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

Air leak syndrome in animals: definition and pathogenesis

Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes.

Use of an equine compression suit to manage a deep axillary wound in a horse

PURPOSE

To describe the use of an equine compression suit to manage a deep axillary wound in a Thoroughbred filly with bilateral pneumothorax.

CASE SUMMARY

A 2-year-old Thoroughbred filly was referred for management of a deep wound to the left axilla. Packing and bandaging of the area were initially attempted, but this became repeatedly dislodged, and bandaging was discontinued. The filly subsequently developed widespread subcutaneous emphysema, and the wound was slow to granulate. Acute onset respiratory distress occurred 11 days after admission, secondary to bilateral worsening pneumothorax, and required placement of a chest drain. A commercially available equine compression suit was then successfully used to hold a primary dressing in place. This resulted in a marked improvement in the subcutaneous emphysema and pneumothorax. Wound granulation subsequently progressed well, and the filly was discharged from the clinic on day 36.

UNIQUE INFORMATION PROVIDED

This case report highlights the potential applicability of a compression suit as an alternative to a stent to effectively prevent entry of air and successfully manage axillary wounds in the horse. It was also noted how delayed the progression of a pneumothorax can be after inadequate bandaging of a deep wound in the axillary region. The compression suit provided an alternative means of securing a dressing onto an awkwardly placed wound and may be useful in locations other than the axilla.