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.     

Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture,diaphragmatic tear,and rupture of the spleen in a dog

Objective– To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary– A 1‐year‐old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco‐ and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided– Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen.     

Safety and efficacy of mid-term pregnancy termination using aglepristone in dogs

O bjectives : To investigate effects and side effects of aglepristone in terminating pregnancy in bitches.
M ethods : Twenty-two bitches were treated in mid-pregnancy with subcutaneous injections of aglepristone at a total dose of 20 mg/kg. Short-term follow-up (one to two weeks after treatment) included clinical examination and abdominal ultrasonography in 18 of the dogs. Long-term telephone follow-up was recorded for all 22 dogs.
R esults : Pregnancy was terminated in 21 bitches (95 per cent). Signs of abortion occurred one to eight days after treatment. Vaginal discharge was evident in 17 (77 per cent) dogs. Obvious signs of parturition were seen in nine (41 per cent) dogs. Eight dogs (36 per cent) developed anorexia, and in two (9 per cent) of the dogs a local reaction at the injection site was evident. Two dogs developed pyometra two and four years after treatment, respectively.
C linical S ignificance : Aglepristone, when administered in mid-gestation, is effective in terminating pregnancy. Side effects are few and transient.     

Familial progressive nephropathy in young Bull Terriers

The clinical, clinicopathological and pathological findings are described in three Bull Terrier bitches with advanced renal disease. The bitches were less than four years old and showed variable presenting signs but anorexia, lethargy and polydipsia were the most frequent. All three dogs were azotaemic and isosthenuric. Urinary protein was measured in two of the three cases. Both were proteinuric. At necropsy all dogs had shrunken kidneys. Histological examination revealed nephron loss, atrophy of glomerular tufts, interstitial fibrosis, and mineralisation of basement membranes.

The progressive renal disease in these dogs was similar to the condition reported in Bull Terriers in Australia, and is probably familial and inherited.     

Familial progressive nephropathy in young Bull Terriers

The clinical, clinicopathological and pathological findings are described in three Bull Terrier bitches with advanced renal disease. The bitches were less than four years old and showed variable presenting signs but anorexia, lethargy and polydipsia were the most frequent. All three dogs were azotaemic and isosthenuric. Urinary protein was measured in two of the three cases. Both were proteinuric. At necropsy all dogs had shrunken kidneys. Histological examination revealed nephron loss, atrophy of glomerular tufts, interstitial fibrosis, and mineralisation of basement membranes. The progressive renal disease in these dogs was similar to the condition reported in Bull Terriers in Australia, and is probably familial and inherited.     

Cecal-Colic Volvulus in Two Dogs

Cecal-colic volvulus was confirmed by surgery in two dogs. Both dogs were intact, male Great Danes. The clinical and diagnostic findings were not specific for large bowel volvulus. Clinical signs included peracute to acute onset of vomiting, mild abdominal distention and pain, lack of feces, and tenesmus. Abdominal radiographs demonstrated severe dilatation of bowel loops in both dogs. One dog survived.     

Unusual urethral calculi in two male dogs

The clinical presentation and advanced size of the two calculi described in this report are both atypical and noteworthy. Both dogs were presented initially with signs of hematuria, stranguria, and perineal discomfort. Each calculus was visible on survey abdominal radiographs and was present in the region of the ischial arch. Both dogs underwent a perineal urethrotomy to retrieve the calculus. Resolution of clinical signs was obtained in one case, which was referred within 2 months of the onset of clinical signs. The second dog was medically managed for approximately 2.5 years before referral. Surgical intervention failed to restore urinary continence in this second dog. Early detection of similar cases may be important in optimizing clinical outcome following appropriate treatment.     

Sclerosing encapsulating peritonitis in three dogs

A condition resembling human sclerosing encapsulating peritonitis was identified in 3 young large-breed dogs. All 3 dogs had similar clinical signs: ascites, vomiting, and excessive borborygmus. The condition was discovered at laparotomy and confirmed histologically. Laparotomy revealed a sac-like formation totally or partially occupying the peritoneal cavity. The predominant histologic abnormality was marked peritoneal and serosal fibrosis. None of the dogs had a favorable response to treatment, and euthanasia was performed because of development of abdominal distention.     

A Review of Canine Pseudocyesis

The purpose of this article is to review the most relevant features of the physiology, clinical signs, diagnosis, treatment and prevention of canine pseudocyesis (PSC). This is a physiological syndrome, characterized by clinical signs such as: nesting, weight gain, mammary enlargement, lactation and maternal behaviour, which appears in non‐pregnant bitches at the end of metaoestrus. PSC is a frequent finding in domestic dogs. Although it is generally admitted that prolactin (PRL) plays a central role in the appearance of PSC, its precise aetiophysiology is not completely understood yet. A number of clinical studies suggest that at some point of metaoestrus circulating PRL levels rise in overtly pseudopregnant bitches. Individual differences in sensitivity to PRL as well as the existence of molecular variants of canine PRL with different bioactivity versus immunoreactivity ratios may help clarify the aetiopathology of PSC. Diagnosis of PSC is based on the presence of typical clinical signs in metaoestrous non‐pregnant bitches. Considering that PSC is a self limiting physiological state, mild cases usually need no treatment. Discouraging maternal behaviour and sometimes fitting Elizabethan collars to prevent licking of the mammary glands may suffice in these cases. Sex steroids (oestrogens, progestins and androgens) have been traditionally used to treat PSC but the side‐effects usually outweigh the benefits of these medications. Inhibition of PRL release by ergot derivatives [ bromocriptine (10–100 μg/kg per day for 10–14 days], cabergoline (5 μg/kg per day during 5–10 days), metergoline (0.2 mg/kg per day during 8–10 days) has proved to be effective for the treatment of canine PSC. Although some of these ergot derivatives present some untoward side‐effects, they are transient and can usually be managed. Predisposed bitches not intended for breeding should be spayed as ovariectomy is the only permanent preventive measure.     

Chronic gastric instability and presumed incomplete volvulus in dogs

Chronic gastric volvulus in dogs results in long-standing gastrointestinal signs unlike those of acute gastric dilatation and volvulus. This report describes chronic gastric volvulus in seven dogs. The majority of dogs presented with weight loss, chronic vomiting, lethargy and abdominal pain. A combination of radiographic, ultrasonographic and endoscopic imaging indicated altered positioning of gastric landmarks. Dynamic changes were identified in some cases. Exploratory coeliotomy and surgical gastropexy were performed in all dogs. Clinical signs improved or resolved in six of seven dogs postoperatively. Chronic gastric volvulus is an uncommon condition in dogs, but should be considered as a differential in cases presenting with the above clinical signs.     

Three cases of canine bile peritonitis with mucinous material in abdominal fluid as the prominent cytologic finding

Background: Bile peritonitis is a severe, nonseptic inflammatory response to bile in the peritoneal cavity. It may result from generalized or localized leakage of bile due to spontaneous rupture of the biliary system or as a complication of biliary tract inflammation, obstruction, manipulation, or trauma. Cytologically, bile in abdominal fluid appears as golden-green granular pigment.
Objective: The purpose of this report is to describe the atypical cytologic features of abdominal fluid in 3 dogs with bile peritonitis.
Methods: As part of a diagnostic workup, abdominal fluid was obtained from 3 dogs with bile peritonitis and analyzed. In 2 dogs, fluid bilirubin concentration was determined and Hall's bile stain, Alcian blue-periodic acid-Schiff stain, and Mayer's mucicarmine stain were applied to direct smears of the fluid.
Results: Acellular mucinous fibrillar material in clumps and lakes was the prominent cytologic finding in the abdominal fluid from all 3 dogs. Bile pigment was not observed. Fluid from the 3 dogs contained increased numbers of inflammatory cells, predominantly neutrophils. Total protein concentration ranged from 2.9 to 5.6 g/dL. Fluid total bilirubin concentration was greater than twice that of the concurrent serum bilirubin concentration. Based on results of the special stains, the amorphous material was positive for mucosubstances, but was negative for bilirubin. In all dogs, bile peritonitis originated from a rent in the common bile duct.
Conclusions: Bile peritonitis with fibrillar mucinous material in abdominal fluid has not been described previously in dogs. The material was similar to "white bile" observed in humans and experimentally in dogs as a sequela to extrahepatic biliary tract obstruction. When mucinous material is observed in abdominal fluid from dogs and the fluid bilirubin concentration is greater than twice the serum bilirubin concentration, rupture of the extrahepatic biliary tract should be suspected.     

Sand impaction of the small intestine in eight dogs

Objective : To describe signalment, clinical findings, imaging and treatment of intestinal sand impaction in the dog. Methods : Medical records of dogs with radiographic evidence of small intestinal sand impaction were reviewed. Results : Sand impaction resulting in small intestinal obstruction was diagnosed in eight dogs. All dogs presented with signs of vomiting. Other clinical signs included anorexia, lethargy and abdominal pain. Radiographs confirmed the presence of radio-opaque material consistent with sand causing distension of the terminal small intestine in all dogs. Four dogs were treated surgically for their impaction and four dogs were managed medically. Seven of the eight dogs survived. Clinical Significance : Both medical and surgical management of intestinal sand impaction in the dog can be effective and both afford a good prognosis for recovery.     

COMPARISON BETWEEN SURVEY RADIOGRAPHY,B‐MODE ULTRASONOGRAPHY,CONTRAST‐ENHANCED ULTRASONOGRAPHY AND CONTRAST‐ENHANCED MULTI‐DETECTOR COMPUTED TOMOGRAPHY FINDINGS IN DOGS WITH ACUTE ABDOMINAL SIGNS

Contrast‐enhanced multi‐detector computed tomography (CE‐MDCT) is used routinely in evaluating human patients with acute abdominal symptoms. Contrast‐enhanced ultrasound (CEUS) continues to be in its infancy as it relates to evaluation of the acute abdomen. The purpose of this study was to compare survey radiography, B‐mode ultrasound, CEUS, and CE‐MDCT findings in canine patients presenting with acute abdominal signs; with a focus on the ability to differentiate surgical from non‐surgical conditions. Nineteen dogs were prospectively enrolled. Inclusion required a clinical diagnosis of acute abdominal signs and confirmed surgical or non‐surgical causes for the clinical signs. Agreement for the majority of recorded imaging features was at least moderate. There was poor agreement in the identification of pneumoperitoneum and in the comparison of pancreatic lesion dimensions for B‐mode vs. CEUS. The CT feature of fat stranding was detected in cases including, but not limited to, gastric neoplasia with perforation, pancreatitis, and small intestinal foreign body. Ultrasound underestimated the size and number of specific lesions when compared with CE‐MDCT. Contrast‐enhanced ultrasound was successful in detecting bowel and pancreatic perfusion deficits that CE‐MDCT failed to identify. Accuracy for differentiation of surgical vs. non‐surgical conditions was high for all modalities; 100%, 94%, and 94% for CE‐MDCT, ultrasonography and survey radiography respectively. Findings indicated that CE‐MDCT is an accurate screening test for differentiating surgical from non‐surgical acute abdominal conditions in dogs. Focused CEUS following CE‐MDCT or B‐mode ultrasonography may be beneficial for identifying potentially significant hypoperfused lesions.     

Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990-2001)

OBJECTIVE: To determine the underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis and identify differences between cats that survived following treatment and cats that did not survive despite treatment. DESIGN: Retrospective study. ANIMALS: 51 cats with septic peritonitis. PROCEDURE: Medical records were reviewed for clinical findings; results of clinicopathologic testing, microbial culture, and radiography; diagnosis; treatment; and outcome. RESULTS: Signs of pain during palpation of the abdomen were reported for only 29 of 47 (62%) cats. Eight (16%) cats had relative bradycardia (heart rate < 140 beats/min). The most commonly isolated organisms included Escherichia coli, Enterococcus spp, and Clostridium spp. The most common cause of peritonitis was gastrointestinal tract leakage (24 cats). No definitive source could be identified in 7 cats. Treatment, including exploratory surgery, was pursued in 23 cats, of which 16 (70%) survived and were discharged. There were no significant differences between survivors and nonsurvivors in regard to heart rate, age, rectal temperature, serum lactate concentration, WBC count, PCV, blood glucose concentration, or serum albumin concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that clinicopathologic abnormalities and outcome in cats with septic peritonitis are similar to those reported for dogs. However, certain features may be unique, including an absence of signs of pain during abdominal palpation, relative bradycardia, and apparent spontaneous peritonitis in some cats.     

Liver lobe torsion in dogs: 13 cases (1995-2004)

OBJECTIVE: To determine history, results of diagnostic testing, surgical findings, complications, and outcome for dogs with liver lobe torsion (LLT). DESIGN: Retrospective case series. ANIMALS: 12 dogs (1 with 2 episodes). PROCEDURE: Signalment, clinical signs, clinicopathologic findings, radiographic and ultrasonographic findings, surgical and histologic findings, complications, and hospitalization time were evaluated. RESULTS: The most common clinical signs were nonspecific abnormalities (eg, vomiting, lethargy, and anorexia) of acute or chronic duration. All dogs were large-breed dogs (median body weight, 37.2 kg [82 lb]). Biochemical abnormalities included high alanine amino-transferase (n = 12) and aspartate aminotransferase (11) activities. Results of abdominal ultrasonography were supportive of the diagnosis in 5 of 8 cases. Affected lobes included the left medial lobe (n = 4), left lateral lobe (3), papillary process of the caudate lobe (2), caudate lobe (1), and right lateral lobe (1). Exploratory celiotomy and liver lobectomy were performed in 12 of 13 cases, and in 11 of those 12 cases, the dog survived. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that development of nonspecific clinical signs of vomiting, lethargy, and anorexia in conjunction with high serum hepatic enzyme activities and mature neutrophilia in a medium-sized or large-breed dog should increase the index of suspicion for LLT. Abdominal ultrasonography with Doppler assessment may be useful in establishing the diagnosis. The long-term outcome for dogs that survive the hospitalization period is excellent.     

Peritonitis associated with Actinobacillus equuli in horses: 51 cases

OBJECTIVE: To review the clinical findings, diagnosis and treatment of 51 horses with peritonitis attributed to Actinobacillus equuli. DESIGN: Retrospective study of clinical cases. METHODS: Breed, age and gender of horse, history, physical examination findings, treatment and outcome were determined from the hospital records of 51 horses in which a diagnosis of peritonitis attributed to A. equuli was made between January 1993 and June 1999. Results of abdominal fluid cytology and bacteriology, antimicrobial sensitivity patterns, haematology and faecal egg counts, when performed, were also retrieved. RESULTS: There was a variety of breeds of horses affected. There were 35 male and 17 female horses, aged from 9 months to 22 years, presented. Lethargy, signs of depression with mild to moderate signs of abdominal pain and inappetence were the most common reasons for presentation. Most horses had elevated heart and respiratory rates, an elevated rectal temperature and reduced intestinal borborygmi heard on auscultation of the abdomen. Abnormal colour with an elevated protein were features of an abdominal fluid sample in 98% of horses and a marked elevation in nucleated cell count was present in all samples. Pleomorphic gram-negative rods were seen on cytology in 53% of samples and a positive culture of A. equuli was returned in 72% of samples. Other laboratory findings in some horses included mild haemoconcentration, hypoproteinaemia, an elevated circulating nucleated cell count with a left shift, an elevation in fibrinogen concentration and an elevated faecal egg count. All horses demonstrated a rapid response to treatment with procaine penicillin alone, or a combination of procaine penicillin and gentamicin sulphate. Where antimicrobial sensitivity tests were performed, all but two isolates were sensitive to procaine penicillin. All horses responded to antimicrobial and supportive therapy and were discharged from hospital. CONCLUSION: Horses with A. equuli peritonitis present with similar clinical signs as horses with other causes of abdominal pain. However, these signs, when evaluated in conjunction with the results of abdominal fluid analysis and response to treatment, are characteristic of A. equuli peritonitis. Pleomorphic gram-negative bacteria may be seen on a cytological preparation of the abdominal fluid sample, and a positive bacterial culture may be obtained in some, but not all, cases. Most isolates are sensitive to procaine penicillin, so treatment with procaine penicillin and gentamicin sulphate is recommended until antimicrobial sensitivity is known.     

Surgical Treatment of Bile Peritonitis in 24 Dogs and 2 Cats: A Retrospective Study (1987–1994)

Objective — The purpose of this study was to determine the signalment, history, clinical signs, diagnosis, treatment, outcome, and factors affecting outcome of dogs and cats surgically treated for bile peritonitis. Study Design — Retrospective study. Animals or Sample Population — Twenty-four dogs and two cats surgically treated for bile peritonitis. Methods — The medical records of dogs and cats surgically treated for biliary effusions at the Ohio State University and Michigan State University between 1987 and 1994 were reviewed. Statistical analysis was performed to compare factors affecting outcome. Results — The cause of the biliary effusion was determined in 24 animals, and resulted from disruption of the biliary tract secondary to trauma (n = 13) or necrotizing cholecystitis (n = 11). Determination of the bilirubin concentration of the abdominal effusion was the only diagnostic test that was 100% effective in diagnosing bile leakage before surgical intervention. The bilirubin concentration of the effusion was consistently at least two times higher than the serum bilirubin concentration. Bacteriologic culture and sensitivity revealed that a septic, biliary effusion was usually associated with multiple types of gram-negative bacteria. The overall survival rate was 50% (13 of 26). The peripheral white blood cell count was significantly lower in survivors (mean 20,608/uL) compared with nonsurvivors (mean 35,712/uL). The immature neutrophil count was also significantly lower in survivors (mean 686/uL) than in nonsurvivors (4,852/uL). Only 27% (3 of 11) of the animals with a septic biliary effusion survived. In contrast, 100% (6 of 6) of the animals in which no bacteria were isolated from the abdominal effusion survived. Open abdominal drainage was not a successful treatment for 7 of 9 animals with septic biliary effusions. Survival was not significantly affected by the distribution of the peritonitis, cause of biliary effusion, or duration of clinical signs before surgical intervention. Conclusions — Patients with sterile biliary effusions have a much lower mortality rate than those with septic biliary effusions. The successful treatment of sterile biliary effusions does not require open abdominal drainage, and is not affected by the duration of the effusion. Clinical Relevance — This retrospective study provides information that may aid the surgeon in the diagnosis and treatment of bile peritonitis.     

Comparison of lipase activity in peritoneal fluid of dogs with different pathologies--a complementary diagnostic tool in acute pancreatitis?

A clinical diagnosis of acute pancreatitis is often difficult to obtain. Histopathology remains the gold standard, whereas clinical signs, diagnostic imaging and laboratory testing, even in combination, may be insufficient. In a prospective study, lipase activity in ascitic fluid of various aetiologies was determined in 44 dogs in order to investigate its performance in cases of acute pancreatitis. Data of simultaneously determined blood lipase activities were available in 27 dogs. Lipase activity was measured by a colorimetric assay. A complete peritoneal fluid analysis was performed. Dogs were divided into four groups, according to their final diagnosis: acute pancreatitis (A), abdominal trauma (B), abdominal neoplasia (C) and others (hepatic or cardiac diseases) (D). Dogs with acute pancreatitis had a significantly higher peritoneal lipase activity than those in other groups (P < or = 0.024), while no significant difference was found between the other groups (P > or = 0.734). Blood lipase activity as well as protein content and total cell count of the ascitic fluid did not show any significant difference between groups. Data show that determination of lipase activity in dogs that develop ascites may be useful in complementing the diagnosis of acute pancreatitis.     

Pneumoperitoneum in dogs and cats: 39 cases (1983-2002)

OBJECTIVE: To identify the most common causes of pneumoperitoneum in dogs and cats and determine history, clinical features, and outcome of affected animals. DESIGN: Retrospective study. ANIMALS: 31 dogs and 8 cats. PROCEDURES: Medical records were reviewed for signalment; history; abnormal physical, clinicopathologic, and radiographic findings; results of cytologic analysis and bacterial culture of abdominal fluid; gross and histologic findings at surgery or necropsy; and outcome. RESULTS: Pneumoperitoneum was classified as spontaneous in 25 animals and traumatic in 14. Causes of traumatic pneumoperitoneum included vehicular impact, gunshot wounds, abdominal dog bite wounds, and iatrogenic pneumothorax. Spontaneous pneumoperitoneum was caused by gastrointestinal tract perforation in 23 animals; underlying causes included neoplasia, nonsteroidal anti-inflammatory drug administration, and corticosteroid administration. Two animals developed spontaneous pneumoperitoneum after bladder rupture. Animals with spontaneous pneumoperitoneum were significantly older and had clinical signs of longer duration than those with traumatic pneumoperitoneum. Sixteen animals survived, including 15 of 23 animals that underwent surgery. Animals that survived had significantly higher serum albumin concentrations than did animals that died or were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE: Although pneumoperitoneum is most often attributable to perforation of a hollow viscus, other causes do exist. Early exploration is recommended for diagnosis and treatment of the underlying condition.