Medical management of pneumoperitoneum, gastric pneumatosis, and hepatic venous gas secondary to 3% hydrogen peroxide toxicity in a dog.

OBJECTIVE: To describe the medical management and outcome of a dog suffering severe hydrogen peroxide toxicity. CASE SUMMARY: A 3-year-old neutered female Bichon Frise was presented to an emergency and referral practice after ingestion of 10-20 mL/kg 3% hydrogen peroxide. On presentation, the dog was obtunded, was tachypneic, and had severe gastric tympany. Abdominal radiographs revealed pneumoperitoneum, gastric pneumatosis, and hepatic venous gas. The dog was managed conservatively with supportive care and oxygen therapy. Repeat radiographs 6 hours later showed complete resolution of all gas inclusions. While hospitalized, the dog developed severe hematemesis, and abdominal ultrasound revealed severe gastric wall thickening. Subsequent endoscopy confirmed severe gastric mucosal necrosis without evidence of deeper ulceration and relatively mild petechiation of the esophagus. The dog was ultimately discharged after 5 days of hospitalization and continued to do well at home. Recheck ultrasound 5 weeks postdischarge showed normal gastric wall appearance. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported case of pneumoperitoneum secondary to hydrogen peroxide toxicity and the first description of the clinical course of severe toxicity in dogs.

Sonographic features of the uncomplicated postoperative abdomen in dogs treated for pyometra by ovariohysterectomy.

Pyometra is a prevalent disease in intact bitches and the standard treatment is ovariohysterectomy (OHE). Published descriptions of normal sonographic findings after OHE are currently lacking. The aims of this prospective observational study were to describe and compare postoperative abdominal sonographic features for three timepoints following OHE in a group of dogs with pyometra and an uneventful recovery. A total of 22 dogs had sequential focused abdominal ultrasound examinations on days 1, 4-6, and 10-15 postsurgery. Recorded sonographic features for each examination time point and characteristics of the cervical stump and the mesovarium, size, and echogenicity of medial iliac lymph nodes (MILNs), presence of free peritoneal fluid, and pneumoperitoneum. The cervical stump appeared as a heterogenous area with a hypoechoic center surrounded by hyperechogenic tissue in all dogs. The cervical stump transverse-sectional area was larger on day 4-6 compared with day 1 and day 10-15 (P = .0009). Mesovarium ligature reactions were identified as heterogeneous and hyperechoic areas with central and/or edge shadowing in all dogs. The size and echogenicity of MILNs and the mesovarium reactions did not significantly differ among time points. Free peritoneal fluid was detected in 45%, 41%, and 9% and pneumoperitoneum in 95%, 82%, and 14% of dogs at sequential time points. Findings from this sample of dogs with an uneventful recovery following OHE due to pyometra can be used to assist veterinarians in interpreting postoperative abdominal ultrasonographic characteristics in future dogs treated surgically for pyometra.

Is pneumothorax secondary to pneumoperitoneum a real risk in dogs undergoing total laparoscopic gastropexy?

Background: There were described in veterinary literature, the possibility of pneumothorax as a complication of laparoscopic surgery in dogs undergoing laparoscopic ovariectomy associated with total laparoscopic gastropexy. Aim: To assess if spontaneous pneumothorax secondary to pneumoperitoneum is a real risk in dogs undergoing total laparoscopic gastropexy. Methods: Dogs undergoing totally laparoscopic gastropexy received chest X-rays (CXR) in lateral (left and right) and ventro-dorsal projection before and after the surgery. Two veterinary radiologists reported the x-rays and indicated the presence or not of pneumothorax. Results: Postoperative pneumothorax was not detected on postoperative CXR in the total of 76 dogs of the study. Conclusion: The odds risk of pneumothorax after total laparoscopic gastropexy surgical procedure is low.

Accuracy of radiographic diagnosis of pneumoperitoneum secondary to gastrointestinal perforation in dogs and cats.

BACKGROUND: Radiography is commonly included in the diagnostic investigation of animals with suspected gastrointestinal perforation and resultant pneumoperitoneum. This study aimed to (1) identify the accuracy of radiographic diagnosis of pneumoperitoneum and (2) determine if observer experience affected accuracy. METHODS: This was a retrospective case-controlled study evaluating abdominal radiographs of dogs and cats with surgical confirmation of gastrointestinal perforation or peritonitis without pneumoperitoneum. Radiographs were reviewed by a radiologist, an imaging resident, a general practitioner and a veterinary student. RESULTS: Radiographs from 60 dogs and eight cats were evaluated; 34 animals had confirmed perforation. Accuracy was fair to excellent for all observers: student 61.8%, general practitioner 70.6%, resident 85.3% and radiologist 83.8%. There was no significant difference in sensitivity between observers (all 70.6%-85.3%); however, there was a significant difference in specificity between both the resident (91.2%) and radiologist (91.2%) compared to the student (52.9%) (p < 0.001) and the general practitioner (55.9%) (p = 0.002). Overall, there was slight to substantial agreement between observers (κ = 0.28-0.73), with the highest being between the radiologist and resident. CONCLUSION: Abdominal radiography, when interpreted by veterinarians with differing experience, has variable accuracy for diagnosis of pneumoperitoneum for animals in this study. Further studies are needed to determine if these results are applicable for other populations of animals with pneumoperitoneum.

Assessment of laparoscopic working space in guinea pigs (Cavia porcellus) undergoing carbon dioxide insufflation at different intra-abdominal pressures.

OBJECTIVE: To evaluate pneumoperitoneal volumes (laparoscopic working space) in guinea pigs (Cavia porcellus) undergoing pneumoperitoneum via carbon dioxide insufflation at different intra-abdominal pressures (IAPs) (4, 6, and 8 mm Hg) and recumbencies (dorsal, right lateral, and left lateral). ANIMALS: Six 3- to 4-month-old sexually intact female Hartley guinea pigs. PROCEDURES: Guinea pigs were anesthetized, intubated, and had an abdominal insufflation catheter placed. A baseline abdominal CT scan was performed. Guinea pigs underwent insufflation, with each IAP given in a random order for 10 to 15 minutes with a washout period of 5 minutes between pressures. Abdominal CT scans were acquired at each IAP and at each recumbency. Pneumoperitoneal volumes were calculated using software. RESULTS: Increases in IAP increased working space significantly (P < .001). The 6- and 8-mm Hg pressures increased working space from 4 mm Hg by 7.3% and 19.8%, respectively. Recumbent positioning (P = .60) and body weight (P = .73) did not affect working space. Order of IAP had a significant (P = .006) effect on working space. One of the guinea pigs experienced oxygen desaturation and bradycardia at 6- and 8-mm Hg IAP. CLINICAL RELEVANCE: Although an increased working space occurred at 6 and 8 mm Hg compared to 4 mm Hg, further research is needed concerning the cardiovascular effects of pneumoperitoneum in guinea pigs to determine whether those higher IAPs are safe in this species. An IAP of 6 mm Hg can be considered for laparoscopic cannula placement, followed by a lower IAP for laparoscopic procedures.

Effect of pneumoperitoneum on gastrointestinal motility, pain behaviors, and stress biomarkers in guinea pigs (Cavia porcellus).

OBJECTIVE: To compare stress markers, gastrointestinal motility, and behavioral indicators of pain between guinea pigs undergoing pneumoperitoneum with carbon dioxide (CO2) and control guinea pigs. ANIMALS: Fourteen 4- to 5-month-old intact female Hartley guinea pigs. PROCEDURES: Guinea pigs were randomized to receive insufflation or serve as controls (anesthesia and abdominal catheter placement without insufflation), with 7 animals/group. Insufflated animals underwent 6 mm Hg of CO2 pneumoperitoneum for 30 minutes. Afterward, results for vital signs, blood glucose, fecal cortisol, appetite, fecal output, and behaviors (via video recording) were compared between the 2 groups. RESULTS: There was no difference between groups and over time for body temperature, heart rate, fecal output in grams, pellets consumed, blood glucose, and fecal cortisol. Guinea pigs that underwent insufflation had significantly more fecal pellets at 36 hours after the procedure. Several behaviors were expressed similarly between groups and over time, such as body turns, incomplete movement, rearing, lying down, drinking, and hiding. Coprophagy occurred less often in the insufflated versus noninsufflated group at 12 h postprocedure but was similar between groups at other time points. At 60 hours after the procedure, insufflated animals spent less time squinting compared to noninsufflated animals. Other behaviors were differentially expressed over time but not between treatments. CLINICAL RELEVANCE: Overall, there were no major differences in appetite, stress markers, and behaviors between insufflated and control guinea pigs. CO2 insufflation did not appear to cause undue pain or stress in guinea pigs and may be a reasonable technique to use during laparoscopy.

Pneumoperitoneum as an uncommon complication after an axillary laceration in a horse.

Lacerations of the axillary region occur frequently in horses. Typical complications caused by entrapment of air in the wound during locomotion are subcutaneous emphysema, with consecutive pneumomediastinum and pneumothorax. In this case report, the clinical, radiographic and laboratory diagnosis and management of these complications after an axillary laceration that finally resulted in pneumoperitoneum are described. A 1-year-old Hannoveranian was presented with a pre-existing axillary laceration of unknown duration and subcutaneous emphysema in the surrounding tissue. Due to extensive tissue loss, attempts to adequately close the wound surgically and by packing with sterile dressing material were unsuccessful. Despite stall confinement and tying of the horse, subcutaneous emphysema was progressive and pneumomediastinum as well as pneumothorax was developed. These complications were monitored radiographically. On day 5 after admission, signs of air accumulation were detected on radiographs craniodorsally in the peritoneum and a pneumoperitoneum was diagnosed. Repeated thoracentesis with a teat cannula to gradually evacuate the thoracic cavity was used in combination with nasal oxygen insufflation to treat global respiratory insufficiency. Subcutaneous emphysema and all other complications resolved progressively and the horse was discharged from the hospital 21 days after admission when the axillary wound was adequately filled with granulation tissue. The wound healed fully 1 month later and the horse did not develop long-term complications within the following year. To the authors´ knowledge, the development of pneumoperitoneum including its radiographic monitoring following an axillary laceration has not been described in horses previously.

Emphysematous Cystitis and Pneumoperitoneum in a Dog with Escherichia coli Urinary Tract Infection and Hyperadrenocorticism.

A 9 yr old male neutered Staffordshire bull terrier with a history of poorly controlled hyperadrenocorticism, urinary tract infections, and emphysematous cystitis (EC) was presented to a veterinary referral teaching hospital for vomiting. Abdominal radiographs revealed EC and a pneumoperitoneum. The urinary bladder was found to be intact based on ultrasound and a pre- and postiohexol contrast computed tomography study with retrograde contrast cystogram. Urine culture confirmed the presence of a recurrent Escherichia coli urinary tract infection. The patient was managed medically, primarily as an outpatient, and had complete resolution of all problems. This case represents an extremely rare form of EC with pneumoperitoneum, without evidence of concurrent urinary bladder rupture. Only six similar cases have been reported in humans, with no previous cases reported in veterinary medicine. This case demonstrated that surgery is not necessarily indicated in all cases of pneumoperitoneum. The patient remained alive at 2 mo follow-up, with no evidence of recurrence of EC.

Spontaneous emphysematous splenitis: Radiographic and ultrasonographic findings in three Golden Retriever dogs.

Spontaneous emphysematous splenitis is a life-threatening condition reported rarely in humans; however, published reports in dogs are currently lacking. The aim of this multicentric, retrospective, case series design study was to describe radiographic and ultrasonographic imaging findings in Golden Retriever dogs diagnosed with spontaneous emphysematous splenitis. A total of three dogs were sampled. All dogs had a history of lethargy, diarrhea, and weight loss. Radiographic findings in all dogs included a mass effect with focal or multifocal coalescing "vesicular-like" gas pattern in the splenic region and focal loss of serosal detail. Ultrasonographic findings in all dogs included focal or multifocal irregularly shaped, hypoechoic areas containing a mixture of hyperechoic fluid and gas within the splenic parenchyma, hyperechoic abdominal free fluid, and generalized hyperechoic mesenteric fat without evidence of splenic torsion. Pneumoperitoneum was detected ultrasonographically and radiographically in two dogs. All three dogs underwent splenectomy and splenic torsion was definitively ruled out at surgery. One dog died three days after surgery, whereas the other two dogs recovered uneventfully. Culture of the splenic tissue and free abdominal fluid was positive for Clostridium spp. in all three cases. Findings supported inclusion of spontaneous emphysematous splenitis and septic peritonitis as differential diagnoses for dogs with this combination of clinical and imaging characteristics.

Cardiovascular and respiratory effects of carbon dioxide pneumoperitoneum in the domestic rabbit (Oryctolagus cuniculus).

The objective of this study was to evaluate the effect of intra-abdominal pressure (IAP) on cardiorespiratory parameters during pneumoperitoneum with carbon dioxide in domestic rabbits. Six juvenile female New Zealand white rabbits were assigned to randomized sequences of IAP (0, 4, 8 mmHg) in a crossover study. The following parameters were measured at each IAP: direct arterial blood pressure (ABP); cardiac output, (CO), cardiac index, and stroke volume index (CI, SVI); heart rate; end-tidal carbon dioxide (ETCO2); arterial blood gases (PaCO2, PaO2); peak inspiratory pressure (PIP); and peripheral oxygen saturation (SpO2). Between IAPs, the abdomen was desufflated for a 5-minute washout period. Mixed linear regression models were used for statistical analysis. Heart rate, SpO2, and ABP were not significantly affected by IAP, although there was a positive increase in ABP with IAP. Partial pressure of carbon dioxide (PaCO2) was increased at an IAP of 8 mmHg and ETCO2 and PIP were greater with each IAP applied. Cardiac output and CI were significantly decreased with IAP and, although SVI showed the same trend, it was not statistically significant. In conclusion, pneumoperitoneum with carbon dioxide causes an increase in ETCO2, PaCO2, and PIP, whereas cardiac output and CI decrease. These cardiorespiratory changes should be considered when determining the optimal IAP for laparoscopic procedures in rabbits.

L'effet de différentes pressions intra-abdominales (IAP) sur les paramètres cardiorespiratoires durant un pneumopéritoine à CO2 a été évalué sur 6 femelles lapins néo-zélandais. Les lapins furent assignés à des séquences aléatoires d'IAP (0, 4, 8 mmHg) dans une étude croisée. Les paramètres suivants furent mesurés à chaque IAP : pression artérielle directe (ABP), débit cardiaque, indice de volume systolique et cardiaque (SVI, CI), fréquence cardiaque, CO2 de fin d'expiration (ETCO2), gaz sanguins artériels (PaCO2, PaO2), pic de pression inspiratoire (PIP) et saturation en oxygène (SpO2). Entre chaque IAP, l'abdomen était dégonflé pendant une période de 5 minutes. Des modèles de régression linéaire mixte ont été utilisés pour l'analyse statistique. La fréquence cardiaque, le SpO2, et l'ABP ne furent pas affectés significativement par l'IAP, bien qu'il y eût une augmentation de l'ABP avec l'IAP. La PaCO2 était augmentée a une pression de 8 mmHg et le ETCO2 et le PIP augmentaient avec chaque pression. Le débit cardiaque et le CI étaient significativement diminués avec une augmentation de l'IAP et, bien que le SVI montraient la même tendance, ces baisses n'étaient pas statistiquement significatives. En conclusion, un pneumopéritoine avec du CO2 entraine une augmentation de la ETCO2, du PaCO2, et du PIP, alors que le débit cardiaque et la CI diminuent. Ces changements cardiorespiratoires doivent être pris en compte pendant la détermination de la pression intra-abdominale optimale à utiliser pour des chirurgies laparoscopiques chez le lapin.(Traduit par les auteurs).

Large-volume pneumoperitoneum and septic peritonitis secondary to splenic abscess rupture in a dog.

An 11-year-old spayed female American pit bull terrier mixed breed dog was presented because of hyporexia and abdominal distension. The dog had large-volume free peritoneal gas on imaging and septic neutrophilic exudate on abdominocentesis. Exploratory laparotomy revealed a ruptured splenic mass draining purulent material. A splenectomy was performed and the abdomen was lavaged. Culture samples grew an anaerobic Gram-positive rod. The dog was discharged 4 days after surgery with no residual problems noted 1 week later. To our knowledge, this is the first report of large-volume pneumoperitoneum and septic peritonitis secondary to rupture of a splenic abscess.

Pneumopéritoine de grand volume et péritonite septique secondaire à la rupture d'un abcès splénique chez un chien. Une chienne stérilisée de race pitbull terrier américain croisée âgée de 11 ans fut présentée à cause d'hyporexie et de distension abdominale. Lors de l'examen par imagerie on nota un large volume de gaz péritonéal libre et un exsudat neutrophilique septique lors de l'abdominocenthèse. Une laparotomie exploratoire révéla une masse splénique rupturée qui drainait du matériel purulent. Une splénectomie fut réalisée, et l'abdomen fut soumis à un lavage. La culture d'échantillons permis la croissance d'un bâtonnet à Gram-positif anaérobie. Le chien reçu son congé 4 jours après la chirurgie et aucun problème résiduel ne fut noté 1 semaine plus tard. À notre connaissance il s'agit du premier rapport d'un pneumopéritoine de grand volume et de péritonite septique secondaire à la rupture d'un abcès splénique chez un chien.(Traduit par Dr Serge Messier).

The left lateral projection is comparable to horizontal beam radiography for identifying experimental small volume pneumoperitoneum in the canine abdomen.

Nontraumatic spontaneous pneumoperitoneum suggests the presence of gastrointestinal perforation; early detection can be lifesaving. Horizontal beam projections have been reported to be more sensitive than standard radiographic views for detecting small volumes of free peritoneal gas. This prospective, experimental, analytical study compared both left lateral (LL) and ventrodorsal (VD) standard views to horizontal beam projections for detecting small volumes of artificially induced pneumoperitoneum in live dogs. The effect of radiology training on accurate detection of small amounts of free peritoneal air was also assessed. Fourteen dogs had four radiographic projections taken after injection of 0, 2.5, 5, and 10 mL of cumulative air into their abdominal cavities. Radiographs were interpreted individually by three American College of Veterinary Radiology-certified radiologists and three small animal internship-trained veterinarians who were blinded to the air volume injected. At 2.5 and 10 mL of air injected, the LL projection had highest odds of an accurate response (odds ratio [OR] = 2.4 and 99.0 when compared to VD horizontal and VD projections, respectively). At 5 mL of air injected, the lateral horizontal (LH) projection had the highest odds of an accurate response (OR = 3.2 compared to VD horizontal). The LL projection was not significantly different from the LH projection at all volumes of air injected. Board certification led to higher odds of accurate responses at volumes of 5 (OR = 2.2) and 10 mL (OR = 3.6), as compared to nonspecialist veterinarians. Overall, LH and standard LL appeared to be the most useful radiographic projections for detection of small amounts of free peritoneal gas.

Nonsurgical management of traumatic pneumoperitoneum in a cat.

OBJECTIVE: To describe the nonsurgical management of a cat with traumatic pneumoperitoneum. CASE SERIES SUMMARY: A 4-year-old cat was presented following vehicular polytrauma. Thoracic radiographs revealed 4 rib fractures, a scapular fracture, and pneumothorax. Abdominal ultrasound revealed a small volume of free abdominal fluid. Computed tomography showed a mild pneumoretroperitoneum and a pneumoperitoneum in the region of the porta hepatis. The cat was managed conservatively with close monitoring. Exploratory laparotomy was not pursued given patient stability and static serial imaging studies revealing no indications for surgical intervention. After 6 days, the pneumoperitoneum was no longer detectable. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first report of successful nonsurgical management of traumatic pneumoperitoneum in a cat.

Avaliação do fluxo de saída do ventrículo esquerdo em gatos anestesiados submetidos ao pneumoperitônio e à posição deTrendelenburg / Evaluation left ventricle Outflow in cats anesthetized submitted to pneumoperitoneum and Trendelenburg position

Objetivou-se avaliar os efeitos do pneumoperitônio e da posição de Trendelenburg sobre o fluxo de saída do ventrículo esquerdo em gatos anestesiados. Quatorze gatos foram alocados aleatoriamente em dois grupos, ambos submetidos ao pneumoperitônio com 10mmHg de dióxido de carbono (CO2). No grupo controle (GC n=7), os animais foram submetidos apenas ao pneumoperitônio e, no grupo Trendelenburg (GTREN n=7), os animais foram colocados em cefalodeclive 20° após o pneumoperitônio. A indução anestésica foi realizada com isoflurano, utilizando-se caixa de indução. Posteriormente, os animais foram mantidos sob anestesia inalatória com o mesmo fármaco. Foram avaliados a velocidade do fluxo de saída do ventrículo esquerdo (VFSVE), os gradientes máximo (GmáxSVE) e médio (GmédSVE) de pressão e a integral velocidade-tempo (IVT). Os parâmetros foram mensurados nos momentos T0 (basal), antes da insuflação; T5 (cinco), T15 (quinze) e T30 (trinta) minutos após a insuflação. Os resultados mostraram um aumento da VFSVE no GC, em T15 e T30 (P=0,024), e um aumento do GmáxSVE no GC, em T30 (P=0,045). As variáveis não se alteraram significativamente em nenhum momento no GTREN. Dessa forma, conclui-se que a posição de Trendelenburg favoreceu o sistema cardiovascular, preservando os índices de fluxo sanguíneo na saída do ventrículo esquerdo.(AU)

The aim of this study was to evaluate the effects of pneumoperitoneum and Trendelenburg position on the left ventricular outflow in anesthetized cats. Fourteen cats were randomly divided into two groups, both submitted to pneumoperitoneum of 10 mmHg with carbon dioxide (CO2), and in the control group (GC n = 7) the animals were subjected only to pneumoperitoneum and the Trendelenburg group (n = 7 GTREN) the animals were placed in cefalodeclive 20° after pneumoperitoneum. Anesthesia of the animals was performed with isoflurane using induction box, keeping the animals under inhalation anesthesia with the same drug. We evaluated the speed of the left ventricular outflow (VFSVE), the maximum pressure gradient (GmáxSVE), mean pressure gradient (GmédSVE) and velocity-time integrals (IVT). The parameters were measured in time, T0 (baseline), before the insufflation; T5 (five); T15 (fifteen) and T30 (thirty) minutes after inflation. The results showed an increase in VFSVE in GC, T15 and T30 (p = 0,024) and an increase in GmáxSVE in GC in T30 (p = 0,045). The variables did not change significantly at any time in GTREN. Thus, it is concluded that the Trendelenburg position favored the cardiovascular system, preserving blood flow rates in the left ventricular outflow.(AU)

Accuracy of sonographic diagnosis of pneumoperitoneum using the enhanced peritoneal stripe sign in Beagle dogs.

The objective of this study was to evaluate the feasibility and accuracy of estimating the smallest amount of abdominal free gas detectible in a large population of Beagles by ultrasonography. Healthy dogs were randomly divided into three groups: group A that received 0.1 mL of air injected into the peritoneal cavity, group B that received 0.2 mL of air injected into the peritoneal cavity, and group C that received 0.5 mL of intraperitoneal air. Randomly, some dogs in each group did not receive air injection for the negative control. All ultrasonographic procedures were performed by individuals blinded to group assignments and the presence of intraperitoneal air. The minimum volume of consistently detectable air with good accuracy and reliability was 0.2 mL. Results of the study demonstrated that the enhanced peritoneal stripe sign (EPSS) can verify cases of pneumoperitoneum if more than 0.2 mL of intra-abdominal free gas is present The EPSS is a reliable and specific ultrasonographic characteristic for diagnosing pneumoperitoneum in dogs.

Conservative management of pneumothorax and pneumoperitoneum in two Florida manatees (Trichechus manatus latirostris).

Two distressed Florida manatees (Trichechus manatus latirostris) were reported to the Florida Fish and Wildlife Conservation Commission. The first animal was determined to be an abandoned, emaciated calf. The second animal was a nursing calf that had sustained watercraft-related trauma. Both animals were captured and transported to Tampa's Lowry Park Zoo, where diagnostic evaluations, including physical examinations, blood work, computed tomography (CT), and radiographs were performed. Radiograph and CT scans identified the presence of free air within the pleural and abdominal cavities of both animals. Based on the lack of substantial findings in the first animal and a rapid resolution of clinical signs in the second animal, both animals were managed conservatively. This report documents simultaneous pneumothorax and pneumoperitoneum, the associated clinical and diagnostic findings, and conservative medical management of these conditions in the Florida manatee.

Sonographic detection of small amounts of free peritoneal gas in beagle dogs.

The detection of small amounts of free peritoneal gas in the canine patient can pose a diagnostic dilemma. The objective of this study was to determine how much of this free gas could be detected ultrasonographically. Ultrasound examinations were carried out after increments (0.1 ml) of air were intraperitoneally injected. Via ultrasonography, 0.4 ml of free gas can be reliably detected. The authors concluded that ultrasonography is a very sensitive modality for the detection of small amounts of peritoneal free gas (above 0.4 ml).

Colonic, ureteral, and vascular injuries secondary to stick impalement in a dog.

OBJECTIVE: To report the surgical repair, case management, and outcome of a dog with sepsis and severe intraabdominal trauma secondary to a penetrating stick injury. CASE OR SERIES SUMMARY: A 1.5-year-old, spayed female, mixed-breed dog was presented to the emergency service after incurring a small laceration on the medial aspect of the left pelvic limb while running in the woods. The wound was surgically explored and a primary closure achieved. The patient was discharged the same day with oral antimicrobial therapy. The following morning the dog was represented to the emergency service for acute vomiting. Abdominal radiographs were performed and demonstrated loss of serosal detail and pneumoperitoneum. An emergency celiotomy was performed and revealed distal colonic perforation, left ureteral laceration, and lacerations of the left common iliac vein. Ureteronephrectomy, as well as primary closure of the distal colonic perforation and left common iliac vein lacerations, were performed. The patient recovered and was ultimately discharged from the hospital 5 days later. Follow-up 1 year later revealed no significant physical exam or biochemical abnormalities. NEW OR UNIQUE INFORMATION PROVIDED: A seemingly benign penetrating stick injury initially deemed to be superficial in nature was later demonstrated to have resulted in sepsis following severe intraabdominal trauma that included lacerations of the distal colon, left ureter, and left common iliac vein in a dog. Successful surgical management and intensive care led to a full recovery without any residual impairment noted a year later.