Surgical management of multi-system trauma in a cat

A cat was presented in coma following severe trauma. The cat was alert and walking within 24 hours, after treatment with intravenous dexamethasone and mannitol. However, he subsequently began to show evidence of severe abdominal pain. An exploratory laparotomy revealed traumatic avulsion of the left limb of the pancreas. A sub-total pancreatectomy was performed and the cat recovered well. Two weeks post-operatively, the cat was re-presented with ataxia, proprioceptive deficits, and upper motor neuron weakness in all four limbs. Radiographs revealed a fracture/luxation of C1–C2 which could not be adequately stabilized solely via a dorsal approach. A combined ventral and dorsal approach produced stabilization of the cervical spine which was clinically successful. Two months post-operatively there was stability but malalignment of C1–C2, and the cat appeared normal.     

Surgical management of an abdominal abscess in a Malayan tapir

A captive Malayan tapir was observed to have inappetence, weight loss, signs of depression, mild dehydration and diar rhoea. Haematological and serum biochemical tests showed anaemia, hypoproteinaemia, hyperfibrinogenaemia and neu-trophilia with a left shift. Ultrasonic examination of the abdomen under anaesthesia revealed a well-encapsulated abscess. The abscess was marsupialised to the ventral body wall. Culture of the pus produced a mixed bacterial growth. Antimicrobial therapy was based on bacterial sensitivity results. Follow-up ultrasonic examinations showed resolution of the abscess. Ninety-one days after surgery the tapir began regurgitating food and water. An abscess originating from the stomach and occluding the lumen of the duodenum was identified at surgery. The abscess ruptured during surgical manipulations and the tapir was euthanased.     

Surgical management of urolithiasis

A review of equine urolithiasis is presented. Special emphasis is placed on clinical diagnosis and management. Although somewhat uncommon, urolithiasis is a potentially serious condition with an apparent predilection for male horses. Although the entire urinary tract is at risk for urolith formation, the bladder and urethra are most commonly affected. The principal signs include stranguria, hematuria, and dysuria. Severe abdominal discomfort is often observed in patients suffering from distal urinary tract obstructions. If urolithiasis is promptly identified, a variety of surgical techniques may be applied to resolve and treat this condition.     

Surgical management of constipation

There are many recognised causes of constipation in the cat and the management of the condition depends on the clinician's ability to recognise the appropriate aetiology in each case. Most surgery therapies for constipation in the cat are related to the management of idiopathic megacolon, although causes such as pelvic outlet obstruction, complications of neutering surgery, perineal herniation, and malunion pelvic fractures may also require surgical intervention. Currently, the surgical management of megacolon consists of subtotal colectomy with the recommendation that the ileocolic junction be preserved. The procedure, in general, is associated with few life-threatening complications although the majority of individuals will experience a transient period of loose stool formation in the immediate post-operative period. In the majority of cases, the long-term outcome following subtotal colectomy is considered excellent.     

Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma

Objective – Evaluate an abdominal fluid scoring (AFS) system using an abdominal focused assessment with sonography for trauma (AFAST) protocol.
Design – Prospective study.
Setting – Private veterinary emergency center.
Animals – One hundred and one client-owned dogs with motor vehicle trauma.
Interventions – AFAST performed on admission and 4 hours post-admission.
Measurements and Main Results – An AFS was assigned to each dog based on the number of AFAST fluid-positive quadrants identified using a 4-point scale: AFS 0 (negative for fluid in all quadrants) to AFS 4 (positive for fluid in all quadrants). Free abdominal fluid was identified in 27 of 101 dogs (27%). Dogs with AFS scores of 3 or 4 (14/27 [52%] AFS-positive dogs) experienced more marked decreases in packed cell volume and total plasma protein, increases in alanine aminotransferase, and needed more blood transfusions than dogs with lower AFS scores and AFS-negative dogs. Serial AFAST was performed in 71% of dogs (71/101); 17% (12/71) of these cases changed AFS score, and 75% (9/12) of the changes were higher (worsened) AFS, correlating with increasing amounts of free abdominal fluid. Ninety-eight percent of the study population was a primary presentation. Overall, median time from trauma to initial AFAST was 60 minutes, and median AFAST examination time was 3 minutes.
Conclusions – Initial and serial AFAST with applied AFS allowed rapid, semiquantitative measure of free abdominal fluid in traumatized patients, was clinically associated with severity of injury, and reliably guided clinical management. Where possible, AFAST and AFS should be applied to the management of blunt trauma cases.     

Surgical management of otitis externa

The surgical management of otitis externa is discussed in conjunction with failed medical management, primary causes, and proper case selection. The techniques of lateral ear canal resection and vertical ear canal ablation are described in detail.     

Surgical management of tetralogy of Fallot

A 3½-month-old female Wirehaired Fox Terrier was referred for diagnosis and treatment of a congenital heart disease. Examination revealed a pan-systolic murmur and cyanotic mucous membranes. A tentative diagnosis of tetralogy of Fallot was confirmed by radiographs, ECG, cardiac catheteriza-tion, and angiograms. End-to-side anastomosis of the left subclavian artery to the pulmonary artery (the palliative Blalock shunt), performed when the patient was 7 months old, provided remission of the clinical signs for 1 ½ years. Physical stress then recurred and the animal died. Post-mortem examination revealed the classic anatomy of tetralogy of Fallot and evidence that the Blalock shunt, which had remained patent for 1½ years, had closed, causing the death of the animal.     

Anesthetic management of the head trauma patient

Objective: To describe the optimal anesthetic management of patients with brain injury, with emphasis on the support of oxygen delivery to the brain, and the effects of anesthetic agents on cerebral perfusion. Data sources: Clinical and experimental studies from both the human and veterinary neuroanesthesia literature. Summary: The management of patients following primary traumatic brain injury (TBI) significantly impacts outcome. Outcome can be improved by strategies that improve oxygen delivery to the brain and prevent cerebral ischemia. Anesthetic agents have widely variable effects on the blood supply to the brain and, therefore, choice of anesthetic agent can influence neurological outcome. Although in the past, anesthetic agents have been selected for their neuroprotective properties, it is increasingly being recognized that the support of cerebral perfusion during anesthesia contributes more significantly to a positive outcome for these patients. Support of cardiorespiratory function is, therefore, highly important when anesthetizing patients with TBI. Conclusion: Choice of anesthetic agent is determined by the extent of brain injury and intracranial pressure (ICP) elevation. Factors that should be considered when anesthetizing head trauma patients include the effects of anesthetic agents on the cardiac and respiratory systems, their effects on cerebral blood flow (CBF), ICP, and possible neuroprotective benefits offered by certain agents.     

Surgical management of urinary incontinence.

Urethral sphincter mechanism incompetence and ureteral ectopia are the two most common causes of urinary incontinence in dogs and cats. Surgical treatments for both disorders have been described.Once a diagnosis is made, surgical intervention may lead to improved outcomes with resolution of incontinence in many patients. Proper case selection and surgical technique are critical in achieving clinical success when managing these difficult cases.     

Surgical management of recurrent laryngeal neuropathy

Recurrent laryngeal neuropathy (RLN, laryngeal hemiplegia, laryngeal paralysis, ‘roaring’) is common in the equine industry with a prevalence ranging from 2.6–11% in light breeds ( Raphel 1982 ; Lane 1987 ; Morris and Seeherman 1990 ) up to 38% in draught breeds ( Brakenhoff et al. 2006 ; Perkins et al. 2009 ). There are a number of different surgical treatments currently available and more being developed. This article aims to discuss factors affecting choice of treatment and then provide an evidence‐based approach to describe surgical approaches, success rates and morbidity. Specific details of surgical methods are not given as they are readily available in surgical textbooks ( Stick 2006 ; McGorum et al. 2007 ).     

Surgical management of advanced ear disease

With careful surgical technique and attention to underlying medical problems, most cases of advanced ear disease in small animals can be managed successfully. Specific techniques and therapy are described.     

Surgical management of gastric torsion.

Considerable investigation has been devoted to the gastric dilatation-torsion complex. An adequate explanation of its cause has yet to be made, or a means of prevention described. We do know of its highly lethal nature, especially if not aggressively treated, of the high incidence of recurrence, and of the associated pathophysiology. As surgeons, we must approach the patient in an aggressive systematic manner. Decompression and patient stabilization must be achieved prior to definitive surgical management. The surgery planned must correct the obvious pathologic state and include procedures designed to prevent recurrence of this condition. The tube gastrostomy technique promotes gastric fixation by dense adhesion bands exceeding that attainable by gastropexy alone. The procedure is easy to perform, requires little surgical time, and does not appear to be discomforting to the patient. In addition, the tube gastrostomy acts as a convenient decompressive pathway during the postoperative period, circumventing gastric intubation or pharyngostomy tube placement should distention occur.     

Surgical interventions and outcome in a population of feline trauma patients

Objective

To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population.

Design

Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases.

Setting

University teaching hospital.

Animals

Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020.

Interventions

None.

Measurements and Main Results

Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups.

Conclusions

Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.     

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.