Successful Management of Urinary Bladder Clot with Intravesical Tissue Plasminogen Activator Infusion in a Cat.

A 5 yr old male neutered domestic shorthair with intermittent signs of urinary tract obstruction was suspected of having a blood clot in the urinary bladder secondary to trauma. The cat was hospitalized and received standard supportive therapy for urinary tract obstruction with urinary catheterization, with the addition of intravesical saline flushes in an attempt to promote bladder clot lysis. The cat was subsequently discharged after voluntary urination was observed. The cat was represented 28 hr after discharge because of clinical signs consistent with urinary tract obstruction. The cat was hospitalized and intravesical tissue plasminogen activator (tPA) infusions (0.5 mg of tPA in 10 mL of saline with 2 hr dwell time q 8 hr) were administered to break down the bladder clot (2.78 × 4.46 cm). Thirty-two hours after starting tPA, the clot was no longer visible on ultrasound. The cat was discharged with no recurrent symptoms in the subsequent 11 mo. This is the first report of tPA being used for dissolution of bladder clot in a cat. There were no observed complications, suggesting that intravesical instillation of tPA may be a safe and efficacious therapy in cats, similar to the previously reported successes in dogs and humans.

IMAGING DIAGNOSIS-ULTRASOUND UNCOMMON FEATURES OF AN ABDOMINAL GOSSYPIBOMA IN A DOG.

An abdominal mass was incidentally detected in a 12-year-old, neutered female, crossed breed dog. Abdominal ultrasonographic examination showed a well-delineated, irregular, heterogeneous mass that did not generate any distal acoustic shadowing. Transcutaneous US-guided biopsy of the mass were nonconclusive but raised the possibility of neoplasia. Surgery discovered a mass embedded in the omentum and a large quantity of surgical sponges were identified in cut section. To the authors' knowledge, this represents the first published case of gossypiboma casting no characteristic distal acoustic shadowing.

A case of feline ectopic abdominal fetuses secondary to trauma.

A multiparous adult cat with a history of prior trauma but no presenting clinical signs was admitted for routine ovariohysterectomy. Uterine abnormalities indicative of trauma were found in addition to 2 ectopic fetuses wrapped in omentum. The ovariohysterectomy was completed and the ectopic fetuses were removed. Recovery was uneventful.

Cas de fœtus abdominaux ectopiques félins secondaires à un traumatisme. Une chatte adulte multipare ayant une anamnèse de traumatismes antérieurs mais ne présentant aucun signe clinique a été admise pour une ovario-hystérectomie de routine. Des anomalies utérines indiquant un traumatisme ont été trouvées en plus de deux fœtus ectopiques enveloppés dans l'omentum. L'ovario-hystérectomie a été réalisée et les fœtus ectopiques ont été enlevés. Le rétablissement s'est effectué normalement.(Traduit par Isabelle Vallières).

Blunt Force Trauma in Veterinary Forensic Pathology.

Veterinary pathologists commonly encounter lesions of blunt trauma. The development of lesions is affected by the object's mass, velocity, size, shape, and angle of impact and by the plasticity and mobility of the impacted organ. Scrape, impact, and pattern abrasions cause localized epidermal loss and sometimes broken hairs and implanted foreign material. Contusions are best identified after reflecting the skin, and must be differentiated from coagulopathies and livor mortis. Lacerations-traumatic tissue tears-may have irregular margins, bridging by more resilient tissue, deviation of the wound tail, crushed hairs, and unilateral abrasion. Hanging or choking can cause circumferential cervical abrasions, contusions and rupture of hairs, hyoid bone fractures, and congestion of the head. Other special forms of blunt trauma include fractured nails, pressure sores, and dog bites. Ocular blunt trauma causes extraocular and intraocular hemorrhages, proptosis, or retinal detachment. The thoracic viscera are relatively protected from blunt trauma but may develop hemorrhages in intercostal muscles, rib fractures, pulmonary or cardiac contusions or lacerations with subsequent hemothorax, pneumothorax, or cardiac arrhythmia. The abdominal wall is resilient and moveable, yet the liver and spleen are susceptible to traumatic laceration or rupture. Whereas extravasation of blood can occur after death, evidence of vital injury includes leukocyte infiltration, erythrophagocytosis, hemosiderin, reparative lesions of fibroblast proliferation, myocyte regeneration in muscle, and callus formation in bone. Understanding these processes aids in the diagnosis of blunt force trauma including estimation of the age of resulting injuries.

Rectal tear repair using barbed suture in the horse.

OBJECTIVE: To describe the repair utilizing integral-anchor barbed suture in equine rectal tears. ANIMALS: 3 horses aged 3 to 10 years old with grade 3 to 4 rectal tears. CLINICAL PRESENTATION: Grade 3 and 4 rectal tears were referred for surgical repair immediately after iatrogenic tearing or tearing during parturition. Integral-anchor barbed suture (Stratafix Symmetric PDS Plus, size 1, 18" CT-1) was placed using long-handled instruments or hand closure depending on the accessibility and visibility of the tear. Closure of grade 3 tears was performed using a continuous appositional pattern. A horizontal mattress pattern was performed in the grade 4 tear. No other surgical procedures were performed. RESULTS: Two grade 3 tears were successfully repaired with no complications and discharged from the hospital. One grade 4 tear was successfully repaired; however, 4 days post-surgery partial dehiscence of the suture site occurred, and the horse was euthanized. CLINICAL RELEVANCE: Grade 3 rectal tears were repaired successfully by using an integral-anchor barbed suture. No post-operative complications were reported. Blind hand suturing could be performed in cranial locations when the laceration could not be made visible. For grade 4 rectal tears, additional surgical procedures beyond barbed suture closure are needed.

Abdominal computed tomography and exploratory laparotomy have high agreement in dogs with surgical disease.

OBJECTIVE: To compare the results of abdominal CT with exploratory laparotomy in the dog. ANIMALS: 100 client-owned dogs from 1 academic institution. METHODS: Medical records were searched for dogs that had undergone a preoperative abdominal CT scan read by a board-certified veterinary radiologist followed by an exploratory laparotomy. CT and surgical reports were compared. RESULTS: The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97%. Overall, there was no evidence that proportion agreement differed on the basis of body condition score, time interval between CT and surgery, or oncologic versus nononcologic disease. CLINICAL RELEVANCE: Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. When performing a specific abdominal surgery, it is acceptable for the surgeon to fully explore the abdomen or forego it for a smaller approach to the organ of interest if an abdominal CT was performed prior.

The use of agitated saline as contrast agent in a contrast-enhanced cystosonography for detection of urinary bladder rupture in animal cadavers.

OBJECTIVE: To determine the value of microbubble contrast cystosonography in the diagnosis of bladder rupture in animals. DESIGN: Prospective, method comparison study from November 2019 to October 2020. SETTING: University teaching hospital. ANIMALS: Thirty-four ethically sourced cadavers of dogs, rats, and rabbits. INTERVENTIONS: In a prospective and blinded study, the cadavers were divided into 2 randomized groups: with bladder rupture (CR), and without bladder rupture (SR). Urinary catheterization was performed in all cadavers. Through the urethral catheter, bladders in CR group were ruptured using a rigid stainless steel guide wire. Microbubble contrast was infused into the bladder through the urethral catheter, while a single, blinded observer sonographically assessed the bladder. The time to diagnosis and the number of attempts needed for diagnosis were recorded. MEASUREMENTS AND MAIN RESULTS: The study included cadavers of 16 female Wistar rats, 6 female dogs, 11 male dogs, and 1 male rabbit. Time to diagnosis in dogs (2.25 ± 0.91 min) was statistically higher when compared to rats (1.15 ± 0.75 min; P = 0.03). Of the 34 cases, incorrect diagnosis of bladder rupture was made in only 2 dogs (6%), indicating a diagnostic sensitivity of 88.88%, specificity of 100%, and an accuracy of 94%. The positive predictive value was 1 and the negative predictive value was 0.9. CONCLUSIONS: Our study showed that the described method is accurate, sensitive, and specific for the detection of bladder rupture in animal cadavers of different species, size, and sex.

Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care.

BACKGROUND: Increased intraabdominal pressure, termed intraabdominal hypertension (IAH), is reported as an independent cause of morbidity and mortality in the human ICU but, until recently, has been rarely described in veterinary species outside of experimental models. Failure to identify severe IAH leads to organ dysfunction, termed abdominal compartment syndrome, and rapidly becomes fatal without therapeutic intervention. Although the veterinary community has been slow to address the concept of IAH and associated comorbidities, recent companion and large animal case series and experimental studies suggest IAH may also be common in veterinary species and correlates well with risk factors and grading systems already described in the human literature. PATHOPHYSIOLOGY: Increasing abdominal pressures exert deleterious local effects through visceral ischemia and reperfusion injury as well as systemic effects on the cardiovascular, pulmonary, renal, and central nervous systems. Even mild grades of IAH increase systemic vascular resistance, impede venous return, increase pulmonary wedge pressure, and decrease pulmonary function. More severe grades cause azotemia, oliguria, decreased coronary blood flow, hypoxia, increased intracranial pressure, and death. IMPORTANCE: Many of the common diseases in veterinary patients are associated with IAH, including gastric dilatation-volvulus, colon volvulus, closed pyometra, hemoperitoneum, ascites, uroperitoneum, and hydrops. Monitoring of the veterinary patient is difficult, but several experimental studies validate both the presence of IAH and the ability to monitor abdominal pressures in large and small animal species. Moreover, prompt recognition of IAH and subsequent treatment is feasible in the veterinary ICU. KEY POINTS: Increasing abdominal pressures exert deleterious local effects through visceral ischemia and reperfusion injury as well as systemic effects on the cardiovascular, pulmonary, renal, and central nervous systems. Increases in central venous pressure, systemic vascular resistance, pulmonary wedge pressure, and a decreased cardiac output by way of both decreased preload and increased afterload have been documented as a result of intraabdominal hypertension (IAH). Direct diagnosis of IAH is achieved by blind or ultrasound-guided abdominal needle puncture attached to a water manometer or direct pressure monitoring transducer. Transvesicular measurement of intraabdominal pressure (IAP) is relatively noninvasive, and many patients that would benefit from rapid diagnosis of IAH and abdominal compartment syndrome already have indwelling bladder catheters. Recommendations for interventions are based on the assigned grade of IAH (mild, moderate, severe). KEY POINTS: If IAH is strongly suspected or diagnosed, abdominal wall compliance may be improved through judicious use of neuromuscular blockers and sedation. Decompression, either minimally invasive or surgical, is absolutely recommended for IAPs consistently above 20 mm Hg, especially in the presence of signs attributed to secondary organ dysfunction.

Umbilical Cord Herniation With Small Intestinal Evisceration in Two Thoroughbred Neonates.

This report describes two cases of spontaneous small intestinal evisceration via normally inserted umbilical stumps, without abdominal wall trauma. Both cases occurred immediately following uneventful parturition. The authors believe that these represent cases of umbilical cord herniation. This is a well-recognised condition in humans, but has not been previously described in equines. One foal died before veterinary intervention. The second foal underwent a jejunal resection with end-to-end anastomosis and survived to successfully race. This report describes a previously unrecognised condition and highlights the importance of rapid and appropriate intervention on farm.

High-rise syndrome in cats and dogs.

OBJECTIVE: To review the current literature pertaining to the pathophysiology, diagnosis, and treatment of injuries sustained from high-rise syndrome in cats and dogs. ETIOLOGY: High-rise syndrome is defined as a fall from a height of 2 or more stories that results in a constellation of injuries, including thoracic, abdominal, orthopedic, and orofacial trauma. Animals often fall after slipping from windowsills, engaging in mating behavior, or chasing prey. Cats suffer less severe injuries than dogs due to their "righting reflex" and smaller body mass. Affected animals are younger, and the frequency of falls is higher in warmer months. DIAGNOSIS: Physical examination coupled with radiographs, ultrasound, and computed tomography can diagnose a myriad of injuries that include pneumothorax, pleural or abdominal effusion, orthopedic fractures, and orofacial injuries. Bloodwork may identify anemia, thrombocytopenia, or increases in hepatic, renal, or pancreatic values consistent with trauma to these organs. Serial venous or arterial blood gas can help determine the severity of respiratory compromise and influence resuscitative efforts. Traditional coagulation tests and thromboelastography can assess trauma-induced coagulopathy and guide transfusion therapy. THERAPY: Animals presenting in shock require hemodynamic stabilization. Initial resuscitation may incorporate crystalloids, colloids, blood products, and analgesics. Thoracic injuries may require oxygen, thoracocentesis, chest tube placement, and mechanical ventilation. Fractures and wounds are decontaminated and splinted/bandaged, with definitive fixation pursued after stabilization. Abdominal injuries are managed medically unless there is severe ongoing bleeding, sepsis, or injury to the urinary tract. PROGNOSIS: In feline high-rise syndrome, the prognosis is generally excellent following treatment, with survival exceeding 90%. Canine literature is sparse. The largest retrospective study reported a >90% survival to discharge and a greater need for surgical stabilization in this species. There are no prognostic factors identified that are associated with survival for either species.

Comparing diagnostic findings and cost of whole body computed tomography to traditional diagnostic imaging in polytrauma patients.

OBJECTIVE: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT. DESIGN: Prospective, observational study. SETTING: Private, level 1 veterinary trauma center. ANIMALS: Convenience sample of 21 client-owned cats and dogs presenting with polytrauma. INTERVENTIONS: Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist. MEASUREMENTS AND MAIN RESULTS: Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001). CONCLUSIONS: Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.

[Life-threatening injuries of the subcutaneous ventral abdominal veins in dairy cows]. / Lebensbedrohliche Verletzungen der Bauchwandvenen bei Milchkühen.

Injuries of the superficial veins on the ventral abdomen of dairy cows can result in life-threatening haemorrhage. Treatment of these injuries can be difficult because of the characteristics of the veins. Five cows aged 6.5 to 12 years were referred to the Animal Hospitale Zurich, because of intermittent haemorrhage from a ventral abdominal vein. Four of the cows were near term and one had calved two weeks before referral. Intermittent bleeding was seen from the highly convoluted and dilated subcutaneous tributaries to the cranial superficial epigastric vein (milk vein). The haematocrit of 2 cows was markedly lower than normal. Emergency slaughter of one of the cows was carried out because of advanced age. The other 4 cows were sedated and after application of local anaesthetic, the wounds were debrided and sutured. Two of the cows required a blood transfusion before being operated. There were no postoperative complications. This type of injury seems to occur predominantly in pluriparous dairy cows close to term, in which the tributaries to the milk vein have undergone varicose changes. Treatment should consist of surgical resection of the injured tissue and suturing of the venous wall, subcutaneous tissues and skin.

Major abdominal evisceration injuries in dogs and cats: 12 cases (1998-2008).

OBJECTIVE- To describe the clinical characteristics, treatment, complications, and outcome of dogs and cats treated surgically for major abdominal evisceration. DESIGN- Retrospective case series. ANIMALS- 8 dogs and 4 cats. PROCEDURES- Medical records from January 1998 through March 2008 were reviewed to identify animals that underwent surgery for major abdominal evisceration. Data regarding cause of evisceration, signalment, physiologic variables, and hematologic variables were collected. Details of treatment, duration of hospitalization, and outcome were recorded. Linear regression analysis was performed to evaluate the association of signalment, physiologic variables, and hematologic variables on the number of days of hospitalization. RESULTS- Major abdominal evisceration was secondary to a traumatic event in 4 animals and to postsurgical dehiscence in 8 animals. All animals had evisceration of the intestines and gross contamination with dirt, leaves, or litter. Two animals eviscerated the spleen, and 1 animal had a perforated colon and was leaking feces into the peritoneal cavity. All animals underwent exploratory abdominal surgery. Surgical procedures performed included resection of compromised intestine, body wall repair, diaphragmatic hernia repair, nephrectomy, splenectomy, and primary colonic repair. All animals survived to discharge from the hospital. Median duration of hospitalization was 4 days (range, 1 to 7 days). Factors associated with an increase in duration of hospitalization included evisceration secondary to trauma, high lactate concentration at time of admission, and small body size. CONCLUSIONS AND CLINICAL RELEVANCE- Despite the dramatic appearance of major abdominal evisceration in cats and dogs, prompt and aggressive medical and surgical intervention can provide a favorable outcome.

Clinical anatomy and surgical repair of prepubic hernia in dogs and cats.

Prepubic hernia is a traumatic hernia in small animals, most often associated with severe trauma to the caudal abdomen. Common causes include vehicular trauma, dog fights, and kicks by large animals. Rupture of the prepubic tendon in dogs and of its equivalent in cats results in a ventral abdominal hernia. Due to the traumatic nature of the injury, concurrent injuries are frequently seen. Clinical signs of herniation are often nonspecific, and the resultant hernia may not be readily apparent during routine physical examination. This being so, diagnosis is often based on a thorough physical examination in conjunction with abdominal radiography and, possibly, abdominal ultrasonography. Multiple methods of repair of prepubic hernia have been reported, and survival rates are quite good if concurrent injuries are not severe.

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.

Radiographic examination and outcome in consecutive feline trauma patients.

Using univariate analysis, the correlation between signalment, history, outcome and radiographic diagnosis made on whole-body radiographs was investigated in 100 consecutive feline trauma patients of an urban clinic. The radiographic findings included: 53 thoracic injuries, 39 abdominal injuries, 34 pelvic injuries, 28 soft tissue injuries, 26 spinal injuries, and 19 cases with signs of hypovolemia. Only four radiographs were considered normal. Surgical intervention was carried out in 51 cases. Of the 100 cases, 73 survived, 23 were euthanatized, and four died. A significant positive correlation with euthanasia was found when compared to patient age (p=0.0059), abdominal trauma (P=0.0500), spinal fractures (P=0.0468), and soft tissue injuries (P=0.0175). A significant negative correlation with survival was found when compared to patient age (P=0.0358), abdominal trauma (P=0.0439), intraperitoneal free air (P=0.0041), and soft tissue injury (P=0.0288). The results of this study indicate that whole-body radiographs are useful in detecting injury in the thorax, abdomen, spine, pelvis and soft tissues, and are valuable in the diagnostic work-up of feline trauma patients.

Penetrating injuries in dogs and cats. A study of 16 cases.

The objective of this retrospective study was to assess radiographical and surgical findings, surgical management and outcome of penetrating injuries in dogs and cats by evaluating patient records. Sixteen patients were identified (15 dogs and one cat), four with gunshot wounds, and 12 with fight wounds (11 with bite wounds, one struck by a claw). The thoracic cavity was affected in six patients, the abdominal cavity in three cases. Both cavities were affected in five dogs and the trachea in two cases. All of the patients with fight wounds were small breed dogs. Multiple injuries to internal organs that required intervention were found surgically after gunshot wounds and a high amount of soft tissue trauma requiring reconstruction was present after fight wounds. Radiography diagnosed body wall disruption in two cases. All of the affected thoracic body walls in the fight group had intercostal muscle disruptions which was diagnosed surgically. Fourteen patients survived until discharge and had a good outcome. In conclusion, penetrating injuries should be explored as they are usually accompanied by severe damage to either the internal organs or to the body wall. A high level of awareness is required to properly determine the degree of trauma of intercostal muscle disruption in thoracic fight wounds.

Chylous ascites associated with abdominal trauma and intestinal resection-anastomosis in a pet ferret (Mustela putorius furo).

CASE DESCRIPTION A 10-week-old 0.73-kg (1.6-lb) castrated male domestic ferret (Mustela putorius furo) was referred for exploratory laparotomy because of pneumoperitoneum and possible septic peritonitis after being bitten by the owner's dog. CLINICAL FINDINGS Abdominal exploration revealed a large laceration of the duodenum, tears of the jejunal mesentery, and 2 small tears in the abdominal wall. Chylous abdominal effusion developed 48 hours after surgery. TREATMENT AND OUTCOME Postoperative care included supportive treatment, analgesia, and antimicrobials. An abdominal drain was placed during the laparotomy and enabled monitoring of abdominal fluid production. Enteral feeding was provided through an esophagostomy tube. The chylous fluid production rapidly decreased after treatment with octreotide was initiated, and the ferret improved. Chyloabdomen resolved after 8 days of hospitalization and medical treatment. CLINICAL RELEVANCE Findings suggested that chylous ascites can potentially develop secondary to blunt abdominal trauma in ferrets. In this ferret, chyloabdomen was successfully treated with octreotide administration and abdominal drainage.

Evaluation of the agreement between focused assessment with sonography for trauma (AFAST/TFAST) and computed tomography in dogs and cats with recent trauma.

OBJECTIVE: To determine the agreement between focused assessment with sonography for trauma (FAST) exams and computed tomography (CT) for the detection of pleural and peritoneal fluid and pneumothorax in animals that have sustained recent trauma. DESIGN: Prospective study. SETTING: University Teaching Hospital. ANIMALS: Thirteen dogs and 2 cats were enrolled into the study, with 10 having sustained blunt force trauma and 5 penetrating trauma. INTERVENTIONS: Abdominal FAST (AFAST) and thoracic FAST (TFAST) exams were performed by emergency room (ER) clinician or house officers and radiology house officers (radiology). TFAST evaluated for the presence of pneumothorax and pleural effusion, and AFAST evaluated for the presence of peritoneal effusion. A minimally sedated, full-body CT exam was performed on each patient and interpreted by a board-certified radiologist. The exams were performed in the same order for all patients: ER FAST, followed by radiology FAST, followed by CT, and operators were blinded to the results of the other exams. A kappa statistic was calculated to assess for agreement between the FAST exams and CT. MEASUREMENTS AND MAIN RESULTS: The median time to perform all 3 exams was 55 minutes (range 30-150 min). There was moderate to excellent agreement between AFAST and CT for detection of free peritoneal fluid (ER K = 0.82; radiology K = 0.53), fair to moderate agreement between TFAST and CT for detection of pleural free fluid (ER K = 0.53; radiology K = 0.36), and poor agreement between TFAST and CT for detection of pneumothorax (ER K = -0.06; radiology K = -0.12). CONCLUSIONS: FAST exams reliably identify the presence of free fluid in the peritoneal and pleural cavities; however, TFAST is not a reliable method to diagnose pneumothorax in dogs and cats following trauma.

Surgical management of impalement injuries to the trunk of dogs: a multicentre retrospective study.

OBJECTIVES: To review a large series of dogs referred for treatment of traumatic impalement injuries to the thorax and/or abdomen and to report aetiologies, injury characteristics, management and long-term outcomes. MATERIALS AND METHODS: Previously collected data on dogs that were surgically treated for impalement injuries to the trunk at six veterinary specialist referral institutions in the UK over an 11-year period were reviewed. Data included patient signalment, physiological variables, injury-specific variables, diagnostic imaging reports, surgical procedures undertaken, duration of hospitalisation, antibiotic use, complications and outcomes. Data were reported with summary statistics. RESULTS: Fifty-four dogs were included. Impalement occurred most frequently on wooden objects (n=34), and the thoracic cavity was most commonly penetrated (n=37). Computed tomography was sensitive and specific to identifying wooden material in 64% and 88% of cases (n=11), respectively. Thoracotomy was performed in 56%, coeliotomy in 20% and a foreign body or its fragments were retrieved during surgery in 37% of the cases. Complications occurred in 19 dogs (35%), and of these, 68% were minor and 32% major. The survival rate for thoracotomy cases was 93% (n=30). Overall long-term survival was 90%. CLINICAL SIGNIFICANCE: Despite the often dramatic presentation of impalement injuries, the majority of patients treated in the specialist referral setting can achieve excellent outcomes. These injuries require thorough diagnostic imaging and interpretation before adequate surgical exploration and management, augmented by anaesthesia and critical care during the peri- and postoperative periods; therefore stable patients should be referred to centres able to provide this type of care.