinase, white blood cell, and red blood cell were determined in peritoneal fluid and venous blood. Serum‐ascites albumin gradient (SAAG) and ratios of peritoneal fluid‐venous blood were calculated. Sensitivity (SN) and specificity (SP) were calculated and receiver operating characteristic curve analysis performed. Results: Peritoneal fluid D‐Dimer was most accurate in diagnosing peritonitis in cows (SN and SP>95.0%). Total protein concentration, LDH and LDH ratio, and SAAG had sensitivities between 49.0 and 67.1%, and specificities between 88.4 and 95.5%. A low‐peritoneal fluid glucose concentration was found to be highly indicative of septic peritonitis. Conclusions and Clinical Importance: Measurement of the recently introduced parameters may increase the diagnostic value of peritoneal fluid analysis and provide additional specific information. Therefore these measurements should be included in the routine procedure.     

Surgical Repair of a Perforated Gastric Ulcer in a Foal

An 11-day-old Thoroughbred colt was presented because of acute colic and a swollen right carpus. Exploration of the abdomen revealed peritonitis secondary to a perforated gastric ulcer. The ulcer was repaired, and the peritoneal cavity was lavaged. The foal recovered from the perforated ulcer but was euthanized one and a half months later because of progressive septic arthritis.     

Intracapsular Prostatic Omentalization: A New Technique for Management of Prostatic Abscesses in Dogs

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependant Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.     

Cytologic diagnosis of peritoneal cestodiasis in dogs caused by Mesocestoides sp

Background: Canine peritoneal larval cestodiasis caused by tapeworm larvae of the genus Mesocestoides is an uncommon and possibly fatal disease that can result in ascites and peritonitis. Although abdominal fluid analysis is recommended for dogs with ascites, the cytologic features of Mesocestoides infection have not been described fully.
Objective: Our goal was to describe the cytologic features of Mesocestoides larvae and of associated ascitic fluid that was collected from the peritoneal cavity of 4 infected dogs.
Methods: Abdominal fluid was obtained from 4 dogs with Mesocestoides sp infection. Gross, chemical, and microscopic evaluations of the fluid were performed using standard techniques.
Results: Cytologic findings in 1 dog included intact acephalic metacestodes (larvae without 4 suckers, not tetrathyridia) in various stages of asexual development, whereas fluid from the other 3 dogs contained primarily calcareous corpuscles, remnant tissue specific to cestodes. Abdominal fluid typically was an exudate, with suppuration, hemorrhage, and evidence of necrosis. Total protein concentrations ranged from 2.4 to 5.3 g/dL.
Conclusions: Abdominal fluid cytology was useful in the diagnosis of Mesocestoides larval infections in the peritoneal cavity of dogs with ascites. Observation of characteristic calcareous corpuscles or intact metacestodes can provide a defininitive diagnosis of canine peritoneal larval cestodiasis in dogs.     

Pyloric outflow obstruction secondary to sclerosing encapsulating peritonitis in a dog

A 6-year-old, male neutered mixed breed dog was presented emergently with a three-week history of hyporexia, vomiting, diarrhoea and weight loss. Upon examination, the patient was dull, had generalised muscle atrophy, moderate abdominal pain and a mild amount of peritoneal effusion. A fluid-filled, distended, corrugated small bowel with marked gastroparesis and moderate peritoneal effusion was noted on abdominal ultrasonography. Endoscopy revealed hyperaemic and friable mucosa and a subjectively narrowed pylorus. Emergency exploratory celiotomy was performed due to worsening patient condition and revealed thick, diffuse, fibrous adhesions of the abdominal cavity. Based on these findings, sclerosing encapsulating peritonitis (SEP) was suspected. A large mass of omentum adjacent to the greater curvature of the stomach had caused a pyloric outflow obstruction. Adhesiolysis was attempted but was unsuccessful due to the friability of the small intestines. The dog was humanely euthanased under anaesthesia. A diagnosis of SEP was confirmed via necropsy. No underlying cause was identified. This is the first known case of a pyloric outflow obstruction secondary to SEP in a dog. Although rare, this condition should be considered as a differential for dogs with signs of a pyloric outflow obstruction with concurrent ascites and abdominal pain, hyporexia, vomiting and diarrhoea.     

Streptococcal peritonitis in a young dromedary camel

A male dromedary camel was presented for a primary Streptococcal zooepidemicus septic peritonitis. An underlying gross lesion was not identified during abdominal exploratory surgery. The camel responded to peritoneal lavage, peritoneal drainage and systemic antibiotic therapy. Thrombophlebitis of the left jugular vein was diagnosed 14 days after surgery. The camel died of an unknown cause 24 days after surgery.     

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.     

Extraction of urethral calculi by transabdominal cystoscopy and urethroscopy in nine dogs

Objectives : To describe a minimally invasive technique for treating urethral obstructions in male dogs and to review the postoperative results. Methods : All dogs (n=9) had urethral obstruction due to calculi. Obstructions were verified by radiographic and ultrasonographic examinations. Dogs with impaired kidney function were not included in the study. A 5‐mm diameter trocar and cannula were placed in the ventral midline, 2 cm cranial to the umbilicus, allowing placement of a 10‐mm diameter cannula under visual guidance, adjacent to the apex of the bladder. The bladder was then partially exteriorised and sutured to the skin. A 5‐mm diameter cystoscopy sheath was introduced into the bladder lumen and advanced into the urethra. Continuous retrograde flushing was used to dislodge the calculi from the site of obstruction and collect them upstream. Results : The nine dogs were followed up for a minimum of 6 months. No major postoperative complications were identified. One dog exhibited transient macroscopic haematuria (for 3 weeks postoperatively). All urethral calculi were removed in the nine dogs. No recurrence was found during the follow‐up period. Clinical Significance : A minimally invasive approach is used to treat urethral obstructions resulting from calculi in the male dogs.     

Acute gaseous peritonitis after rupture of a retroperitoneal rectal diverticulum in a dog

An 11-year-old, entire male coton de tulear was presented on emergency with acute and severe depression, acute abdominal pain and vomiting of 24 hours duration. Historical complaints included right perineal swelling, dyschezia and tenesmus of 18 months duration. Abdominal ultrasonography and radiography suggested a pneumoperitoneum and positive-contrast colonography showed leakage of contrast medium into the caudal abdomen and the presence of a large retroperitoneal pouch. Exploratory laparotomy allowed the visualisation of faecal leakage from the retroperitoneal space into the peritoneal cavity. Using a perineal approach, a large necrotised rectal diverticulum filled with faeces was found over the retroperitoneal structures. A standard herniorrhaphy was then performed. The dog recovered uneventfully and dyschezia did not recur at the nine month follow-up. Rectal diverticulum rupture associated with peritonitis has not been described in the veterinary literature, to the authors' knowledge, and should be considered as a rare differential diagnosis in dogs being presented with gaseous peritonitis.     

Hypocalcemia in a critically ill patient

Objective: To present a case of clinical hypocalcemia in a critically ill septic dog. Case summary: A 12‐year old, female spayed English sheepdog presented in septic shock 5 days following hemilaminectomy surgery. Streptococcus canis was cultured from the incision site. Seven days after surgery, muscle tremors were noted and a subsequent low serum ionized calcium level was measured and treated. Intensive monitoring, fluid therapy, and antibiotic treatment were continued because of the sepsis and hypocalcemia, but the dog was euthanized 2 weeks after surgery. New or unique information provided: Low serum ionized calcium levels are a common finding in critically ill human patients, especially in cases of sepsis, pancreatitis, and rhabdomyolysis. In veterinary patients, sepsis or streptococcal infections are not commonly thought of as a contributing factor for hypocalcemia. Potential mechanisms of low serum ionized calcium levels in critically ill patients include intracellular accumulation of calcium ions, altered sensitivity and function of the parathyroid gland, alterations in Vitamin D levels or activity, renal loss of calcium, and severe hypomagnesemia. Pro‐inflammatory cytokines and calcitonin have also been proposed to contribute to low ionized calcium in the critically ill. Many veterinarians rely on total calcium levels instead of serum ionized calcium levels to assess critical patients and may be missing the development of hypocalcemia. Serum ionized calcium levels are recommended over total calcium levels to evaluate critically ill veterinary patients.