ESOFAGORRAFIA INTRATORÁCICA COM RETALHO DIAFRAGMÁTICO E DE OMENTO, NO TRATAMENTO DE PERFURAÇÃOEM UM CÃO

The ingestion of foreign bodies is the main cause of esophageal obstruction in dogs and cats and can affect any portion of the organ along its path. In dogs, they have a high incidence and the most commonly found objects are bones, needles, wooden sticks, rubber and plastic toys, and coins. Clinical signs typically observed are regurgitation, gagging, odynophagia, ptyalism, and dysphagia. Diagnosis is based on history, clinical signs, radiographic study, and/or endoscopy. Esophagoscopy is the treatment of choice, except when there is evidence of esophageal perforation. Foreign bodies can be surgically removed through esophagotomy, esophagectomy, or gastrotomy. Complications such as dehiscence and strictures are common after surgical interventions in the esophagus. Therefore, using techniques to aid healing and sealing, such as the mobilization of muscle and omentum flaps, may be necessary. The prognosis is favorable, becoming reserved in the presence of complications, such as esophageal perforations. This study aims to report a case of esophageal perforation secondary to a foreign body in an American Pitbull dog, emphasizing the diagnostic means and the clinical-surgical approach used to treat the condition, which proved to be effective, providing the complete recovery of the patient.A ingestão de corpos estranhos é a principal causa de obstrução esofágica em cãs e gatos, podendo acometer qualquer porção do órgão, ao longo de seu trajeto. Na espécie canina, possui incidência alta e os objetos mais comumente encontrados são ossos, agulhas, gravetos de madeira, brinquedos de borracha, plástico e moedas. Os sinais clínicos tipicamente observados são a regurgitação, engasgos, odinofagia, ptialismo e disfagia. O diagnóstico se baseia no histórico, sinais clínicos, estudo radiográfico e/ou endoscopia. A esofagoscopia é o tratamento de eleição, exceto quando há evidências de perfuração esofágica. Cirurgicamente, os corpos estranhos podem ser removidos por meio de esofagotomia, esofagectomia ou gastrotomia. Complicações como deiscência e estenoses são comuns, após intervenções cirúrgicas no esôfago. Deste modo, pode-se fazer necessário o uso de técnicas de auxílio à cicatrização e vedação, como a mobilização de retalhos musculares e de omento. O prognóstico é favorável, tornando-se reservado na presença de complicações, como perfurações esofágicas. O objetivo do presente trabalho é relatar um caso de perfuração esofágica, secundária a corpo estranho em um cão da raça Pitbull Americano, enfatizando o meio diagnóstico e a conduta clinicocirúrgica empregada, para o tratamento da afecção, a qual mostrou-se efetiva, proporcionando a completa recuperação do paciente

ESOFAGOTOMIA INTRATORÁCICA EM CÃO PARA REMOÇÃO DE CORPO ESTRANHO

Esophageal foreign bodies (EFBs) are inanimate objects that partially or completely obstruct the lumen of the esophagus. There is a higher prevalence in young dogs of small breeds, due to their less selective eating habits. However, the condition can affect dogs of any age and size. In dogs, the incidence of esophageal FBs is high, whereas in cats, it is sporadic. In cases of ingestion of an esophageal FB, animals may present clinical signs such as: lethargy, anorexia, salivation, attempted vomiting, dysphagia, choking, and difficulty swallowing. The diagnosis is based on history, clinical signs, and complementary tests such as radiography, ultrasound, and endoscopy. Regarding the treatment, FBs can be removed endoscopically, which is the treatment of choice, or by surgical approach via esophagotomy, esophagectomy or gastrotomy, however, their number is low compared to other surgical interventions in small animals. The prognosis is favorable in the absence of complications, such as esophageal perforations, and in the face of rapid intervention and diagnosis. In the present work, the objective was to report a case of intrathoracic esophagotomy to remove a FB in a male canine of the German Spitz breed, emphasizing the diagnostic method, the clinical and surgical approach adopted, and the complications observed during the treatment period for the condition. After treatment, the patient presented good clinical evolution, demonstrating that trans-diaphragmatic mobilization of the omentum associated with the gastrostomy technique was beneficial to assist and accelerate the healing of the organ.Corpos estranhos esfágicos (CEEs) são objetos inanimados que obstruem o lúmen do esôfago de forma parcial ou completa. Nota-se maior prevalência em cães jovens de raças pequenas, devido aos seus hábitos alimentares pouco seletivos. Todavia, a afecção pode acometer cães de qualquer idade e tamanho. Em cães, a incidência de CEs esofágicos é alta, já nos gatos, é esporádica. Nos casos de ingestão de um CE esofágico, os animais podem apresentar sinais clínicos como: letargia, anorexia, salivação, tentativa de vômito, disfagia, engasgos e dificuldade de deglutição. O diagnóstico se baseia no histórico, sinais clínicos e exames complementares como radiografia, ultrassonografia e endoscopia. Quanto ao tratamento, os CEs podem ser removidos endoscopicamente, sendo este o tratamento de eleição, ou pela abordagem cirúrgica via esofagotomia, esofagectomia ou gastrotomia, entretanto, sua casuística é baixa, se comparada a outras intervenções cirúrgicas em pequenos animais. O prognóstico é favorável na ausência de complicações, como perfurações esofágicas e frente à rápida intervenção e diagnóstico. No presente trabalho, objetivou-se relatar um caso de esofagotomia intratorácica para remoção de CE em um canino macho da raça Spitz Alemão, enfatizando o meio diagnóstico, a conduta clínica e cirúrgica adotada e as complicações observadas durante o período de tratamento da afecção. Após o tratamento, o paciente apresentou boa evolução clínica, demonstrando ser benéfica a mobilização trans-diafragmática do omento associada a técnica de gastrostomia, a fim de auxiliar e acelerar a cicatrização do órgão

Biliary Peritonitis in a Dog after Perforation of the Gallbladder during Laparoscopic Cholecystectomy

Background: Iatrogenic gallbladder perforation during laparoscopic cholecystectomy (LC) is a common complication and occurs in at least one third of human patients undergoing LC. This is attributed to the fragility of the gallbladder wall associated with mucocele and cholecystitis, in addition to the need for repetitive gripping and traction of the gallbladder during its manipulation with laparoscopic instruments. As complications from this event are rare in human patients, conversion to laparotomy is not routinely indicated and the adverse consequences of bile spillage are minimized by abundant irrigation of the peritoneal cavity and adequate antimicrobial therapy. On the other hand, there is little information regarding the outcome of laparoscopic management of this complication in laparoscopic cholecystectomies in dogs, particularly since most surgeons indicate conversion in these cases. Thus, we describe a case of biliary peritonitis that developed in a dog after laparoscopic management of iatrogenic perforation of the gallbladder during a laparoscopic cholecystectomy, in a case of gallbladder mucocele. To the best of our knowledge, there are no reports of biliary peritonitis following laparoscopic management of iatrogenic gallbladder perforation during LC in dogs. Case: A 14-year-old Poodle was referred for clinical evaluation with selective appetite, recurrent episodes of hyporexia, and abdominal discomfort. Ultrasound findings characterized chronic liver disease and gallbladder mucocele. The patient was referred for laparoscopic cholecystectomy, during which the gallbladder was iatrogenically perforated, with extravasation of a large volume of bile content. This complication was managed by copious abdominal irrigation via laparoscopic access and antimicrobial therapy. On the second postoperative day, the patient started to present apathy, hyporexia, emesis, and jaundice. The patient remained hospitalized in the intensive care unit for stabilization and monitoring through hematological examinations and serial abdominal ultrasound. Due to progressive worsening of the clinical picture, an exploratory laparotomy was performed ten days after the initial surgical procedure. This examination showed multiple adhesions and the presence of bile residues adhered to numerous points on the peritoneal surface. Despite the intensive treatment instituted, death occurred 10 h after the second surgical procedure. Discussion: The high risk of gallbladder perforation during laparoscopic cholecystectomies correlates with the dissection step or repetitive grasping and traction of the gallbladder with laparoscopic instruments. Conversion is not routinely indicated and laparoscopic management is considered effective in humans. However, in this case, the presence of a large volume of extravasated semisolid bile content and its adherence to the mesothelial surface made it impossible to remove it in its entirety despite the abundant irrigation of the abdominal cavity, resulting in a picture of biliary peritonitis in the postoperative period. In view of the reported negative outcome, the authors encourage the adoption of measures that minimize the risk of gallbladder perforation when performing LC in dogs. These include the use of atraumatic instruments or aspiration of bile content before surgical manipulation. Cases in which such a complication is recorded should be carefully monitored to enable early diagnosis and treatment of biliary peritonitis. Furthermore, conversion should be considered when there is extravasation of large volumes of bile, particularly in the presence of gallbladder mucocele, until future studies establish the safety and effectiveness of laparoscopic management of this complication. Keywords: gallbladder mucocele, minimally invasive surgery, laparoscopic cholecystectomy, dogs

CORPO ESTRANHO ESÔFAGO-GÁSTRICO EM UM CANINO

The ingestion of foreign bodies (FB) is recurrent in the clinical-surgical routine of dogs and cats. These are defined as inanimate objects that cannot be digested or are digested more slowly, obstructing the gastrointestinal tract to varying degrees. In dogs, the most commonly observed FBs include bones, plastics, stones, coins, fabrics, threads, sticks, fruit seeds, balls, small toys, and metallic objects such as needles and hooks. After ingesting a FB, the symptoms presented vary according to the degree of obstruction, the duration of the object’s presence, and whether there is any perforation. The animal's history, the radiography, the ultrasound, and the endoscopy contribute to the diagnosis of the condition. Such objects can be removed by endoscopy or surgical approach via esophagotomy, gastrotomy, or enterotomy, taking into account the obstruction site and the shape of the FB. Thus, this study aimed to report a case of ingestion of a bony foreign body, in a four-month-old male canine, submitted to surgical removal via gastrotomy, emphasizing the diagnostic method and the clinical-surgical approach used to treat the condition. The patient's clinical evolution was satisfactory due to the rapid diagnosis and assertive management, as well as the absence of complications, such as esophageal or gastric perforation.A ingestão de corpos estranhos (CE) é recorrente na rotina clínico-cirúrgica de cães e gatos. São definidos como objetos inanimados, que não podem ser digeridos ou que são digeridos mais lentamente, obstruindo o trato gastrointestinal em diferentes graus. Nos cães, os CE mais observados são: ossos, plásticos, pedras, moedas, tecidos, linhas, gravetos, caroço de frutas, bolas, brinquedos pequenos e objetos metálicos como agulhas e anzóis. Após a ingestão de um CE, a sintomatologia apresentada varia de acordo com o grau de obstrução, tempo de permanência do objeto e se há presença de perfuração. O histórico do animal, a radiografia, a ultrassonografia e a endoscopia contribuem para o diagnóstico da afecção. Tais objetos, podem ser removidos por endoscopia ou pela abordagem cirúrgica via esofagotomia, gastrotomia ou enterotomia, tendo em vista o local de obstrução e o formato do CE. Desta forma, o objetivo deste trabalho foi relatar um caso de ingestão de corpo estranho ósseo, em um canino macho de quatro meses de idade, submetido à remoção cirúrgica via gastrotomia, enfatizando o meio diagnóstico e a conduta clínico-cirúrgica empregada para o tratamento da afecção. A evolução clínica do paciente foi satisfatória, em virtude do rápido diagnóstico e conduta assertiva, bem como a ausência de complicações, como a perfuração esofágica ou gástrica

Laparoscopic diaphragmatic hernioplasty in a dog

A hérnia diafragmática é caracterizada pela passagem das vísceras abdominais para a cavidade torácica, podendo ser de origem congênita ou adquirida, que exige o tratamento cirúrgico. Quando houver ausência de tecido ou em casos de herniação com evolução crônica, recomenda-se a utilização de implantes biológicos ou sintéticos. O objetivo deste trabalho é relatar a técnica de herniorrafia diafragmática laparoscópica com o uso de pericárdio bovino conservado em um canino, a partir do acesso laparoscópico com três portais. Devido ao grande defeito diafragmático, optou-se pela sua redução com o auxílio de implante de pericárdio bovino conservado em formaldeído a 4%, este fixado a musculatura diafragmática com sutura intracorpórea, utilizando para isso duas camadas de sutura ambas com náilon 0, a primeira contínua simples seguida de pontos isolados simples, em toda extensão da membrana conservada. Apesar do animal vir a óbito nas primeiras 24 horas do pós-operatório, a técnica adotada se mostrou viável.A diaphragmatic hernia is characterized by the passage of the abdominal viscera into the thoracic cavity, which may be congenital or acquired. Its treatment is achieved by surgical correction. When there is no tissue or in cases of herniation with a chronic disease, the use biological or synthetic implants is recommended. The objective of this study was to report a technique of laparoscopic diaphragmatic hernia repair using bovine pericardium preserved in a canine, using three portal accesses. Due to the large diaphragmatic defect, reduction with the aid of a network of preserved bovine pericardium in formaldehyde 4% was chosen. The mesh was sutured to the transversus abdominus muscle in two layers. The first layer was sutured using simple continuous pattern, and the second one using simple interrupted sutures. The patient collapsed and died 24hours postoperatively. However, the purposed technique was feasible.

Anestesia em Jacaré-americano (Alligator mississipiensis) para Amputação de Membro

Background: The knowledge of secure anesthetic protocols for reptiles is very important, especially because they are aggressive species and they have peculiar physiology, unpredictable reactions to the same drug in different environmental conditions and different physiological responses can be observed. The anesthetic protocol aims immobilization, analgesia and muscle relaxation for adequate, safe and easily reversible anesthesia. Few reports have been described on anesthesia in animals and, before that, the objective of this study is to report the anesthetic protocol that was used and vital parameters monitoring in an Alligator mississipiensis that was submitted to surgery for limb amputation.Case: A female American alligator was attended, with about 8-year-old, 2 m long and 268,964 pounds, with fight history with other animal six months ago, resulting in a wound in the right toracic limb. When the lesion occurred, it was the breeding season of the species, so we chose not to perform the treatment at that time. An X-ray of the member was performed, which showed, among other changes, osteomyelitis and septic arthritis. Thus, the limb amputation was indicated. Ketamine association (10 mg/kg) and medetomidine (0.1 mg/kg) were used as anestesic premedication, both administered intramuscularly. For anesthetic induction, propofol (4 mg/kg) intravenously was used. The animal was intubated using an endotracheal tube number 11 without inflating the cuffing, and for the maintenance it was employed isoflurane. The heart rate was measured using Doppler and the respiratory rate by visual and balloon observation in the oxygen circular system. The other parameters were measured using a multiparameter monitor sensor connected to the tongue. The local anesthetic block was made close to the incision line, the medium third humerus with 2 mg/kg of 2% lidocaine without vasoconstrictor, diluted in 0.9% NaCl until the volume of 10 mL is completed to assist in analgesia. The parameters recorded during the procedure, which lasted 80 min, remained within the normal pattern of species (three breaths per minute, 30 heart beats per min and 80.6°F temperature). After surgery meloxicam (0.2 mg/kg) and atipamezole reverser (0.5 mg/kg) were administered, both intramuscularly. The animal took about seven hours to fully return from anesthesia.Discussion: Different anesthetics protocols may be employed to crocodilians using both local anesthetic techniques and general, in order to promote analgesia, muscle relaxation and adequate anesthesia. Still, it is very important to monitor the patient during the procedure, in order to be a different physiology kind of species. Cardiac auscultation is quite difficult in these animals, so it is recommended to use non-invasive electronic equipment as the Doppler, the multiparameter monitor, the pulse oximeter and esophageal stethoscope for assistance in monitoring heart and respiratory rate, providing important trans-operative information. The realization of amputations in crocodilians is common, however there are few reports in the literature about their anesthesia, this way, this article has a significant contribution to a better anesthetic protocol clarification to be used in these animals. Therefore, it is concluded that the anesthetic protocol based on premedication with ketamine and medetomindina, propofol induction and maintenance with isoflurane, besides local anesthesia with lidocaine was effective and safe for thoracic limb amputation surgery in an American alligator

Laparoscopic Nephrotomy to Removal of Staghorn Calculus in a Canine

Background: Renal urolithiasis is the third most common disease of the urinary tract of dogs. In humans, staghorn lithiasis affects 1 to 1.5% of the population, often women over 50 years old. In veterinary medicine, this type of lithiasis has been little reported, and there are few descriptions of treatment, both in small and large animals. The objective of this work is to report a rare case of renal staghorn stones treated by laparoscopic nephrotomy.Case: A six-year-old female schnauzer with 6 kg body weight was evaluated clinically in order to spay. According to the owner, the animal showed polydipsia. Additional tests such as blood count, serum biochemistry, radiography and abdominal ultrasound were done, showing hematological examinations within the standards for the species. After the ultrasound we noticed an asymmetric kidneys with the right kidney with preserved cortical layer and hyperechoic line corticomedullary interface, with posterior acoustic shadow and left kidney with relative/corticomedullary differentiation and pelvis preserved without alteration; this evocative image of kidney stones in kidney right. In abdominal radiographs was possible to visualize radiopaque mass in the right kidney compatible with renal staghorn stones. Excretory urography was done, which demonstrated evident excretion of contrast material in the left kidney and the right kidney doubtful. Based on these findings, we opted for exploratory laparoscopy followed by laparoscopic nephrectomy or nephrotomy for removal of urolithiasis, depending of the lesions visualized during the procedure. All procedure were performed using a minimally invasive approach without the need for conversion to open or videoassisted procedures. The most complex and delicate step was the nephrorrafy, due the little time for suturing to avoid renal ischemia. Eight months after the surgery, the owner is contacted, and it said that the animal was well, without clinical signs of kidney disease. After returning and performing ultrasound and excretory urography revealed that the right kidney had atrophied, but there was still draining contrast shown by excretory urography.Discussion: Although the use of laparoscopy is increasing worldwide is still considered an underexplored approach to renal calculi in veterinary medicine. Our choice in this case was due the numerous potential advantages that have minimally invasive compared to open technique, as demonstrated in medicine and veterinary medicine studies. At the beginning of laparoscopy was possible to elect the procedure (nephrectomy or nephrotomy) to be performed; the anatomic changes presente as renal artery patency /coloring kidney and wrist, observed by laparoscopic visualization, with amplification, showed the possibly of renal preservation. This is an advantage associated with videosurgical access. Laparoscopic view allowed to discard residual gallstones as well as to promote the correct synthesis of renal tissue. All steps of the nephrotomy were performed by minimally invasive access. It was not possible to directly correlate with the histological analysis technique renal disorder before and after the surgery, because the kidney was already reduced in size in the first operation and biopsy was not done in that occasion. The present report demonstrates that laparoscopic surgery can be considered viable for the management of renal staghorn stones in dogs.Keywords: surgery, nephrolity, canine

Laparoscopic diaphragmatic hernioplasty in a dog

A diaphragmatic hernia is characterized by the passage of the abdominal viscera into the thoracic cavity, which may be congenital or acquired. Its treatment is achieved by surgical correction. When there is no tissue or in cases of herniation with a chronic disease, the use biological or synthetic implants is recommended. The objective of this study was to report a technique of laparoscopic diaphragmatic hernia repair using bovine pericardium preserved in a canine, using three portal accesses. Due to the large diaphragmatic defect, reduction with the aid of a network of preserved bovine pericardium in formaldehyde 4% was chosen. The mesh was sutured to the transversus abdominus muscle in two layers. The first layer was sutured using simple continuous pattern, and the second one using simple interrupted sutures. The patient collapsed and died 24hours postoperatively. However, the purposed technique was feasible