Ventilatory support of the critically ill foal.

Critically ill foals often have respiratory failure and benefit from respiratory support. Conventional mechanical ventilation using modem mechanical ventilators is easily adapted to foals. Establish-ing ventilator settings is a dynamic process aided by constant monitoring of blood gas values, end-tidal carbon dioxide, airway pressures, respiratory volumes, airway resistance, and respiratory compliance. Early weaning is as important as timely initiation of ventilation.     

Diagnosis of ruptured urinary bladder in a foal by the identification of calcium carbonate crystals in the peritoneal fluid.

A 3-day-old Quarter Horse colt was examined because of signs of severe depression, discomfort, and abdominal straining. The foal seemed disoriented, and the abdomen was tense and distended ventrally. The differential diagnoses included ruptured urinary bladder, retained meconium, septicemia/bacteremia, and neonatal maladjustment syndrome. Serum biochemical analysis revealed marked hyponatremia, hypochloremia, and moderate hyperkalemia, as well as mildly high urea, creatinine, and phosphorus concentrations. The primary differential diagnosis at this time was ruptured urinary bladder. Abdominocentesis was performed to confirm this diagnosis. Microscopic examination of abdominal fluid revealed calcium carbonate crystals, which originated from the urine of the foal. Biochemical analysis also confirmed the diagnosis of ruptured urinary bladder, because the ratio of peritoneal fluid creatinine to serum creatinine was 2.8:1. The foal died before surgical correction could be attempted.     

Laparoscopic repair of ruptured urinary bladder in a stallion

A 12-year-old stallion was evaluated because of pollakiuria; endoscopy of the urinary tract during general anesthesia revealed that the urinary bladder was intact. After recovery, the stallion developed clinical and biochemical signs of bladder rupture, which was confirmed by endoscopy. Cystoplasty in adult stallions represents a unique surgical dilemma; the large distance between the incision site and the bladder necessitates the repair be accomplished under maximum tension with minimal exposure. Because traditional surgical approaches through ventral midline or paramedian incisions provide limited access and viewing, laparoscopy was used to provide a definitive diagnosis, good viewing, easy access, tension-free dissection, and a secure repair. Lack of surgical complications and postoperative discomfort, rapid and uncomplicated healing, and patient-client satisfaction make laparoscopic cystoplasty the preferred method for surgical repair of ruptured urinary bladder in adult stallions.     

Standing laparoscopic repair of a ruptured urinary bladder in a mature draught horse

Rupture of the urinary bladder, although relatively common in foals, is an infrequent occurrence in adult stallions. Standing laparoscopic repair of a ruptured urinary bladder offers significant advantages over other treatment options, and to date, there are no reports describing this technique in treating adult stallions. This case study details the treatment of a mature draught horse for uroperitoneum secondary to a ruptured urinary bladder. Standing laparoscopic repair of the ruptured bladder was performed. No major post operative complications developed, and the horse has not had any recurrence of problems with the urinary bladder. Successful standing laparoscopic repair in this horse demonstrated the method's viability, which offers superior intraoperative visualisation and access to the bladder, while eliminating the risks of general anaesthesia.     

Surgical reconstruction of a ruptured medial collateral ligament in a foal

An avulsed carpal medial collateral ligament was diagnosed by clinical and radiographic examination in a 1-day-old foal that was unable to bear weight on the affected limb. The foal had a valgus deviation originating at the carpus and medial to lateral instability of the affected carpus. The ligament was reconstructed with screws and suture tape. Surgical reconstruction is a viable alternative to long-term casting or splinting for treatment of a ruptured carpal medial collateral ligament in a foal.     

Nonsurgical removal of a catheter embolus from the heart of a foal

Nonsurgical, percutaneous, transvenous removal of a catheter fragment embolus was performed in a 14-day-old Thoroughbred foal. A basket retrieval catheter was introduced into the jugular vein and manipulated under fluoroscopic guidance to remove the fragment from the right side of the heart. Percutaneous retrieval should be considered as an alternative to thoracotomy for retrieval of intracardiac or intravascular foreign bodies.     

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.     

Inguinal rupture with herniation of the urinary bladder through the scrotal fascia in a Shetland pony foal

Herniation of the urinary bladder in the inguinal region has not previously been described in the horse. A case of inguinal rupture with herniation of the bladder through the scrotal fascia in a 3‐month‐old Shetland pony, diagnosed by external palpation, urinary catheterisation and external ultrasonographic examination is reported. Surgical management of the case was by dissection of the scrotal fascia, partial cystectomy and unilateral castration. During the period of hospitalisation the only complication was a slight seroma, which resolved spontaneously. Follow‐up after 6 months did not reveal any abnormality.     

Medical and surgical management of uroperitoneum in a foal

A 4-day-old, male, American paint foal was presented for abdominal distention, respiratory distress, and diarrhea. Bladder rupture and uroperitoneum were diagnosed following abdominal ultrasonography and abdominocentesis. The defect in the dorsocranial part of the bladder wall was surgically repaired.     

Surgical management of Rhodococcus equi metaphysitis in a foal

A chronic Rhodococcus equi metaphysitis involving the distal growth plate of the left third metatarsal bone had induced a longstanding lameness in a young foal. Abnormal hematologic values included mild anemia, hyperfibrinogemia, mild leukocytosis, and neutrophilia. Radiography of the distal portion of MT3 revealed a radiolucent zone on the medial aspect of the growth plate, and small pieces of bone suggestive of sequestra. Treatment with erythromycin estolate and rifampin, aggressive surgical debridement, and cancellous bone grafting helped resolve the bone infection.     

Suspected relative adrenal insufficiency in a critically ill cat

Objective: To describe a case of likely relative adrenal insufficiency (RAI) in a cat with critical illness. Case summary: A cat recovering from polytrauma developed hypotension unresponsive to intravenous fluid support and vasopressor therapy. An adrenocorticotropin hormone stimulation test documented insufficient adrenal function. Treatment with exogenous low‐dose glucocorticoids in addition to standard therapies resulted in rapid hemodynamic and clinical improvement. The cat ultimately recovered and was weaned from supplemental glucocorticoids. New or unique information provided: This is the first report of changes consistent with acquired RAI in a cat with critical illness.     

Laparoscopic repair of a ruptured bladder in an adult mare

A bladder rupture suffered by an adult mare during parturition was repaired, using a laparoscopic approach with the mare in dorsal recumbency. During the laparoscopic approach, the bladder was empty, inverted and had a rent on the dorsal apical surface. The bladder was located far caudally within the pelvis. By grasping the left lateral ligament and exerting gentle traction, it proved possible to manoeuvre the bladder more cranially where the rupture could be sutured. The benefits of the laparoscopic approach are reduction in incision size, visualisation of the tear, reachability of the empty bladder and the tear, and reduced reconvalescence time.