Open Peritoneal Drainage in Horses With Experimentally Induced Peritonitis

Peritonitis was induced in 12 horses by median celiotomy and 1 hour of small intestinal ischemia. Six horses had primary closure of the incision, whereas six horses had a plastic mesh sutured to the ventral abdominal wall leaving the abdomen open for ventral drainage. The mesh was removed after 5 days and the abdominal wall was closed by apposition of the linea alba and subcutaneous tissues and approximation of the skin edges. Peritoneal fluid was collected and analyzed for nucleated cell count and total protein concentration on days 0 and 5. Serum biochemical profiles, serum electrolyte concentrations, and complete blood counts were performed on days 0, 1, 2, 5, 6, 10, and 14. Body weight, rectal temperature, and physical examination findings were recorded daily for 30 days, then horses were euthanatized and the abdominal cavity was examined for the presence of adhesions. Histological examination was performed to assess the inflammatory response of the healing body wall; inflammation scores were significantly lower in horses that had primary closure of the incision. The mesh was well tolerated by all horses and allowed egress of peritoneal fluid for 5 days. Adhesions were present in four control horses and in two horses that had open peritoneal drainage. All horses that had open drainage developed incisional infections after mesh removal. Abdominal wall herniation did not occur in any of the horses. The mild peritonitis induced in this study was insufficient to establish the efficacy of open peritoneal drainage for an established peritonitis in horses; however, the results of this study indicate that open peritoneal drainage is feasible in horses.     

The use of vacuum-assisted closure in the management of septic peritonitis in six dogs

The purpose of this study was to describe the appropriate surgical technique, postoperative monitoring, and complications encountered with use of vacuum-assisted closure (VAC) in six dogs with confirmed septic peritonitis. Initial diagnosis of septic peritonitis was performed by measuring either the blood-to-fluid lactate ratio and glucose concentration differences or cytologic verification of intracellular bacteria. After appropriate surgical procedures were performed to manage the primary cause of peritoneal sepsis, a VAC was performed. Serum and abdominal fluid protein levels were measured, and all complications were noted during the postoperative period. Three of the six dogs (50%) survived to the secondary closure and were subsequent discharged, which is similar to previous studies where the abdomen was either closed primarily or treated with open abdominal drainage. No major complications occurred with bandage management during hospitalization. The results of this study support VAC as a feasible technique for managing septic peritonitis.     

Surgical treatment of septic peritonitis without abdominal drainage in 28 dogs

The purpose of this study was to evaluate the surgical outcomes of 28 dogs with generalized septic peritonitis treated without postoperative abdominal drainage. The overall mortality rate was 46%, with most cases of peritonitis being caused by leakage of the gastrointestinal tract (75%). Etiology of peritonitis, abdominal cytopathology, total white blood cell count, packed cell volume, total protein, and results of serum biochemistries were not statistically different between survivors and nonsurvivors. The mortality rate of 46% is similar to other studies in which the abdomen was left open postoperatively for the management of septic peritonitis, although more advanced medical treatment than that used in earlier studies may have positively affected the outcome. The results of this study show that closure of the abdomen after the source of contamination has been successfully corrected, in combination with thorough intraoperative peritoneal lavage and appropriate postoperative medical management, may be an acceptable alternative method for the management of septic peritonitis.     

Use of tamoxifen in a German shepherd dog with sclerosing encapsulating peritonitis

A German shepherd dog was diagnosed with sclerosing encapsulating peritonitis after an episode of peritonitis caused by a free intra-abdominal foreign body (stick). The foreign body had initially been treated by surgical removal and abdominal lavage. Postoperatively, peritoneal effusion persisted despite the use of methylprednisolone for 1 month and a second surgical exploration and abdominal lavage. After a third surgery at our institution (to breakdown abdominal adhesions) followed by open abdominal drainage, treatment with tamoxifen orally was initiated and within 2 weeks the dog's condition improved dramatically. Two months later, no fluid was present in the abdomen. The only apparent adverse reaction to tamoxifen therapy was swelling of the vulva. In humans, sclerosing encapsulating peritonitis is a known life-threatening complication following peritoneal dialysis. In veterinary medicine, most animals with sclerosing encapsulating peritonitis die because of chronic weight loss, peritoneal effusion and progression of concurrent disease. This dog's condition was unresponsive to methylprednisolone alone but was successfully treated with aggressive surgery including enterolysis and open abdominal lavage and the addition of tamoxifen.     

Open peritoneal drainage for treatment of contaminated peritoneal cavity and septic peritonitis in dogs and cats: 24 cases (1980-1986)

The medical records of 22 dogs and 2 cats in which generalized peritonitis had been treated by open peritoneal drainage were reviewed. The age of the affected animals ranged from 5 months to 14 years. The causes of peritonitis were numerous, with the most common being leakage of gastrointestinal contents through spontaneous gastric or intestinal perforations and peritoneal contamination resulting from surgical complications. Bacteria were isolated from 18 (94.7%) of 19 specimens obtained for culturing at the time of diagnosis of peritonitis and from 8 (80%) of 10 specimens obtained for culturing at the time of final abdominal closure. Only 2 (25%) of 8 of the animals in which bacteria were isolated at the time of final abdominal closure died. The overall mortality was 33%. The mortality attributable to peritonitis or its direct complications was 21%. Open peritoneal drainage was tolerated well by all patients.     

Open Peritoneal Drainage in Experimental Peritonitis in Dogs

Peritonitis was induced In 12 dogs by creation of an avascular jejunal loop. After 24 hours, the avascular jejunal loop was removed, and purulent material was removed by aspiration. The abdominal incision in six experimental dogs was left open under a bandage, while the incision was closed in six control dogs. All six open abdomen, and four control, dogs survived the 8 days of the study. The number of bacteria in the peritoneal exudate in experimental animals was less than in control animals. At the end of the 8 day study, experimental animals were more active, had better appetites, and were less likely to have fever, vomition, diarrhea, and dehydration. Experimental animals weighed significantly less than control animals. There were no differences between groups with respect to biochemical and hematologic parameters. At necropsy, experimental animals had fewer adhesions and less peritoneal fluid accumulation than control animals. Complications of open peritoneal drainage included persistent fluid loss, weight loss, adhesions of abdominal viscera to the bandage, and contamination of the peritoneal cavity with cutaneous organisms.     

Nocardial peritonitis in a cat

Objective To illustrate a successfully managed case of nocardial peritonitis in a cat.
Design Case report.
Animal An 8 year old neutered male Burmese cat presented for nonspecific signs of depression, anorexia, pallor and mild dehydration. Pyrexia, loss of weight and abdominal distension developed despite treatment with amoxycillin-clavulanate and supportive therapy.
Procedure Various medical and surgical procedures were used.
Results Haematology revealed severe inflammatory left shift. Biochemistry showed mild prerenal azotemia. A "ground glass" appearance to the abdomen was seen on radiographs. Fluid collected by abdominocentesis contained "sulphur granules" and had characteristics of a septic exudate. Laparotomy allowed drainage of peritoneal fluid and extensive lavage of the peritoneal cavity. Culture of the fluid revealed Nocardia sp. Sensitivity testing resulted in a change of antimicrobial therapy to trimethoprim-sulphadiazine.
Conclusion Response to surgical drainage and change in antibacterial therapy was excellent. No toxic side effects were encountered during the 3 months course of trimethoprim-sulphonamide. The cat made a complete recovery.     

Mesenteric vascular thrombosis associated with disseminated abdominal visceral hemangiosarcoma in a cat

An adult castrated male cat was evaluated because of a 4 day history of lethargy and partial anorexia. Physical examination revealed abdominal pain with a palpable fluid wave. Cytologic and biochemical analyses of peritoneal effusion were suggestive of septic peritonitis. On surgical exploration of the abdomen, the mesenteric vessels had no palpable pulses and they contained gross thromboses. The intestines were white with no visible peristalsis. Necropsy findings included disseminated, poorly differentiated hemangiosarcoma throughout the abdomen. Mesenteric arterioles contained fibrin thrombi. To the author's knowledge, no previous reports exist of complete mesenteric vascular thrombosis associated with disseminated abdominal visceral hemangiosarcoma in a cat.     

Potential Prognostic Indicators in Diffuse Peritonitis Treated with Open Peritoneal Drainage in the Canine Patient

The purpose of this study was to identify prognostic indicators that may help to predict outcome in clinical cases of diffuse peritonitis treated with open peritoneal drainage. Medical records from 19 canine patients with generalized peritonitis treated with open peritoneal drainage between 1990 and 1996 were reviewed. The signalment, preoperative complete blood count (CBC), preoperative biochemical profiles, and number of days of open peritoneal drainage of surviving patients (n = 15) were compared to nonsurviving patients (n = 4). Significant differences were noted between the surviving and nonsurviving groups in the ALT (p = 0.02) and GGT (p = 0.01) values. Seventy-nine percent of the patients in this study survived.     

Open Intestinal Anastomosis with Surgical Stapling Equipment in 24 Dogs and Cats

Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.     

A retrospective study of surgically treated cases of septic peritonitis in the cat (2000–2007)

O bjectives : To review aetiology, clinical signs and outcome of cats surgically treated for septic peritonitis (2000-2007).
M ethods : A retrospective study. Inclusion criteria were the identification of intracellular bacteria and degenerate neutrophils and/or a positive culture from abdominal fluid and exploratory coeliotomy. Aetiology, clinical signs, haematological and biochemical parameters, surgical treatment and outcome were recorded and analysed.
R esults : Twenty-six cats fulfilled the inclusion criteria. Abdominal pain was reported in 10 (38 per cent) and vomiting was reported in 11 (42 per cent) of the cats. The most common aetiology was trauma (31 per cent). The principal source of contamination was the gastrointestinal tract. Hyperlactataemia, hypoproteinaemia and hyperglycaemia were reported in 9, 13 and 14 of the 26 cases, respectively. Non-survivors had significantly higher blood lactate concentrations than survivors (P=0·02). Nineteen cats were managed with primary closure, two with closed suction drains and three with open peritoneal drainage. Twelve (46 per cent) cats survived to discharge.
C linical S ignificance : In cats, lethargy, depression and anorexia were more common clinical signs than abdominal pain. Lactate level at the time of diagnosis may be a useful prognostic indicator in cats. The proportion of cats that survived was lower than previously reported and owners should be given a guarded prognosis.     

Experimental peritonitis induced by oral administration of indomethacin in Mongolian gerbils

The possibility of inducing peritoneal inflammation in three murine species (gerbils, rats and mice) via the oral administration of indomethacin was investigated with the overall aim of developing an experimental animal model for human peritonitis. Gerbils given high doses of indomethacin at a rate of 30 mg and 40 mg/kg body weight showed swelling of the abdomen, depression and dyspnea within 4 days after the treatment. The severity of the clinical symptoms increased with time. The animals were confirmed as having developed peritonitis based on the pathological features including inflammation of the peritoneum, and fibrinous adhesion of the abdominal organs in the abdominal cavity. The severity of peritonitis increased with increasing dose of indomethacin, and was not related to the gender of the animal. On the other hand, peritoneal inflammation did not develop in the rats and mice even at high doses. Therefore, the administration of 30 mg/kg body weight of indomethacin is an effective and simple method of inducing peritonitis in 5-week-old Mongolian gerbils. The animal peritonitis model used in this study can be used as an effective tool for examining potential therapeutic compounds for preventing peritoneal damage during peritonitis, and provide insight into the pathophysiology of peritonitis.     

Use of an active intra-abdominal drain in 67 horses

OBJECTIVE: To describe the insertion technique, efficacy, and complications associated with the use of an active (closed-suction) abdominal drain in horses. STUDY DESIGN: Retrospective study. Animals-Sixty-seven horses with abdominal contamination treated by abdominal lavage and use of a closed-suction abdominal drain. METHODS: Medical records of horses (1989-1996) that had a closed-suction abdominal drain were reviewed. Follow-up information was obtained by telephone interviews with owners. RESULTS: Sixty-eight closed-suction abdominal drains were used in 67 horses that had abdominal contamination, peritonitis, or to prevent adhesion formation. The drain was placed under general anesthesia (62 horses) or in a standing position (6 horses). Abdominal lavage was performed every 4 to 12 hours and about 83% of the peritoneal lavage solution was retrieved. Minor complications associated with drain use occurred in 49% of the horses and included obstruction or slow passage of fluid through the drain in 18 horses (26%), leakage of fluid around the drain in 11 horses (16%), and subcutaneous fluid accumulation around the drain in 8 horses (12%). Incisional suppuration developed in 20 of 62 (32%) and incisional herniation in 5 of 46 (11%) horses. CONCLUSIONS: A closed-suction drain system was easily placed and was associated with only minor complications in most horses. CLINICAL RELEVANCE: Active abdominal drainage and lavage is a useful adjunct in the treatment of peritonitis or as a prophylactic procedure in horses at risk of developing septic peritonitis and abdominal adhesions. Clinicians should be aware of the high incidence of minor complications.     

Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003)

OBJECTIVES: To describe preoperative, surgical, and postoperative findings and determine prognostic indicators and treatment recommendations in dogs treated surgically for gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURES: Medical records of dogs with gallbladder mucoceles that were treated surgically were reviewed. History, clinical signs, results of selected clinicopathologic analyses and abdominal ultrasonography, surgical procedure performed, results of histologic examination of a liver biopsy specimen, and survival time were recorded. Follow-up information was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs were 7 to 15 years of age and had non-specific clinical signs (vomiting, anorexia, and lethargy). Physical examination findings included icterus, signs of depression, and signs of discomfort on palpation of the abdomen. Sixteen dogs had a definitive diagnosis and 6 dogs were strongly suspected of having a gallbladder mucocele on the basis of results of abdominal ultrasonography. Fifteen dogs survived after surgery; 3 of these dogs had bile-induced peritonitis, and 4 had pancreatitis. One dog was euthanatized as a result of severe pancreatitis, and 1 was euthanatized because of acute renal failure; 5 dogs died as a result of pancreatitis, cholecystitis, or bile-induced peritonitis. Hepatic abnormalities were detected histologically in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: No predictors of survival were identified. No associations between outcome of surgical treatment (survival vs nonsurvival) and preoperative findings, biliary rupture, surgical procedure performed, results of histologic examination of the liver, or development of pancreatitis were found. Cholecystoduodenostomy and cholecystectomy appear to be acceptable treatments for gallbladder mucocele.     

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.     

Uterine rupture as a postpartum complication in two mares

Uterine rupture was diagnosed in 2 postpartum mares with hemorrhagic vaginal discharge. Both mares had abdominal pain, as evidenced by pawing, kicking at the abdomen, or attempting to roll. Peritoneal fluid analysis was useful in establishing a diagnosis. One mare had many RBC in the peritoneal fluid and was anemic; this mare was managed medically with oxytocin, antibiotics, and blood transfusion. The mare was able to raise her foal to weaning age. The second mare had many RBC, degenerate neutrophils, and intracellular and extracellular bacteria in peritoneal fluid. Surgical repair of the uterus was performed, and the mare was treated for peritonitis. The mare later became pregnant.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

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.     

Intraperitoneal Circulation and Drainage in the Dog

The patterns of dispersion and drainage of a low viscosity, oil-based contrast medium within the peritoneal cavity were examined in 12 normal dogs. Intraperitoneal injection of contrast medium was cranial or caudal and drainage was by the sump-Penrose or open peritoneal method. Radiographs were made over a 96 hour period, before and after peritoneal drainage was established. Each dog was euthanatized and necropsied. The contrast medium was dispersed throughout the peritoneal cavity 15 to 30 minutes after cranial injection and 1 to 2 hours after caudal injection. Most of the contrast medium drained within 6 hours after open peritoneal drainage and within 24 to 48 hours after sump-Penrose drainage. At necropsy, there was complete encasement of all sump-Penrose drains and partial occlusion of all open peritoneal incisions by omentum adhered to the abdominal wound edges. Peritonitis was not grossly evident, but all dogs showed histologic evidence of an acute inflammatory reaction associated with the drain or wound edge.     

Splenic foreign body in a cat

An 8-year-old domestic shorthair cat was evaluated for a several day history of anorexia and vomiting. Abdominal distention was noted on physical examination and diagnostics including abdominal radiographs and abdominal ultrasound demonstrated the presence of free fluid in the peritoneal cavity. Septic peritonitis was diagnosed on cytologic evaluation of the peritoneal fluid. The cat was taken to surgery and a foreign body composed of plant material was found embedded within the spleen. A splenectomy was performed and both open and active peritoneal drainages were used to successfully treat this case.