Anaerobic peritonitis caused by Clostridium septicum as a complication of routine castration in a 2‐year‐old Warmblood horse

This case report describes an unusual case of anaerobic peritonitis in a 2‐year‐old horse following castration. The horse was evaluated 2 weeks following castration for signs of acute, severe abdominal pain and swelling surrounding a previous castration site. Physical examination revealed marked scrotal and ventral abdominal oedema that was cool and crepitant upon palpation. Ultrasonographic evaluation was unrewarding because gas shadowing distributed throughout the subcutis prevented imaging of the abdominal cavity. Ventral midline celiotomy revealed a copious amount of malodorous, serosangious, cloudy peritoneal fluid that was submitted for culture. Abdominal exploration revealed the gastrointestinal tract to be in its anatomically correct position. There was diffuse petechiation of the small intestine and large intestine, oedema and crepitant swelling surrounding the left inguinal ring and body wall. The abdomen was lavaged with 10 l of sterile saline prior to closure of the celiotomy and the left castration incision was opened digitally, releasing a large volume of serosanguinous fluid and gas that flowed freely from the incision site and deeper inguinal tissues. The horse was placed in the recovery box where it suffered cardiac arrest. Culture of the peritoneal fluid revealed heavy growth of Clostridium septicum. This case of anaerobic peritonitis represents an unusual complication following castration not previously reported in the horse.     

Review of 30 cases of peritonitis in the horse

Thirty cases of peritonitis, in which the diagnosis was based on a peritoneal fluid white blood cell count in excess of 10 x 10(9)/litre, are described. Colic, ileus, pyrexia, weight loss and diarrhoea were common presenting signs. Treatments included intravenous fluids, anti-inflammatory analgesics, broad spectrum antibiotics and anthelmintics. Duration of treatment was determined by the clinical condition of the horse and sequential analyses of the peritoneal fluid and the haemogram. In the majority of cases the primary cause of peritonitis was not accurately determined, but 21 horses (70 per cent) recovered. All the horses with diarrhoea were killed after marked deterioration in their clinical condition despite intensive treatment. No individual laboratory parameter was of value in determining prognosis, although of the eight (27 per cent) horses from which bacteria were identified in the initial peritoneal fluid by Gram stain, four (50 per cent) were subsequently killed.     

Idiopathic perforating ulceration of the small intestine in five adult horses

Perforating ulceration of the small intestine was diagnosed in 5 adult horses. Affected horses presented with signs of low‐grade colic, depression and inappetance. Abdominal paracentesis yielded abnormal peritoneal fluid in all cases. Perforating ulcers were located at the mesenteric border in 4 horses and the ileum in one horse. All horses had diffuse septic peritonitis. The aetiology of the condition is unknown.     

Effects of blood contamination on equine peritoneal fluid analysis.

Peritoneal fluid and blood was collected from 8 healthy adult horses. Four 1-ml aliquots of peritoneal fluid from each horse were then contaminated with 0 ml (normal), 0.05 ml (1 drop), 0.10 ml (2 drops), and 0.20 ml (4 drops) of blood from the same horse. Samples were analyzed for RBC count, nucleated blood cell count, total protein concentration, and nucleated cell differential count. Statistical analysis revealed no significant changes in nucleated cell number, nucleated cell differential, or total protein concentration in peritoneal samples contaminated with blood. The RBC count significantly increased with blood contamination. It was concluded that up to 17% blood contamination of peritoneal fluid in clinically normal horses did not significantly alter interpretation of the nucleated cell count or protein concentration.     

Septic cholangitis and peritonitis in a gelding.

An 8-year-old Arabian gelding with septic cholangitis and peritonitis was successfully treated with trimethoprim/sulfadiazine. The gelding was referred for evaluation of signs of abdominal pain, icterus, fever, and weight loss. Peritoneal fluid analysis revealed septic and suppurative peritonitis. Culture of the peritoneal fluid yielded Escherichia coli and Klebsiella pneumoniae, which were sensitive to trimethoprim/sulfadiazine. On the basis of results of hepatic ultrasonography, a diagnosis of septic cholangitis also was made. The horse was treated with 30 mg of trimethoprim/sulfadiazine/kg, PO, q 12 h for approximately 6 weeks. The horse improved steadily, and telephone follow-up with the owner 1 year later disclosed that the horse had complete return to normal condition, appetite, and attitude. On the basis of our findings, aggressive, long-term anti-inflammatory and antibiotic treatment may result in complete return to health and normal athletic function in horses with septic cholangitis and concurrent septic peritonitis.     

Bicavitary effusion in a horse with multicentric lymphoma

A 14-year-old Quarter Horse gelding presented for a 2-week history of increased respiratory rate, fever and weight loss. The referring veterinarian performed an ultrasonographic examination on the farm and considered a differential diagnosis of pleuritis and pleuropneumonia. On presentation, transtracheal wash showed suppurative septic inflammation with bacteria within macrophages. Thoracic ultrasonography showed increased hypoechoic fluid in the pleural and peritoneal cavities. Cytologic analysis of pleural and peritoneal fluids revealed lymphorrhagic effusion with atypical lymphocytes, suggestive of a lymphatic flow obstruction or lymphoma. Treatment consisted of drainage of the pleural fluid, anti-inflammatory agents, fluid therapy and antimicrobial therapy. Continued fluid accumulation in the thoracic cavity, tachypnoea, lack of response to pain medication and progressive lethargy resulted in the horse being subjected to euthanasia. At necropsy, bicavitary effusion was confirmed and histopathological diagnosis of multicentric lymphoma was made. Horses presenting with pleural effusion should also be evaluated for peritoneal effusion, as bicavitary effusion may indicate noninflammatory conditions such as neoplasia.     

Differentiation between intra-abdominal neoplasms and abscesses in horses, using clinical and laboratory data: 40 cases (1973-1988)

The medical records of 25 horses with intra-abdominal neoplasms and 15 horses with intra-abdominal abscesses were reviewed. Common clinical signs of disease observed by owners of horses in both groups included anorexia, weight loss, fever, signs of colic, and depression. Clinical laboratory abnormalities included leukocytosis, hyperfibrinogenemia, hypoalbuminemia, and hypocalcemia. There was considerable overlap of laboratory test results within and between the 2 groups of horses. Peritoneal fluid was classified as an exudate in 12 of 15 horses with intra-abdominal abscesses and in 14 of 25 horses with intra-abdominal neoplasms. Cytologic examination of peritoneal fluid yielded an accurate diagnosis in 11 of 25 horses with neoplasia and in 3 of 15 horses with abscesses. A mean number of 1.45 cytologic analyses/horse was needed to diagnose neoplasms in the 11 horses in which the analysis was successful in definitively diagnosing the condition.     

Effects of Castration on Peritoneal Fluid in the Horse

Twenty-four clinically normal horses were castrated by routine methods. Peritoneal fluid was collected prior to castration and at 1, 3, 5, and 7 days postcastration. Peritoneal fluid was collected on days 9 and 11 if nucleated cell (NC) counts were still markedly elevated on day 7. Peritonitis, defined as NC counts greater than 10,000/microliters, was evident in 15 horses following castration. Mean NC counts peaked on day 5 but were less than 10,000/microliters for 74% of the horses by day 7, and 90% of the horses by day 9. One horse had a NC count greater than 60,000/microliters on day 11 when sampling ended. Postcastration peritoneal fluid was obviously blood-tinged in 21 horses. Peak RBC counts occurred on day 3 but markedly decreased by day 5. Elevated peritoneal RBC counts correlated well with elevated NC counts (P less than 0.001). Horses with peritonitis tended to have fever (P less than 0.05). Other clinical signs of peritonitis were not apparent.     

Septic peritonitis in a Percheron mare associated with Clostridium haemolyticum

This report describes an 11‐year‐old Percheron mare that presented with signs of colic and was ultimately diagnosed with bacterial peritonitis of unknown origin. Bacterial culture of a peritoneal fluid sample isolated 2 Clostridial species, one of which was strongly suspected to be Clostridium haemolyticum. The horse was markedly hypoalbuminaemic at presentation, leading to the development of low oncotic pressure and ventral oedema. The mare was administered a low molecular weight/low molar substitution hydroxyethyl starch solution in conjunction with other therapies that resulted in marked improvement of clinical signs. The purpose of this report is to describe the clinical findings associated with equine peritonitis associated with C. haemolyticum, a rarely identified pathogen in the horse. Secondly, this report serves to describe the beneficial effects of tetrastarch administration in a clinical case with severe hypoalbuminaemia and ventral oedema.     

Surgical Treatment of an Abdominal Abscess Caused by a Migrating Iron Wire From the Ventral Colon,a Case Report

A 13-year-old mare presented for evaluation of recurrent colic episodes. The horse was diagnosed with a mass within the spleen at the ultrasound examination of the abdomen; the levels of Serum Amyloid A and the fibrinogen were high and so a presumptive diagnosis of an abscess involving the spleen was made base on clinical, ultrasonographic and laboratory findings and it was decided to perform n exploratory laparotomy for a definitive diagnosis and possible treatment. Upon abdominal exploration a mass involving the spleen, the lateral wall of the ventral colon adherent to the left abdominal wall was diagnosed and with an intraoperative ultrasound examination a linear hyperechoic foreign body was diagnosed within the mass. It was removed through an enterotomy of the left ventral colon that allowed the digital exploration of the mass without spilling of pus within the peritoneal cavity. The horse was discharged and the long term follow-up revealed no complications and no more signs of abdominal pain.     

Hematuria and weight loss in a mare with pancreatic adenocarcinoma.

This clinical report describes an 11-yr-old Thoroughbred mare that presented with clinical signs of weight loss and hematuria. History and clinical findings suggested the mare had neoplasia of the urogenital system. Although ultrasound-guided biopsy of the perirenal mass did not yield abnormal cells, large irregular cells were isolated from the thoracic and peritoneal fluid. At necropsy, multiple firm nodules were disseminated throughout the peritoneal cavity. Histological examination of the nodules revealed cells that were consistent with a pancreatic exocrine adenocarcinoma. This is the first report of pancreatic adenocarcinoma causing dysfunction of the urogenital system.     

Ascites and the anatomy of the peritoneal sacs of broilers

Although the ascites syndrome of broilers is well documented, all the authors fail to describe exactly in which of the various coelomic cavities ascitic fluid is found. Determination of the precise location of this fluid is essential if the pathogenesis of the syndrome is to be understood and explained. Post-mortem examinations were done on 100 broilers that had ascites or had died of the ascites syndrome. In all of them large quantities of fluid were found in the ventral hepatic peritoneal cavities, moderate amounts in the right dorsal hepatic peritoneal cavities and small amounts in the intestinal peritoneal and pericardial cavities. No ascitic fluid was found in the left dorsal hepatic peritoneal cavity. The amount of ascitic fluid effusing from the liver was directly proportional to the surface area of the liver in a given peritoneal cavity.     

Simulated small intestinal volvulus in the anesthetized horse

Experimental closed loop small intestinal volvulus was studied in the anesthetized horse. Volvulus was simulated by ligation of the mesenterial veins to a segment of small intestine. Physical signs and hemodynamic, hematologic, clinical chemical, bacteriologic and peritoneal fluid values were examined. Compared to conscious horses anesthesia highly delayed and modified the clinical signs of shock (changes in mucosal colour, dehydration, decreased skin temperature, elevated pulse rate, low blood pressures) and of small intestinal volvulus (altered peristalsis, gastric dilation). Plasma glucose response to shock was also modified by unconsciousness. However, a dose response relationship was indicated between the extent of small intestinal damage and clinical symptoms. The same was applicable to changes in blood pressures, blood acid-base balance, lactate, potassium, chloride, glucose, inorganic phosphorus, creatinine, creatine kinase, red blood cell and total white blood cell counts and serum total protein. The relationship was also indicated in the following peritoneal fluid values: volume, lactate, pH, total white cell counts, alkaline phosphatase and bacteriology. Changes related to shock (insufficient tissue perfusion) were low blood pressures and metabolic acidosis due to anaerobic glycolysis with accumulation of lactic acid. Also low plasma glucose and elevated plasma potassium, creatinine, inorganic phosphorus and creatine kinase were regarded as consequences of shock.     

What is your diagnosis? Peritoneal fluid from an Arabian horse after colic surgery

A 16-year-old castrated male Arabian horse was presented to the Purdue University Veterinary Teaching Hospital with a 4-hour history of colic. Initial examinations provided strong evidence for small intestinal obstruction. Abdominal surgery revealed a strangulating lipoma, and 25 feet of small intestine were resected. Postoperatively, the horse developed obstructive ileus due to adhesion formation, which required a second laparotomy. During and after surgery, the abdomen was lavaged with sodium carboxymethylcellulose (CMC). One week after the second surgery, evaluation of peritoneal fluid revealed an inflammatory exudate, with many macrophages containing amorphous to granular, pink to magenta phagocytosed material. Extracellular aggregates of the material were also observed. The material was consistent with CMC. To our knowledge, this report is the first to demonstrate the phagocytosis of CMC by peritoneal fluid macrophages.     

Medial pterygoid myositis in a Thoroughbred gelding

This case report describes the investigation and treatment of an adult horse with purulent, malodorous exudate originating from a large intermandibular mass. Microbial culture of fluid aspirated from a draining tract yielded Peptostreptococcus and Prevotella species which are usually considered to originate from the oral cavity. Computed tomography (CT) was used to aid in the diagnosis and to allow careful presurgical planning, and the horse underwent successful debridement of the abscess cavity under general anaesthesia. Post-operatively, the horse developed trismus (reduced opening of the jaws) but repeat CT identified that the surgery site was healing appropriately. It was recommended to continue feeding the horse hay to act as physiotherapy and the masticatory action of the horse subsequently returned to normal.     

Ascites in a 13‐year‐old miniature horse mare with an ovarian granulosa theca‐cell tumour: A manifestation of Meigs' syndrome?

A 13‐year‐old miniature horse mare presented for evaluation of ascites. Abdominal ultrasound showed severe free peritoneal fluid accumulation as well as a caudal abdominal mass. The peritoneal fluid was characterised as a transudate with no evidence of sepsis. Surgical exploration of the abdomen was performed; copious free peritoneal fluid and a large right ovarian mass were discovered. The abnormal ovary was removed, and the mass was determined histologically to be a benign granulosa theca‐cell tumour. Although there was mild peritoneal fluid accumulation in the immediate post operative period, the ascites effectively resolved with removal of the tumour, and the mare returned to a normal lifestyle. This is similar to reports of Meigs' syndrome in human women, in which a benign ovarian mass of significant size causes ascites that resolves once the mass is removed.     

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.     

Gastric squamous cell carcinoma in three horses

Gastric squamous cell carcinoma was diagnosed in three horses. Clinical signs observed in all cases were weight loss, anorexia and lethargy. Respiratory signs were prominent in one case. All three horses had depressed albumin and elevated globulin and fibrinogen concentrations. Two horses were mildly anaemic. Inflammatory exudates were present in peritoneal cavities in all cases, and cytological evaluation provided a positive diagnosis of squamous cell carcinoma in two cases. Pleural fluid samples taken from two cases were also classified as inflammatory exudates, but no neoplastic cells were detected on initial examination. In all cases the neoplasms had arisen from the oesophageal region of the stomach, and had metastised throughout the abdomen. Two cases had metastatic lesions within the pleural cavity.     

Peritoneal fluid values from healthy foals

Peritoneal fluid was analysed from 17 foals, aged 13 to 134 days with a mean age of 68 days. Cytologically, the peritoneal fluid was characterised by a mean total cell count of 0.45 x 10(9)/litre (range 0.06 to 1.42 x 10(9)/litre), rare eosinophils, rare cytophagia and variable percentages of neutrophils and mononuclear cells. These data indicate that peritoneal fluid nucleated cell counts over 1.50 x 10(9)/litre in the foal should be interpreted as elevated. Biochemical evaluation revealed a mean biuret protein level of 12 g/litre, mean refractive index protein level of 16 g/litre and urea nitrogen concentration of 1.96 mmol/litre. There was no correlation between the foals' white blood cell and peritoneal fluid nucleated cell counts. Results of this study indicate that adult horse reference values for evaluation of peritoneal fluid are of questionable validity for foals. Diagnostically, the most important observation was that maximum peritoneal fluid nucleated cell counts in healthy foals were much lower than reported maximal reference values for adult horses (1.5 x 10(9)/litre versus 5.0 x 10(9)/litre or 10.0 x 10(9)/litre).     

Eumycotic mycetoma caused by Pseudallescheria boydii in the abdominal cavity of a dog

An abdominal eumycotic mycetoma with multiorgan dissemination was diagnosed in a 2-year-old dog. Clinical signs included fever, vomiting, diarrhea, weight loss, and a palpable abdominal mass. The dog developed disseminated intravascular coagulation and died. Pseudallescheria boydii was isolated from the abdominal mass, liver, and peritoneal fluid. Relevant history included an ovariohysterectomy when the dog was 6 months old, which was complicated by dehiscence of the incision site and evisceration. It appears that P boydii has a propensity for establishing itself in the abdominal cavity of the dog, subsequent to surgical dehiscence.