Tracheal perforation secondary to suture irritation in a dog following a ventral slot procedure

An eight-year-old springer spaniel was presented with acute-onset subcutaneous emphysema of five days' duration. The dog had undergone ventral slot decompression of the C5-C6 intervertebral disc space eight weeks before presentation. Cervical tracheoscopy demonstrated perforation of the dorsal tracheal membrane of the distal cervical trachea. Perforation of the dorsal tracheal membrane secondary to suture knot irritation was confirmed by exploratory surgery. Repair of the perforation was performed by plication of the dorsal tracheal membrane. The dog was re-presented nine days after the initial surgery with acute recurrence of subcutaneous emphysema. Air leakage at the plicated dorsal tracheal membrane was observed at exploratory surgery, and a bipedicle sternothyroideus muscle flap was used to support the plicated membrane. Recovery was uneventful and 10 months postoperatively there had been no recurrence of clinical signs.     

Management of apposing,full‐thickness tracheal perforations in two horses

Two horses, one 15‐year‐old Arabian gelding and one 10‐year‐old Quarter Horse gelding, presented with a history of marked subcutaneous emphysema. The first case exhibited no external wound, although there was a depression noted on the ventral neck. The second case had a laceration on the ventral aspect of the neck over the trachea. Endoscopic examination revealed both horses to have concurrent dorsal and ventral perforations of the trachea. The horses were managed by placing a short, cuffed, J‐shaped tracheostomy tube in the ventral perforation, while the dorsal perforation healed. The dorsal perforation in the first horse was allowed to heal by second intention, whereas sutures were placed in the dorsal perforation in the second case to reduce the healing time. Both horses were maintained on oral antimicrobial and nonsteroidal anti‐inflammatory medications throughout treatment. The dorsal perforation healed after 13 days in the first horse, and 22 days in the second horse. The ventral perforation healed in both horses by second intention following tracheostomy removal, giving a cosmetically acceptable result. In addition to facilitating tracheal healing, the tracheostomy tubes prevented the progression of subcutaneous emphysema, and promoted its resolution.     

Caecal impactions: Diagnosis,management and prognosis

A caecal impaction can be caused by an accumulation of dry ingesta (type I) or abnormal caecal motility resulting in a feed impaction of fluid consistency (type II). Horses that develop a caecal impaction have often been administered a nonsteroidal anti-inflammatory drug (NSAID) during hospitalisation for treatment of a painful condition such as an ocular or orthopaedic disease. Clinical signs of caecal impaction can be mild, and progress to more moderate to severe signs of abdominal pain as the impaction enlarges. Since an impacted caecum has a high risk of rupture, early diagnosis and treatment are important. Horses with a caecal impaction can be treated medically or surgically, and treatment decisions are based on clinical signs, results of transrectal palpation, character of peritoneal fluid and response to medical management. For type I caecal impaction, medical management consists of aggressive fluid therapy, both intravenous and enteral, to soften ingesta. Fluid therapy can be combined with laxatives, motility-enhancing drugs and analgesic drugs. Surgery is indicated if results of transrectal abdominal examination indicate that the impaction is unchanged or has enlarged, signs of abdominal pain increase, or if there is cardiovascular deterioration. Horses with type II caecal impaction have a greater chance of survival if managed surgically. Using a ventral mid-line celiotomy approach, a caecal impaction can be resolved via a typhlotomy. When caecal motility is poor, or there are signs of chronic caecal dysfunction, a caecal bypass procedure (jejunocolostomy or ileocolostomy) should be considered. Although the prognosis for horses with a caecal impaction is claimed to be fair to good, choice of treatment is controversial and may influence prognosis. If the affected horse survives to discharge from the hospital, the long-term prognosis is generally good. Many retrospective studies of cases of caecal impaction are weakened by failure to distinguish between types I and II.     

Tracheal perforation managed by temporary tracheostomy in a horse

Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.     

Relationships between electromyographic ileal and colonic motility patterns in cats during fasting and feeding.

The relationship between ileal and colonic electromyographic motility patterns were investigated in six awake cats chronically fitted with subserosal electrodes implanted in the smooth muscles of the ileum and colon. Smooth muscle electrical activity (electromyogram) was recorded in both fed and fasted conditions under a 12-12 hours dark-light schedule. It consisted of electrical long spike bursts having two different patterns for each condition. Short sequences of three to five long spike bursts were propagated either aborally or orally from any part of the colon; they were most frequent during the interdigestive or fasting period and no relationship was observed between these long spike bursts and the electrical activity of the ileum. During the digestive or feeding period, the colonic activity was organized in long sequences of 10-15 long spike bursts, termed migrating spike bursts, which started near the caecal junction and propagated aborally to the distal colon. These migrating spike bursts were correlated with the ileal motility. This relationship demonstrated between ileum and colon after feeding is dependent upon the amount of food intake.     

Computed tomographic findings in a Bluetick Coonhound with a longitudinal thoracic tracheal tear

A 9‐year‐old intact male Bluetick Coonhound presented for progressive subcutaneous emphysema of 5 days’ duration due to a suspected tracheal tear. Cervical computed tomography (CT) and thoracic CT were performed after failure to identify the tracheal tear with tracheoscopy. A longitudinal tracheal tear was identified starting 4.3 cm cranial to the tracheal bifurcation and extending caudally over a distance of 3.6 cm. Severe pneumomediastinum, subcutaneous emphysema, and retroperitoneal gas were also present. A follow‐up CT 7 days postoperatively confirmed the successful repair of the tear with partial resolution of the presurgical secondary pathology and the patient recovered uneventfully.     

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.     

Avulsion of the left renal artery following blunt abdominal trauma in a dog

A two-year-old, male, crossbreed dog was presented three days after being involved in a motor vehicle accident. Survey radiographs showed multiple pelvic fractures and poor intraperitoneal and retroperitoneal contrast. Ultrasound indicated the left kidney to be hypoperfused, and a thrombus was visible at the origin of the left renal artery. Ultrasound-guided fine needle aspiration confirmed that free fluid visible in the retroperitoneal and peritoneal spaces was blood. No improvement was seen in the renal perfusion over a 43 hour period, and the intestinal hypomotility worsened over this time. The haemoperitoneum and the haemoretroperitoneum both resolved ultrasonographically within this 43 hour period. Surgery confirmed an avulsion of the left renal artery approximately 10 mm from its origin on the aorta and an avulsion of the left ureter at the ureteropelvic junction. An ureteronephrectomy was performed on the left kidney and the dog recovered uneventfully.     

Subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum after gastrostomy tube placement in a cat

A 17-year-old spayed female domestic shorthair cat developed subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum during endoscopic placement of a gastrostomy feeding tube after gastric insufflation and cannula insertion. The cat underwent exploratory laparotomy to investigate the possibility of gastric rupture but only a 2- to 3-mm defect was found in the gastric fundus at the site of cannula insertion. Pasteurella multocida and Enterobacter spp were cultured aerobically from the peritoneal cavity. The cat recovered without complications.     

Use of positive contrast rhinography and intranasal sinography for diagnosis of a nasofacial sinus tract in a dog

Twelve days after a dog fight, a 2-year-old sexually intact female Bulldog was evaluated because of subcutaneous emphysema of increasing severity throughout the dogs body. Thoracic radiography revealed severe pneumomediastinum from which free air had extended into the retroperitoneal space, resulting in pneumoperitoneum. Tracheoscopic examination did not reveal a discontinuity of the trachea, pharynx, or larynx. A breach between the nasal cavity and subcutaneous tissues of the nasal region was suspected. Further diagnostic investigations included positive contrast rhinography and intranasal sinography. Via an angiographic catheter inserted into the left naris, positive contrast intranasal sinography revealed a sinus tract extending between the left nasal cavity and the subcutaneous tissue of the dorsal aspect of the nasal planum. Resolution of subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum began 1 day after surgical closure of the intranasal opening of the sinus tract. To the authors' knowledge, this radiographic technique has not been reported.     

Successful surgical management of a perforating oesophageal foreign body in a cat

CASE PRESENTATION AND SURGICAL INTERVENTION: a 3-year-old cat was presented with a recent history of dysphagia and intermittent regurgitation. Radiography revealed a bony oesophageal foreign body at the level of the thoracic inlet. Endoscopic retrieval was attempted but resulted in severe dyspnoea due to the development of pneumomediastinum, pneumothorax and subcutaneous emphysema secondary to perforation of the oesophageal wall. Immediate surgical exploration was carried out. Extensive necrosis of the oesophagus resulting from the presence of the foreign body led to a decision to perform an oesophageal resection and anastomosis. CLINICAL RELEVANCE: this is the first clinical report of a cat treated successfully by oesophagectomy following oesophageal perforation due to an obstructive foreign body. The authors suggest that prompt surgical intervention, the ability to convert to a surgical procedure under the same anaesthetic as a non-surgical retrieval, placement of a gastrostomy tube and the availability of advanced anaesthetic and critical care support are important factors to consider when managing feline patients with a perforating oesophageal foreign body.     

Outcome and long‐term follow‐up of 20 horses undergoing surgery for caecal impaction: A retrospective study (2000–2008)

Reasons for performing study: If untreated, caecal impaction may progress to rupture of the caecum and reports of long‐term outcome for horses undergoing surgery for caecal impaction are required. Objectives: To describe short‐ and long‐term complication rates for horses undergoing surgery for caecal impaction in an otherwise life‐threatening gastrointestinal condition. Methods: Case records were reviewed for horses undergoing surgery for caecal impaction. Horses were included in the study if an abnormally large, fluid‐distended or feed‐impacted caecum was the primary diagnosis at surgery and excluded if the caecum had already ruptured upon opening the abdomen, necessitating euthanasia. Short‐term follow‐up data were obtained from clinical records; and included complications, repeat celiotomy and survival to discharge. Long‐term survival was defined as survival for >1 year post operatively. Long‐term follow‐up data were obtained through telephone interviews with owners and referring veterinary surgeons. Survival, occurrence of post operative colic and subsequent use of the horse were recorded. Results: Twenty horses underwent surgery for caecal impaction: 16 horses underwent caecal bypass (typhlotomy and removal of caecal contents, ileal transection followed by ileocolostomy); 3 underwent typhlotomy alone; and one horse underwent typhlotomy followed by a second procedure where caecal bypass was performed. Five horses (25%) were admitted for colic evaluation with primary caecal impactions, in 10/20 (50%) of cases the impaction was secondary to previous orthopaedic surgery and in 5/20 (25%) caecal impaction was identified at repeat celiotomy following a previous colic surgery. Sixty‐five percent (13/20) of horses survived to discharge; 11/13 (85%) of horses discharged survived long term; 100% (3/3) horses that received typhlotomy alone were discharged and survived long term. Conclusions: The prognosis following caecal impaction surgery is fair, if the horse survives to discharge then prognosis for long‐term survival is good. Potential relevance: Surgery for caecal impaction carries a fair prognosis for a potentially life threatening disease, in particular where caecal dysfunction is suspected.     

Impact of the Salmonella status of market-age pigs and the pre-slaughter process on Salmonella caecal contamination at slaughter

The aim of this study was to evaluate the impact of the pre-slaughter process on Salmonella caecal contamination of pigs at slaughter. An observational study was carried out in 2001 on 101 conventional farrow-to-finish pig farms. On each farm, one batch of contemporary pigs was followed from the end of the fattening period until slaughter. The Salmonella bacteriological status of the batches was assessed by environmental samples of faecal material. The serological Salmonella status was obtained on 30 individually identified market-age pigs using an indirect ELISA test. At the slaughterhouse, 25 g of caecal contents were taken from 10 of the identified pigs. Faecal and caecal material were analysed according to a classical bacteriological method. A questionnaire was designed to obtain information about the type of feeding during the fattening period (dry versus wet), the duration of fasting on the farm before leaving for the slaughterhouse, the duration of transport between the farm and the slaughterhouse, the holding time in lairage at the slaughterhouse and loading and unloading conditions on the farm and at the slaughterhouse. To assess the relationships between these factors and the Salmonella caecal status of the pigs and the batches, two logistic models were fitted at the individual and at the batch level, respectively. The first analysis was performed using a random effects logistic regression model. The second analysis was based on a cumulative logit model with a positive caecal rate classified into three classes as the outcome variable. The results showed that the Salmonella status of market-age pigs assessed on the farm either by serological or bacteriological examinations and the time spent in lairage before slaughtering played a crucial role on caecal contamination. In the light of these results, actions should be considered both on the farm and at the slaughterhouse to decrease the risk of Salmonella contamination of the caecal contents.     

ULTRASONOGRAPHIC FINDINGS IN DOGS AND CATS WITH GASTROINTESTINAL PERFORATION

A retrospective study was performed to evaluate the sonographic features of gastrointestinal (GI) perforation in dogs and cats. Sonographic findings in 19 animals (14 dogs and 5 cats) included regional bright mesenteric fat (19), peritoneal effusion (16), fluid-filled stomach or intestines (12), GI wall thickening (11), presence of free air (9), loss of GI wall layering (9), regional lymphadenopathy (8), reduced GI motility (7), pancreatic changes (4), corrugated intestines (4), presence of a mass (3), presence of a foreign body (3), and mineralization of the gastric wall (1). In 14 patients, "perforation" was listed as a differential diagnosis by the sonographer. Abdominal radiographs and radiographic reports were available for 14 patients. Radiographic findings were decreased serosal detail (12), free air (8), peritoneal contrast medium (1), and suspected foreign body (1). GI perforation was listed as radiographic diagnosis in eight patients, seven of which had evidence of pneumoperitoneum, and one had leakage of contrast material on an upper GI study. In 9/14 patients with radiography, "GI perforation" was listed as a sonographic diagnosis. In three patients in which free air was diagnosed sonographically, radiographs were either not available (2) or the presence of free air was not detected at presentation (1). Peritoneal fluid analysis was performed in nine patients, five of which were identified as septic inflammation, and the remaining four were classified as neutrophilic inflammation with no etiologic agent identified. The histologic or surgical diagnoses were as follows: three intestinal surgical dehiscence; one percutaneous endoscopic gastrostomy tube site leakage; one duodenal adenocarcinoma; one ileocolic lymphoma; one trichobezoar; one ascarid impaction; and one bobby pin foreign body. In the remaining 10 patients, a focal area of gastric/intestinal ulceration or transmural necrosis with perforation was identified without evidence of an underlying cause.     

Coccidial infection with Eimeria tenella and caecal defaecation in chicks.

1. The periodicity of caecal defaecation was investigated in chicks infected with Eimeria tenella. The birds were illuminated for 12 h/d (07.00-19.00) and faeces were collected at 3-h intervals for up to 21 d. 2. In uninfected birds caecal faeces were never collected during the dark period. During the periods 07.00-10.00 h, 10.00-13.00 h, 13.00-16.00 h and 16.00-19.00 h, caecal defaecation occurred on approximately 44, 19, 55 and 91% of the total number of days respectively. 3. In infected birds production of haemorrhagic caecal faeces began from between 90 and 156 h after infection and continued during both light and dark periods for between 12 and 48 h. After this period, no caecal faeces were observed for between 39 and 120 h. Normal caecal defaecation resumed from between 198 and 264 h.     

Plasma disposition of amikacin and interactions with gastrointestinal microflora in Equidae following intravenous and oral administration

Amikacin was detectable (> 0.02 μg/ml) in plasma for 12 h in horses and donkeys and for 8 h in ponies following intravenous (i.v.) administration at a dose the rate of 6 mg/kg bodyweight The elimination half-life (harmonic mean) of amikacin was 2.8, 1.6 and 1.9 h in horses, ponies and donkeys, respectively, and the mean body clearance was relatively slow (45.2, 82.4 and 58.0 ml/h.kg, respectively). A suitable dosage interval for the i.v. administration of amikacin sulphate to horses, ponies and donkeys, at a dose rate of 6 mg/kg, would be every 8 h in horses, and every 6 h in ponies and donkeys. Following i.v. administration there were no marked alterations in caecal liquor pH, the number of viable bacteria isolated, or the short chain fatty acid (SCFA) concentrations in caecal liquor and faeces. Amikacin was not detected (< 0.02 μg/ml) in plasma following administration by nasogastric tube to ponies with cannu-lated caecal fistulae; however, there were high concentrations of amikacin measured in caecal liquor (maximum 16.2–99.4 μg/ml). Despite the high drug concentrations in caecal liquor, there were only slight alterations in the number of viable bacteria isolated. However, there was a reduction in caecal liquor pH to < 6.6, but few changes in caecal liquor SCFA concentrations. Faecal SCFA concentrations, dry matter content and consistency did not alter markedly.     

Spontaneous gastroduodenal perforation in 16 dogs and seven cats (1982-1999)

The records of 23 dogs and cats diagnosed with spontaneous gastroduodenal perforation (GDP) were retrospectively reviewed. Survival was 63% in dogs and 14% in cats. Rottweilers <5 years of age were overrepresented. Clinical evidence of gastrointestinal bleeding was common in dogs but not in cats. Shock was an uncommon presenting condition in dogs and was not closely linked to outcome. In fact, progression of an ulcerating lesion to GDP was not associated with marked changes in symptoms exhibited by many patients in this study. Most GDPs were associated with histopathological evidence of subacute or chronic peritoneal reaction at the time of diagnosis. This suggests that diagnostic methods employed lacked sensitivity in identifying early perforating lesions, and that dramatic signs of acute abdomen following gastroduodenal perforation may not be as common as was previously thought.     

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.     

Caecal disease in equids

Objective To review the breed, age, gender, clinical and laboratory findings, treatment and outcome of horses with caecal disease presented to a referral centre. Design Retrospective study of 96 cases. Procedure The breed, age, and gender of the study population were compared with the corresponding hospital population for the same period. The means (± SD) for clinical and laboratory findings were recorded for each caecal disorder. Treatment was categorised as medical or surgical, and outcome was recorded. Results Caecal diseases included impaction (40% of total cases), rupture associated with concurrent unrelated disease (13%), rupture with parturition (9%), rupture with no associated disease (5%), infarction (11%), torsion (9%), abscess or adhesion (7%), tumour (3%), and miscellaneous conditions (3%). The breed or gender of affected horses did not differ from the hospital population, although horses > 15 years were more frequently represented (P < 0.05). This age group was specifically more predisposed to caecal impaction (P < 0.05), as were Arabian, Morgan, and Appaloosa breeds (P < 0.05). In horses with caecal impaction transrectal examination was the most useful diagnostic procedure; 90% of affected horses treated medically were discharged while horses treated by typhlotomy alone, or typhlotomy and blind end ileocolostomy, had survival rates to discharge of 71% and 86%, respectively. Horses with caecal rupture associated with concurrent un-related disease showed no signs of impending rupture; all were receiving phenylbutazone, all were euthanased, and 50% had caecal ulceration at necropsy. Of horses with caecal rupture with parturition 56% had prior dystocia; in two-thirds the site of rupture was the ileocaecal junction and all were euthanased. Horses with caecal rupture with no associated disease died or were euthanased; rupture was idiopathic. Horses with caecal infarction usually had signs of abdominal pain and abdominal fluid changes consistent with peritonitis; transrectal examination was nonspecific, and typhlectomy was successful in seven of eight horses. Horses with caecal torsion had signs of severe, acute abdominal pain and typhlectomy was successful in three of five horses. Diagnosis of caecal adhesion or abscess was assisted by transrectal palpation in two of seven horses and surgical treatment was successful in two of five horses. A caecal tumour was diagnosed in three horses aged 20 years or older that presented with chronic weight loss. Other caecal diseases were uncommon. Conclusion Caecal disease is uncommon in equids but some specific features of the history and physical findings can alert the veterinarian to the possibility of caecal involvement in horses with gastrointestinal dysfunction. Medical or surgical therapy can be effective in horses where caecal rupture has not occurred.     

Age and incubation time effects on in vitro caecal fermentation pattern in rabbits before and after weaning.

The caecal fermentation pattern was studied in four litters of rabbits. Rabbits were sequentially slaughtered at the age of 4 (before weaning), 6, 8 and 11 weeks. Their caecal contents were analyzed and incubated in vitro at 39 degrees C for 6 and 12 h. Net productions of short-chain fatty acids (SCFA), hydrogen and methane were determined. The average caecal weight increased three-times within two weeks after weaning, from 31.4 to 93.7 g. At the end of the experiment, the caecal weight was on average 134.4 g. A large variability of the SCFA concentration observed before weaning decreased after weaning. Measurements of caecal metabolite profiles and results of in vitro experiments indicated a certain decrease of propionate in favour of butyrate, associated with the weaning. The establishment of methanogens in rabbits was slow. Methanogenesis started in one out of four rabbits at the age of 6 weeks. Five weeks later, one of four rabbits still did not produce methane. The hydrogen recovery decreased between the 4th and the 6th week of age, due to the increase of the butyrate/propionate ratio. After the 6th week, the hydrogen recovery increased with age, apparently because of the increase in methane production. Hydrogen recovery tended to increase during incubation, suggesting a decrease of reductive acetogenesis. This increase was observed both in methanogenic and non-methanogenic rabbit caecal cultures. In former cultures, the ratio CH4/SCFA rose with time of incubation.