Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

BACKGROUND: Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. HYPOTHESIS/OBJECTIVES: Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). ANIMALS: Eight client-owned dogs with UD treated with an AUS. METHODS: Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. INCLUSION CRITERIA:  diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. RESULTS: Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). CONCLUSION: Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Description and clinical relevance of the variable conformation of canine spinal arachnoid diverticula.

The conformation of spinal arachnoid diverticula (SAD) and their clinical implications are poorly characterized in dogs. This retrospective cross-sectional study describes different SAD conformations in dogs and aims to identify if there is an association between SAD conformation and clinical features, localization, syringomyelia (SM) presence, concurrent vertebral condition, treatment option, and short as well as long-term outcome. Sixty-two dogs were included (12 cervical and 50 thoracolumbar SAD). All dogs with a cervical SAD had a cranial tethered conformation and were not included in the statistical analysis. Half of the dogs with a thoracolumbar SAD were cranial tethered, and the other half were caudal tethered. SM associated with SAD had a moderate prevalence in the cervical region (58.3%) and a high prevalence in the thoracolumbar region (82%). All dogs with the presence of SM and caudal tethered SAD had a cranial positioned SM, and all dogs with SM and a cranial tethered SAD had a caudal positioned SM. The SM absolute length and SM length/L2 ratio were significantly higher (P = .018, respectively) in the caudal tethered SAD compared with the cranial tethered SAD. The short-term outcome was statistically different (P = .045) between caudal and cranial tethered thoracolumbar SAD, but not the long-term outcome (P = .062). Multivariable logistic regression identified thoracolumbar caudal tethered SAD conformation had a better short-term outcome (P = 0.017, OR: 0.043, CI: 0.003-0.563), independently of SM length measurements. SAD conformation in dogs can influence SM formation. A possible link between short-term outcome and SAD conformation was found, but further research is warranted.

Congenital right atrial diverticulum in a kitten.

A four-month-old domestic shorthair cat with no clinical signs was referred for further examination of a heart murmur. An echocardiogram revealed marked right atrial dilation, extending into the left hemithorax. Computed tomography angiography was conducted to investigate further, which revealed a balloon-shaped, contrast-filled cavity on the cranial and left side of the chest that connected to the right atrium through a narrow passage. This was diagnosed as a congenital right atrial diverticulum. Treatment included clopidogrel to reduce the risk of thrombus formation. Two months after the initial diagnosis, castration surgery was successfully performed without complications. The cat died suddenly at home 10 months after diagnosis. To the authors' knowledge, this is the first right atrial diverticulum reported in a cat.

Surgical management of a cervical esophageal diverticulum in and long-term outcome for a five-month-old cat.

CASE DESCRIPTION: A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier. CLINICAL FINDINGS: Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed. TREATMENT AND OUTCOME: A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery. CLINICAL RELEVANCE: An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.

Spinal subarachnoid diverticula in dogs: A review.

Spinal subarachnoid diverticula are fluid dilations of the subarachnoid space that can cause a compressive myelopathy in dogs. These diverticula are usually associated with high motion areas in the cervical and caudal thoracic spine. The definitive etiopathogenesis has not been determined but likely involves congenital or acquired causes. Pugs, French bulldogs, and Rottweilers are overrepresented breeds. Clinical signs typically include ataxia, paresis, and upper motor neuron urinary and/or fecal incontinence; pain is a less common feature. Diagnosis is based on advanced imaging, with magnetic resonance imaging now being favored given the additional detail of the spinal cord parenchyma that can be obtained. Outcomes are better with surgical intervention than with medical therapies, though there is a lack of long-term data. No superior surgical technique has been identified, and questions remain on the significance of addressing leptomeningeal adhesions at the time of surgery. Clinical signs can recur, though not always due to recurrence of diverticulum formation, and pugs may be less likely to have a successful long-term outcome.

Diverticule subarachnoïdien spinal chez des chiens : une revue. Les diverticules subarachnoïdiens spinaux sont des dilatations liquides de l'espace subarachnoïdien qui peuvent causer une myélopathie compressive chez les chiens. Ces diverticules sont généralement associés à des régions à motion élevée de la colonne vertébrale cervicale et caudale. L'étiopathogénie définitive n'a pas été déterminée mais implique fort probablement des causes congénitales ou acquises. Les carlins, bulldogs français et rottweiler sont des races sur-représentées. Les signes cliniques inclus typiquement de l'ataxie, de la parésie et un neurone moteur supérieur d'incontinence urinaire et/ou fécale; la douleur est une caractéristique moins fréquente. Le diagnostic est basé sur des analyses avancées d'imagerie, avec l'imagerie par résonnance magnétique maintenant favorisée étant donné les détails additionnels du parenchyme de la colonne vertébrale qui peuvent être obtenus. Les résultats sont meilleurs avec l'intervention chirurgicale qu'avec les thérapies médicales, bien qu'il y ait un manque de données à long terme. Aucune technique chirurgicale supérieure n'a été identifiée, et des questions persistent sur l'importance de s'attarder aux adhésions leptoméningées au moment de la chirurgie. Les signes cliniques peuvent réapparaitre, quoique pas toujours à cause de la récurrence de la formation des diverticules, et les carlins pourraient être moins enclin à avoir une issue favorable à long terme.(Traduit par Dr Serge Messier).

Jejunal Lesion Identified at a Previous Anastomosis Site in a Dog Using Capsule Endoscopy.

A 3 yr old spayed female French bulldog was evaluated for a progressive regenerative anemia of unknown origin that was unresponsive to empiric immunosuppressive and gastroprotective therapy. The patient had a history of previous resection and anastomosis of a small intestinal diverticulum ∼2 yr prior to evaluation for her anemia. Capsule endoscopy revealed a focal abnormality in the distal jejunum at the site of a previous bowel resection and anastomosis. This lesion was suspected to be the cause of ongoing gastrointestinal bleeding and anemia. Exploratory laparotomy combined with endoscopy was performed to further investigate and localize the jejunal lesion. The lesion was resected, and a primary end-to-end jejunal anastomosis was performed. Histopathology of the specimen revealed jejunal suture granulomas with focal ulceration. The patient recovered well from surgery with significant improvement of the anemia and resolution of clinical signs at recheck examinations 1 and 2 wk postoperatively. Complete resolution of the anemia was noted at a 6 wk follow-up. The case report demonstrates how, in cases of unknown causes of anemia, capsule endoscopy is a noninvasive method of identifying the presence of gastrointestinal bleeding as a result of lesions that might otherwise not be detectable with abdominal ultrasound or conventional endoscopy. The report also documents a long-term complication to a resection and anastomosis surgery.

Superficial swellings in sheep (Ovis aries) and goats (Capra hircus): Clinical and ultrasonographic findings.

This study describes the clinical presentation of superficial swellings and evaluates the utility of ultrasonography in the diagnosis of such swellings in sheep and goats. Ninety-three sheep and 73 goats were included in this study on the basis of presence of superficial swellings on the head (n=56), neck (n=16), chest wall (n=3), abdominal wall (n=40), umbilicus (n=14), scrotum (n=16), testes (n=1), udder (n=7), limbs (n=2), gluteal region (n=5), tail (n=1), and penile urethra (n=5). Ultrasonographic evaluation of these superficial swellings allowed the diagnosis of abscesses (n=54; 32.52%), cysts (n=12; 7.23%), hernias (n=57; 34.33%), hematomas (n=14; 8.44%), tumors (n=24; 14.45%), and urethral diverticula (n=5; 3.03%). Each lesion type could be precisely discriminated (sensitivity, 88-100%; specificity, 80-100%; and P=0.001). Ultrasonography was found to have a specificity of 100% for the diagnosis of hernias, urethral diverticula, and tumors, and a lower specificity of 80% for hematomas and 93% for abscesses when used for evaluation of superficial swellings in sheep and goats. In conclusion, ultrasonography is a unique, non-invasive diagnostic imaging tool that allows the diagnosis, differential diagnosis, and subsequent surgical treatment of different types of superficial swellings in sheep and goats.

Computed tomographic retrograde positive contrast cystography and computed tomographic excretory urography characterization of a urinary bladder diverticulum in a dog.

A one-year-old intact male German shepherd dog was referred with a 3-month history of dysuria and pollakiuria. Physical examination revealed a large firm mass in the caudal abdomen. Findings from survey radiography, negative contrast cystography, computed tomographic (CT) retrograde positive contrast cystography, and CT excretory urography were consistent with a large urinary bladder diverticulum. An exploratory laparotomy revealed a normal wall appearance in the ventral compartment (true bladder) and marked thinning of the wall in the dorsal compartment (diverticulum). Both ureters inserted into the ventral compartment. The dorsal compartment was excised and histopathology confirmed the diagnosis of urinary bladder diverticulum.

Preputial diverticulum dilation in a Goettingen minipig.

Preputial dilation is an infrequently reported condition in pigs. The pathophysiology and etiology is unclear. Causes for diverticulum dilation are proposed to be chronic preputial diverticulitis with subsequent fibrosis of the preputial cavity, phimosis of the preputial orifice or the preputial diverticulum, but the large majority of cases are reportedly idiopathic in nature. Surgical interventions include ablative procedures, but many cases are not treated because of an assumed lack of clinical relevance in pigs not used for breeding. We report a case of progressive preputial dilation that recurred after surgical intervention. Histopathological examination revealed no primary inflammatory condition, contrary to literature suggesting a role for inflammatory mediators in pathogenesis. Phimosis of the preputial orifice was noted post mortem and might be a contributing factor. These findings partially contradict the current assumptions in regards to pathophysiology and treatment choices in the literature and warrant further investigation into alternative therapeutic interventions for this condition.

Urethral diverticulum and urolithiasis in a female guinea pig (Cavia porcellus).

CASE DESCRIPTION A 5-year-old sexually intact female guinea pig was evaluated because of mild dysuria and a subcutaneous mass located cranioventral to the urogenital openings. CLINICAL FINDINGS Non-contrast-enhanced CT and surgical exploration of the distal aspect of the urethra revealed a urethral diverticulum with an intraluminal urolith. Analysis revealed that the urolith was composed of calcium carbonate and struvite. TREATMENT AND OUTCOME The urolith was surgically removed and ablation of the urethral diverticulum was attempted. Approximately 3 months later, the guinea pig was reevaluated for masses in the perineal region, and positive-contrast urethrocystography revealed 2 uroliths present in the same diverticulum. Uroliths were manually expressed with the patient under general anesthesia. Approximately 2 weeks later, urethroplasty was performed to create an enlarged stoma with the diverticulum, thereby preventing urine from pooling in the diverticulum and potentially reducing the risk of future urolith formation. The urethroplasty site healed well with no reported complications or evidence of urolith recurrence 6 months after surgery. CLINICAL RELEVANCE Urolithiasis is common in guinea pigs, and urethral diverticulum and intraluminal urolith formation should be considered as a potential differential diagnosis for a subcutaneous mass along the distal aspect of the urethra. Creation of a urethral stoma from a urethral diverticulum via urethroplasty achieved a successful outcome in this patient.

COLONIC DIVERTICULOSIS AND DIVERTICULAR HEMORRHAGE IN A GERIATRIC FEMALE ORANGUTAN ( PONGO ABELII).

A 57-yr-old female Sumatran orangutan ( Pongo abelii) presented with signs of intermittent lethargy and inappetence, then subsequently developed profuse hemorrhagic diarrhea. Colonoscopy under anesthesia revealed diverticulosis of the descending colon, with multiple large diverticula containing fecoliths. There was no evidence of diverticulitis, but a regenerative anemia had developed following an acute diverticular bleed. The orangutan recovered with conservative therapy. Colonic diverticulosis has been reported in nonhuman primates and appears to have a similar clinical presentation to the condition as it occurs in humans. This is the first published report of colonic diverticulosis in a great ape.

Utility of ultrasonography for diagnosis of superficial swellings in buffalo (Bubalus bubalis).

We studied 72 buffalo with superficial swellings in the head (n=4), neck (n=5), chest wall (n=4), abdominal wall (n=28), limbs (n=16), gluteal region (n=8), perineal region (n=6) and udder (n=1). Ultrasonographically, the swellings varied according to type, duration, content and location. The clinical use of ultrasound to assess these superficial swellings allowed diagnosis of abscesses (n=21), hematomas (n=11), hernias (n=17), bursitis (n=13), urethral diverticula (n=6) and tumors (n=4). Ultrasonography could precisely discriminate each lesion type (sensitivity, 71-100%; specificity, 75-100%; odds ratio, 1.0-8.4; Confidence Interval, 74.2-20; and P value 0.001). The specificity for ultrasonographic evaluation of superficial swellings was 100% for hernias, urethral diverticula and tumors, whilst the lowest specificity was recorded for hematomas (75%) and abscesses (92%). In conclusion, ultrasonography provides a precise, non-invasive and fast technique for the evaluation, classification and subsequent treatment of a variety of superficial swellings in buffalo.

Reversible paralysis and loss of deep pain sensation after topical intrathecal morphine administration following durotomy.

OBJECTIVE: To report 2 dogs that developed temporary pelvic limb paralysis with loss of deep pain sensation after topical intrathecal morphine administration during spinal surgery. STUDY DESIGN: Clinical report. ANIMALS: Dogs (n = 2). METHODS: A 5-year-old castrated male French Bulldog with a subarachnoid diverticulum at T9-T10 and a 9.5-year-old castrated male Belgian Shepherd dog with a herniated disc at T12-T13 and intradural component, had Gelfoam soaked with morphine placed over the dura mater defect. RESULTS: Pelvic limb paralysis and loss of deep pain sensation was noticed immediately after recovery from anesthesia. After intravenous naloxone administration, both dogs immediately regained ambulation and normal pain sensation; however the effect was temporary lasting only a few hours. Permanent resolution of clinical signs occurred 24 hours after surgery. CONCLUSIONS: Topical intrathecal morphine administration resulted in temporary pelvic limb paralysis and loss of deep pain sensation. This route of administration should be used cautiously until further determination of the efficacy and adverse effects associated with topical intrathecal morphine administration.

Multiple small intestinal pseudodiverticula associated with lymphoma in three horses.

Three mature horses presented with progressive weight loss, inappetence, ventral abdominal oedema and lethargy. Two of the animals had intermittent signs of low grade abdominal pain. At presentation, all 3 had hypoalbuminaemia; 2 had hyperfibrinogenaemia and the other had neutrophilia. An oral glucose tolerance test was performed in 2 cases, both of which demonstrated impaired glucose absorption. One pony treated with corticosteroids failed to improve and developed peritonitis and was subjected to euthanasia after 2 weeks. One pony had small intestinal biopsies obtained via a standing flank laparotomy, which revealed a mainly mononuclear cell infiltrate of the mucosa. It failed to respond to treatment with antibiotics and corticosteroids and, after 2 months, developed sternal oedema in addition to the ventral abdominal oedema and peritonitis and was subjected to euthanasia. The remaining pony deteriorated despite symptomatic therapy and was subjected to euthanasia after one week. At post mortem examination, all 3 animals had multifocal lesions of small intestinal wall thickening, mucosal ulceration, pseudodiverticula and enlarged mesenteric lymph nodes. One pony also had a multinodular mass at the root of the mesentery, a mediastinal mass and a lung mass. Histological examination confirmed the presence of lymphoma of the intestinal wall at post mortem examination in each case and immunohistochemistry (including retrospective evaluation of the intestinal biopsies obtained from the pony that underwent a flank laparotomy) indicated that the lymphomas were of T cell origin.

Acquired jejunal pseudodiverticula in a yearling Arabian filly.

OBJECTIVE: To report a case of multiple acquired jejunal pseudodiverticula managed successfully by resection and jejunojejunostomy. STUDY DESIGN: Clinical report. ANIMALS: Arabian filly. METHODS: The filly was referred for signs of acute colic of several hours duration and had a 2-week history of inappetence and weight loss. Three meters of thickened, edematous, and dilated jejunum removed during exploratory celiotomy had an intussusception and numerous diverticula; jejunojejunostomy performed. The pathoanatomic diagnosis was proliferative enteropathy with pseudodiverticula formation and jejunal muscular hypertrophy and diverticulosis. The diverticula appeared to be acquired; however, the exact cause was not determined. RESULTS: There were no postoperative gastrointestinal complications and 1 year later, the filly was doing well. CONCLUSION: Multiple acquired jejunal pseudodiverticula not associated with classic muscular hypertrophy can occur in young horses. Long-term prognosis seemingly can be excellent after resection and jejunojejunostomy. CLINICAL RELEVANCE: Compared with other reports of small intestinal diverticula in horses, this case is unique because it was not congenital or associated with classic muscular hypertrophy.

Imaging diagnosis--duodenal diverticulum in a dog.

A young female Boxer had a history of chronic soft stool. Survey abdominal radiographs were unremarkable. A duodenal diverticulum was identified in abdominal ultrasound and barium upper-gastrointestinal contrast examinations. Before surgery a 99mTc-pertechnetate study was performed to evaluate for ectopic gastric mucosa in the duodenal diverticulum. Focal abnormal increased radioactivity was identified in the right caudal abdominal quadrant. The diverticulum was excised. Upon histopathologic examination of the duodenal diverticulum, ectopic gastric mucosa was not identified but ectopic pancreatic tissue was found. Mild eosinophilic inflammation within the diverticulum was suspected to be the cause of the mild 99mTc uptake seen in this dog.

Repair of extensive perineal hypospadias in a Boston terrier using tubularized incised plate urethroplasty.

This report provides a detailed description of the surgical repair of perineal hypospadias in a Boston terrier. A 2-year patient follow-up, including diagnostic data demonstrating urethral patency and resolution of recurrent urocystitis and urine skin scald are reported.

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.