MVSC CLINCIAL CLUB 24TH MARCH 2010
Case One
This dog is an 8yo entire male that presented with tenesmus and a perineal bulge.
1.1
What is your likely diagnosis?
Perineal hernia
1.2
Name THREE methods of surgical repair
Standard repair with sutures between anal sphincter, medial coccygeus and levator ani
Transposition of the internal obturator
Use of SIS (Biosyst)
1.3
What is the structure being grasped with the deBakey forceps?
Internal obturator muscle
1.4
List THREE complications from surgery
Recurrence
Ongoing tenesmus
Incisional infection
Sciatic nerve entrapment
Incontinence
1.5
What is the “two step” approach that can be used with “complicated cases” that
have bladder entrapment?
1. Colopexy and cystopexy
2. Perineal hernia repair
Case Two
9 year old spayed female British Shorthair
Multiple seizures over a three day period. The owner reported that the cat had been
mentally dull since a dental cleaning was performed 2 months previously. At presentation
there was a history of seizures, generalized weakness and anorexia
2.1
What is your likely diagnosis?
CNS mass
2.2
Describe the MRI findings
The images showed a contrast-enhancing mass on the right cortex. The mass is causing
compression and edema of the underlying cortex. The overlying skull showed evidence
of bone loss
2.3
What is your likely diagnosis?
Cerebral meningiona
2.4
What is cerebral vascular autoregulation?
Preservation of intracranial pressure despite variances in arterial blood pressure (between
MABP of 50 and 150 mmHg)
2.5
What is the effect of increased PaCO2 on cerebral blood flow?
Increased PaCO2 causes the cerebral vessels to dilate and increases CBF
2.6
What is the surgical approach?
Lateral rostrotentorial craniotomy
2.7
What is the expected survival time from surgery?
22 months
Case Three
2 year old Border Terrier with an acute history of drooling and regurgitation.
3.1
Describe the radiographic abnormality in “A”
Radiolucent foreign body in the caudal oesophagus at the oesophageal hiatus
3.2
What is your management of this case based on radiograph “A”?
Attempt non surgical removal via oesophagoscopy, if unsuccessful then thoracotomy
3.3
What are the indications for a thoracotomy?
Unsuccessful removal via non surgical means
Perforation of the oesophagus
Presence of a very sharp foreign body that risks laceration of the oesophagus on removal
Severe pressure necrosis of wall of oesophagus
Radiographs “B” and “C” were taken 3 days post surgery.
3.4
What is your diagnosis?
Pleural effusion secondary to likely dehiscence of the oesophagotomy incision with
pyothorax
3.5
What are the factors that negatively affect wound healing in the oesophagus?
No serosal covering (only adventitia)→ poor fibrin seal
Segmental blood supply but does have intramural anastomosing vasculature
No omentum to seal leaks
Difficult exposure especially thoracic, difficult to mobilize
Movement of food and saliva, respirations- constant motion and distension
Poorly tolerant of longitudinal stretching and tension- may result in post operative strictures,
will tolerate distension alone
Fixed nature makes it difficult to avoid tension at the surgical site
3.6
What is the preferred means of closing an oesophagotomy?
Double layer simple interrupted- first layer mucosa/submucosa and second layer in the
muscularis
Simple interrupted absorbable incorporating muscularis, mucosa and submucosa
Case Four
The picture on the left is a canine pelvis following a road traffic accident and the slide on
the right is a post operative radiograph following surgical repair
4.1
Describe the radiograph on the LEFT
Right SI luxation, pubic and ischial fractures
4.2
What are the indications for surgical repair of this condition
Neurologic dysfunction
Marked instability and displacement
Obstruction of pelvic canal due to medial displacement of caudal fragment
Bilateral instability
Complex injuries with involvement of contralateral limb
Improve prognosis for a normal gait- restore the weight bearing axis
4.3
Describe the landmarks used to position the lag screw used for this repair
1) Notch in the cranial adge of rhe sacral wing- sacral body always located just caudal to
this notch
2) Draw a line from point A- the most craniodorsal point of the sacral wing to point Bventral most aspect of the sarcal wing- landmark for screw is 60% along this line from
point A, screw placement just caudal to the line AB (just caudal to the notch in the cranial
edge of the sacral wing and at a distance of about 60% of sacral wing height, measured
from the dorsal edge of the sacral wing)
4.4
What structures should be avoided?
Important to avoid neural canal, IV disc space, pelvic foramina then thin ventral wing of
the sacrum and to ensure rigid fixation of the screw
4.5
60%
What is the ideal “cumulative” screw length for screw placement?
Case Five
11 year old castrated male Jack Russell Terrier
Presented with a history of a sore mouth-owner noticed his teeth seemed wobbly and
loose, PU/PD, he has also been a little “shaky” and “tremory” over the last month or so
5.1
What is your next diagnostic step(s)?
Blood work
5.2
•
•
•
The blood results revealed :
Hypercalcaemia 4.2mmol/L (1.9-2.9)
↑ Urea 22.3 (2.5-10)
↑ Creatinine 0.17 (0.05-0.15)
What is your next diagnostic step(s)?
PTH assay, PTHrp, cervical ultrasound, abdominal ultrasound, thoracic radiographs
5.3
What are the differential diagnoses for hypercalcaemia in the dog?
Primary hyperparathyroidism
Hypercalcemia of malignancy
Addisons
Hypervitaminosis D
Renal secondary hyperparathyroidism
Inflammatory/granulomatous disease
Primary hyperplasia of the parathyroid glands
5.4
What are the treatment options in this case?
Percutaneous/ultrasound guided ablation- RF heat ablation or chemical ablation (ethanol)
Cervical exploratory and excision
5.5 What is the most common post operative complication?
Hypocalcaemia