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Boullenger J, Lafuma F, Baudin Trehiou C, Blond L, Gibert S, Kulendra N. Transmural migration of a subcutaneous ureteral bypass into the intestine in three cats. J Small Anim Pract 2022; 63:792-796. [PMID: 35419828 DOI: 10.1111/jsap.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
Subcutaneous ureteral bypass™ is a device placed in cats with ureteral obstruction. The most common complications include system occlusion, urinary tract infection and sterile cystitis. In this case series, we describe three cats with subcutaneous ureteral bypass devices placed where transmural migration of subcutaneous ureteral bypass catheters into the small intestine resulted in gastrointestinal signs, urinary infection and subcutaneous ureteral bypass occlusion. The system was changed in one case and removed in the other two. In all cases, an intestinal resection and anastomosis was performed. All cats had a good medium-term outcome, and urinary infection persisted in the case for which the subcutaneous ureteral bypass system was changed. Transmural migration of the device should be considered in cats with subcutaneous ureteral bypass presenting with persistent urinary tract infection, gastrointestinal signs or device obstruction, even if imaging studies such as ultrasound or contrast studies do not demonstrate any abnormalities.
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Affiliation(s)
- J Boullenger
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - F Lafuma
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - C Baudin Trehiou
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - L Blond
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - S Gibert
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - N Kulendra
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK.,Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, Hertfordshire, AL97TA, UK
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Garcia-Pertierra S, Das S, Burton C, Barnes D, Murgia D, Anderson D, Kulendra N, Harris K, Forster K. Surgical management of intrathoracic wooden skewers migrating from the stomach and duodenum in dogs: 11 cases (2014-2020). J Small Anim Pract 2022; 63:403-411. [PMID: 35083753 PMCID: PMC9303292 DOI: 10.1111/jsap.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/08/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
Objectives To describe the clinical presentation, management and outcome of cases presenting with intrathoracic wooden skewers originating from the abdominal gastrointestinal tract. Materials and Methods Clinical records of dogs presented and treated for an intrathoracic wooden skewer were reviewed from June to August 2020. Data included signalment, clinical presentation, duration of clinical signs, haematological and biochemical abnormalities, diagnostic imaging findings, surgical procedure, postoperative complications and outcome. Results Eleven dogs were included in the study. In all cases, the foreign body was identified as a wooden skewer. The most common clinical signs were anorexia/hyporexia (n=7), vomiting/regurgitation (n=7), lethargy (n=6), pyrexia (n=4) and gait abnormalities/lameness (n=3). CT correctly identified a wooden skewer in all cases when performed (n=7). A coeliotomy combined with transdiaphragmatic thoracotomy was performed in six of 11 cases (55%), a coeliotomy combined with median sternotomy in four of 11 cases (36%) and a median sternotomy alone was performed in one case. Foreign bodies penetrated from the stomach (n=10) or the duodenum (n=1). Intrathoracic trauma was most commonly identified to the lungs (n=3) and pericardium (n=3). Complications occurred in three of 11 cases (27%), two minor and one resulting in death. Ten of the 11 cases (91%) survived to discharge. Long‐term outcome was available for seven of 11 cases (66%), all of them excellent. Clinical Significance Despite the challenges of managing wooden skewers penetrating the thoracic cavity from the abdominal gastrointestinal tract, the majority of the patients are stable to undergo diagnostic procedures, surgical exploration and management with low morbidity and excellent short‐ and long‐term prognosis.
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Affiliation(s)
- S Garcia-Pertierra
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and Roslin Institute, Midlothian, EH25 9RG, UK
| | - S Das
- Davies Veterinary Specialists, Hertfordshire, SG5 3HR, UK
| | - C Burton
- Davies Veterinary Specialists, Hertfordshire, SG5 3HR, UK
| | - D Barnes
- Dick White Referrals, Cambridge, CB8 0UH, UK
| | - D Murgia
- Dick White Referrals, Cambridge, CB8 0UH, UK
| | - D Anderson
- Anderson Moores Veterinary Specialists, Hampshire, SO21 2LL, UK
| | - N Kulendra
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK
| | - K Harris
- Southern Counties Veterinary Specialists, Hampshire, BH24 3JW, UK
| | - K Forster
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK
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Forster K, Cutando LS, Ladlow J, Anderson D, Burton C, Das S, Gibson S, Kulendra N, Emmerson T, Baines S, Rutherford L, Paulino RD, Fontanini R, Compagnone K, De La Puerta B. Outcome of caudal superficial epigastric axial pattern flaps in dogs and cats: 70 cases (2007-2020). J Small Anim Pract 2021; 63:128-135. [PMID: 34937131 DOI: 10.1111/jsap.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the outcome and complications associated with the use of caudal superficial epigastric axial pattern flaps in dogs and cats. MATERIAL AND METHODS Multicentre retrospective review and descriptive study of clinical records of dogs and cats having undergone caudal superficial epigastric axial pattern flaps between 2007 and 2020. Data retrieved included signalment, aetiology of surgical defect, tumour type, presence/absence of clean surgical margins, presence/absence of post-operative wound infection, use of peri- and post-operative antibiotics, duration of anaesthesia, duration of surgery, presence and duration of hypothermia, presence and duration of hypotension, presence/absence of post-operative surgical drain and length of caudal superficial epigastric axial pattern flap. The incidence of complications and outcomes were documented. RESULTS Seventy cases met the inclusion criteria; 51 dogs and 19 cats. In dogs, 67% of cases developed complications (59% minor, 8% major) and 33% had uneventful wound healing. In cats, 53% of cases developed complications, (47% minor, 5% major) and 47% had uneventful wound healing. In dogs, the percentage of cases experiencing dehiscence, necrosis, seroma, oedema and post-operative infection was 31%, 29%, 26%, 26% and 16% respectively. In cats, this was 26%, 16%, 11%, 0% and 5% respectively. A good overall outcome was seen in 77% of dogs and 79% of cats. A poor overall outcome was seen in 4% of dogs and 0% of cats. CLINICAL SIGNIFICANCE Caudal superficial epigastric axial pattern flaps are traditionally thought more robust than other flaps, yet complication rates remain high, despite a high overall success rate.
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Affiliation(s)
- K Forster
- North Downs Specialist Referrals, The Friesian Buildings 3 and 4, Bletchingley RH1 4QP, UK
| | - L S Cutando
- The Ralph Veterinary Referral Centre, Fourth Avenue Globe Business Park, Marlow SL7 1 YG, UK
| | - J Ladlow
- Hamilton Specialist Referrals, Cressex Business Park, High Wycombe HP12 3SD, UK
| | - D Anderson
- Anderson Moores, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire, SO21 2LL, UK
| | - C Burton
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, SG5 3HR, UK
| | - S Das
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, SG5 3HR, UK
| | - S Gibson
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, SG5 3HR, UK
| | - N Kulendra
- North Downs Specialist Referrals, The Friesian Buildings 3 and 4, Bletchingley RH1 4QP, UK
| | - T Emmerson
- North Downs Specialist Referrals, The Friesian Buildings 3 and 4, Bletchingley RH1 4QP, UK
| | - S Baines
- Willows Veterinary Centre and Referral Service, Shirley, Solihull, West Midlands B90 4NH, UK
| | - L Rutherford
- The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - R D Paulino
- Dick White Referrals, Station Farm, Six Mile Bottom, Cambridge, CB8 0UH, UK
| | - R Fontanini
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and Roslin Institute, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - K Compagnone
- Northwest Veterinary Specialists, Delamere House, Ashville Point, Beechwood, Sutton Weaver, Runcorn WA7 3FW, UK
| | - B De La Puerta
- North Downs Specialist Referrals, The Friesian Buildings 3 and 4, Bletchingley RH1 4QP, UK
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Hattersley R, Downing F, Gibson S, Demetriou J, Elmenhorst K, Kulendra N, Mielke B, Woods S. Impact of intra-operative hypotension on mortality rates and post-operative complications in dogs undergoing cholecystectomy. J Small Anim Pract 2020; 61:624-629. [PMID: 32845022 DOI: 10.1111/jsap.13199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To report the mortality rate within a cohort of dogs undergoing cholecystectomy and investigate the impact of intra-operative hypotension on mortality. MATERIALS AND METHODS Clinical records at five UK referral centres were reviewed for dogs undergoing cholecystectomy. Data collected included presenting signs, pre-operative blood test results, intra-operative data including frequency and duration of hypotension and the incidence and type of post-operative complications. RESULTS Data from 119 dogs were included. Sixteen dogs (13%) died before discharge and by 28 days after surgery the total mortality was 19 dogs (17%). Hypotension lasting over 10 minutes during general anaesthesia occurred in 65 dogs (54.6%), with a mean ± sd duration of 36.1 ± 30.0 minutes. Intra-operative hypotension or the number of hypotensive episodes did not appear to be associated with in-hospital or 28-day mortality. American Society of Anaesthesiologists grade (of fitness for surgery) was significantly associated with both in-hospital and 28-day mortality on univariable analysis, as were post-operative hypoproteinaemia, ileus and pancreatitis. However on multivariable analysis, only ileus and pancreatitis were found to significantly impact mortality. CLINICAL SIGNIFICANCE Dogs presenting with a higher American Society of Anaesthesiologists grade appear to have a higher risk of mortality, although intra-operative hypotension did not appear to be part of this risk.
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Affiliation(s)
| | - F Downing
- Davies Veterinary Specialists, Hertfordshire, UK
| | - S Gibson
- Davies Veterinary Specialists, Hertfordshire, UK
| | | | - K Elmenhorst
- Anderson Moores Veterinary Specialists, Hampshire, UK
| | - N Kulendra
- North Downs Specialist Referrals, Surrey, UK
| | - B Mielke
- Royal Veterinary College, Hertfordshire, UK
| | - S Woods
- Veterinary Specialists Scotland, Livingston, UK
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Dirrig H, Lamb CR, Kulendra N, Halfacree Z. Diagnostic imaging observations in cats treated with the subcutaneous ureteral bypass system. J Small Anim Pract 2019; 61:24-31. [PMID: 31592537 DOI: 10.1111/jsap.13071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe pre- and post-operative ultrasonographic and fluoroscopic findings, including any abnormalities, in cats treated for ureteral obstruction with a subcutaneous ureteral bypass system. METHODS Retrospective review of imaging findings in cats with ureteral obstruction that had surgery to place the first version of the bypass system and at least one follow-up ultrasound or fluoroscopic study. Pre- and post-operative renal pelvic diameter on ultrasound, fluoroscopic appearance of the bypass system and any related abnormality were recorded. RESULTS Eighty-one cats were included (47 unilateral, 34 bilateral bypass systems). Median preoperative renal pelvic diameter was 9 mm (range 3 to 28 mm) and median renal pelvic diameter at the first postoperative ultrasound was 3 mm (range 2 to 23 mm). The median number of postoperative imaging studies was two (range 1 to 8) and the median follow-up period after surgery was 205 days (range 1 to 1378 days). Bypass system abnormalities were identified postoperatively in 43 (53%) cats, including nephrostomy or cystostomy catheter blockage due to an undetermined cause or kinking of the catheter, nephrostomy or cystostomy catheter leakage, non-obstructive kinking of the catheter and loose nephrostomy pig-tail loop. Many abnormalities required repeat surgery, but others were managed conservatively. Fifty-four percent of obstructed ureters became patent after bypass placement, although the majority remained slightly dilated or had irregular margins compatible with chronic inflammation. CLINICAL SIGNIFICANCE Bypass abnormalities, mainly tube blockage, occurred frequently in cats treated for ureteral obstruction. Ultrasonography and fluoroscopy were useful for postoperative examination, including documenting renewed ureteral patency and investigation of suspected abnormalities.
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Affiliation(s)
- H Dirrig
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - C R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - N Kulendra
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK
| | - Z Halfacree
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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Sajik D, Meeson RL, Kulendra N, Jordan CJ, James D, Calvo I, Farrell M, Kulendra E. Multi‐centre retrospective study of long‐term outcomes following traumatic elbow luxation in 37 dogs. J Small Anim Pract 2016; 57:422-8. [DOI: 10.1111/jsap.12499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/26/2016] [Accepted: 02/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- D. Sajik
- The Queen Mother Hospital for Animals, The Royal Veterinary College Hatfield Hertfordshire AL9 7TA
| | - R. L. Meeson
- The Queen Mother Hospital for Animals, The Royal Veterinary College Hatfield Hertfordshire AL9 7TA
| | - N. Kulendra
- The Queen Mother Hospital for Animals, The Royal Veterinary College Hatfield Hertfordshire AL9 7TA
| | - C. J. Jordan
- Anderson Moores Veterinary Specialists, The Granary Winchester Hampshire SO21 2LL
| | - D. James
- The Small Animal Specialist Hospital Sydney New South Wales 2113 Australia
| | - I. Calvo
- The Queen Mother Hospital for Animals, The Royal Veterinary College Hatfield Hertfordshire AL9 7TA
| | - M. Farrell
- Fitzpatrick Referrals Godalming Surrey GU7 2QQ1
| | - E. Kulendra
- The Queen Mother Hospital for Animals, The Royal Veterinary College Hatfield Hertfordshire AL9 7TA
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Proot JLJ, Nelissen P, Ladlow JF, Bowlt Blacklock K, Kulendra N, de la Puerta B, Sheahan DE. Parotidectomy for the treatment of parotid sialocoele in 14 dogs. J Small Anim Pract 2015; 57:79-83. [DOI: 10.1111/jsap.12429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/13/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - P. Nelissen
- Department of Surgery; Dick White Referrals; Newmarket Suffolk CB8 0UH
| | - J. F. Ladlow
- Queen's Veterinary School Hospital; The University of Cambridge Veterinary School; Cambridge CB3 0ES
| | - K. Bowlt Blacklock
- Department of Small Animal Surgery; Animal Health Trust; Newmarket Suffolk CB8 7UU
| | - N. Kulendra
- Department of Veterinary Clinical Sciences; The Royal Veterinary College; North Mymms Herts AL9 7TA
| | - B. de la Puerta
- Department of Small Animal Surgery; North Downs Specialist Referrals; Redhill Surrey RH1 4QP
| | - D. E. Sheahan
- Department of Small Animal Surgery; Dogwood Vets; Sale Manchester M33 6JN
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