Case report: Is bilateral renal dioctophymosis and severe uremia in a dog synonymous of euthanasia? Not today

A dog with bilateral renal dioctophymosis presented with stage 5 acute kidney injury, weight loss, vomiting, apathy, and hematuria. Laboratory tests showed creatinine of 17.2 mg/dL and Dioctophyme renale eggs in the urine. It underwent a 30-min session of hyperbaric oxygen preconditioning at a pressure of 2 ATA. Subsequently, bilateral nephroscopy was performed, without warm ischemia, using Amplatz-type renal dilators. Five parasites were removed, three females from the right kidney, one female from the left kidney, and one male from the abdominal cavity. After surgery, the patient continued doing daily hyperbaric oxygen therapy (HBOT) sessions and clinical therapy. Postoperative care consisted of analgesics, antimicrobials, antioxidants, gastric protector and fluid therapy. Ultrasound monitoring showed a reduction in the area of renal dilation and the hematological and biochemical tests showed rapid recovery from acute kidney injury. There was no bacterial growth in the urine sample collected directly from the kidneys. The patient had an excellent clinical progression and was discharged from hospital 7 days postoperatively, with creatinine values of 2.9 mg/dL. This is the first report of the use of nephroscopy in the treatment of dioctophymosis and indicates excellent chances of cure even in severe cases of bilateral parasitosis. HBOT was shown to be an ally in the clinical therapy of patients with D. renale by helping with stabilization and postoperative recovery

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

Cortisol plasmático como indicador de estresse em colopexias laparoscópicas com implante de tela de polipropileno en cães

A realização de cirurgias convencionais, mesmo com a utilização recomendada de fármacos analgésicos, geralmente está associada a um período de recuperação longo, além de causar estresse, dor e desconforto nos animais, dependendo do grau de invasão do procedimento. Considerando a crescente busca por métodos que minimizem o estresse cirúrgico em cães, reduzindo o período de recuperação pós-cirúrgico, o presente trabalho foi desenvolvido para avaliar a técnica de colopexia laparoscópica em relação aos níveis de cortisol plasmático, as frequências respiratórias, e as frequências cardíacas nos períodos pré, trans e pós-operatório imediatos. Foram utilizados nove cães, fêmeas adultas, SRD. As coletas sanguíneas para mensuração dos níveis de cortisol, e os parâmetros de frequências respiratórias (FR) e cardíacas (FC) foram efetuadas a partir do préoperatório até o término do procedimento. Após esse período, a tomada de dados foi realizada de três em três horas até completar as primeiras 12 horas pós-operatórias. Os níveis de cortisol foram mensurados com a utilização de Kit ELISA para cortisol. Os resultados foram submetidos à ANOVA e ao teste de Tukey, considerando as diferenças significativas 

One-stage Laparoscopic Nephrectomy and Ovariohysterectomy for Concurrent Dioctophymosis and Pyometra in a Bitch

Background: Dioctophyme renale, also known as “giant kidney worm”, is a cosmopolitan parasite, which usually affects domestic and wildlife canids in wetlands. Nephrotomy and nephrectomy are the only treatment options. Laparoscopic nephrectomy for dioctophymosis was first performed in veterinary patients in the late 90’s. Canine pyometra is one of themost frequent surgical disorder in the small animal setting. The purpose of this study was to report a case of successful one-stage laparoscopic approach for nephrectomy and ovariohysterectomy in a bitch.Case: A female stray dog, rescued from a riverside community, was presenting hematuria. Abdominal echography revealed presence of Dioctophyme renale worms within the right renal parenchyma. Moreover, the uterus was moderately filled by anechoic content. The patient was clinically stable and undergone laparoscopy. A 10-mm trocar was established at the middle third of the right flank, followed by 12-mmHg CO2 insufflation. The telescope was inserted and a giant worm wasseen free within the abdominal cavity. A second 10-mm port was inserted cranial and dorsally to the first one. The parasite was retrieved using a laparoscopic Kelly forceps. A third 5-mm trocar was inserted in a classic laparoscopic triangulation port positioning. Renal artery and vein were individually triple ligated using titanium clips and then transected. The rightovarian pedicle was sequentially coagulated and transected using laparoscopic bipolar forceps. The right kidney was then dissected and detached from the abdominal wall, followed by cauterization and transection of the left ovarian pedicle. The uterus was exposed out of the abdominal cavity through the 5-mm port access. Uterine body and vessels were double ligated using polyglactin 910, with transfixating ligatures, and then transected. The opening of the retrieval bag was exposed through the cranial port site incision. Eight dioctophyme worms and the kidney sections were withdrawn through the sacusing a Kelly hemostat. Abdominal wounds were closed in two layers using cross-mattress polyglactin 910 sutures. Skinwas closed using interrupted horizontal mattress nylon sutures. Patient was discharged on the early post-op, receiving tramadol chloride and sodium dipyrone for three days and enrofloxacin for seven days. The patient recovered uneventfully. Owner was contacted by phone eight months following surgery, which informed the bitch was clinically stable.Discussion: Riverside stray dogs present high incidence of dioctophymosis worldwide, due to irregular feeding and consequent intake of intermediate hosts. The reported patient met those features, without previous background regarding infestation episode. It presented hematuria, which usually results from renal parenchyma consumption by the worms. The patient was retrieved nine dioctophyme worms. Laparoscopic approach for nephrectomy has already been reported in veterinary patients, as well as three-port lap-assisted OVH have been performed. Innovative aspect of this case report concerns the one-stage laparoscopic approach for both nephrectomy and OVH. Moreover, the procedures required only three-port access, which was considered a suitable and safe minimally invasive approach in dogs affected by Dioctophyme renale and concurrent indication for OVH. The three-port access shown is adequate to perform one-stage nephrectomy and ovariohysterectomy in bitches, for reaching benefits of laparoscopic surgery in comparison to conventional approaches.Keywords: canine, endosurgery, kidney, laparoscopy, videosurgery

Liposarcoma in a quaker parrot (Myiopsitta monachus) : case report

Os lipossarcomas são tumores malignos de lipócitos e lipoblastos raramente relatados em espécies aviárias. Acometem geralmente pássaros adultos ou velhos e em regiões onde existe acúmulo de tecido adiposo. O presente trabalho relata um caso raro de lipossarcoma em uma caturrita (Myiopsitta monachus) com cinco anos de idade que apresentava nódulo de crescimento progressivo na extremidade distal da asa esquerda, com evolução de seis meses. Apesar da dificuldade de deambulação, a ave apresentava disposição e normorexia. Procedeu-se à extirpação cirúrgica da massa tumoral, e o exame histopatológico permitiu o diagnóstico de lipossarcoma bem diferenciado. Não foram observadas recidivas ou metástases durante o período de 24 meses após o procedimento, o que confirma a adequação da conduta cirúrgica realizada.Liposarcomas are malignant tumors that involve lipocytes and lipoblasts. This neoplasm is not frequently reported in avian species and generally occurs in adult or old birds and it is always seen in areas of adipose accumulation. This report presents a rare case of liposarcoma in a five-year-old quaker parrot (Myiopsitta monachus). The patient had a 6-month progressive growing nodule at the left wing extremity and ataxia; however, normal appetite and disposition were noticed. After the neoplasm extirpation, the pathological study pointed out a well-differentiated liposarcoma. Local disease or metastasis signals were not observed within 24 months after the surgery. The surgical procedure was effective to control the liposarcoma in this bird

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

OVÁRIO-HISTERECTOMIA VIDEOASSISTIDA EM UMA CADELA COM HEMATOMETRA

A piometrite canina é uma enfermidade da cadela adulta, caracterizada por inflamação do útero com acúmulo de exsudatos. A hematometra é uma consequência da piometrite, porém caracteriza-se por diapese de eritrócitos para a luz uterina, modificando a coloração da secreção.   A terapia deve ser imediata e agressiva. Ovário-histerectomia é o tratamento de escolha para animais gravemente acometidos. O presente trabalho descreve a ovário-histerectomia videoassistida no tratamento de hematometra em uma cadela da raça Akita, com seis anos de idade e 34 kg de massa corporal. Utilizou-se o acesso com três portais, os quais permitiram a ligadura dos vasos ovarianos e a secção do mesométrio. Já  o útero e os vasos uterinos foram manipulados por meio de miniceliotomia pré-púbica. Não se constataram complicações transoperatórias ou recidiva da doença, o que demonstra a eficácia do procedimento em cães, pois a evolução pós-operatória sete meses após o procedimento respalda a conduta cirúrgica adotada. PALAVRAS-CHAVES: Cadelas, cirurgia, laparoscopia, piometrite, tratamento

Infiltrative Lipoma - Atypical Presentation in a Bitch

Background: Primary pelvic tumors have a less favorable prognosis when compared to long bone tumors. Infiltrativelipomas are benign neoplasms of mesenchymal origin, but with an invasive nature, in which highly differentiated adipocytes infiltrate tissues such as muscles, connective tissues, bones, peripheral nerves and spinal cord. Reports of infiltrative lipoma causing bone and joint damage are rare, so the objective of this report is to present clinical-surgical aspects and particularities involved in the treatment of a bitch, with an extensive tumoral mass in the left pelvic limb and coxofemoral and femoro-tibio-patellar joint destruction. The treatment used in search of a cure for the patient is highlighted.Case: One bitch, 1 and a half years old, not neutered, Australian Cattle, 13 kg body weight, with a history of increased volume in the left pelvic limb for approximately 1 year, was admitted at the Veterinary Hospital. The radiographic examination showed loss of delimitation of the coxofemoral joint, irregularity, and the presence of a proliferative and lytic process in the femoro-tibio-patellar portion, in addition to an increase in volume in adjacent soft tissue. A thoracic radiographic study was also carried out to search for metastases and cytological examination by fine-needle aspiration in several points of the limb, including the popliteal lymph node. Aggressive surgical treatment was based on evidence of bone destruction and existing damage to the joints. A mid-to-caudal partial hemipelvectomy was chosen, accompanied by limb amputation. To perform the surgery, a tumor-free area was identified and osteotomy was performed at three points, in the body of the proximal ilium, ischium plate, and pubic body. Due to the removal of the limb and the tumor, there was no muscle to close the pelvic wall, requiring the use of polypropylene mesh to correct the defect. The patient was discharged from the hospital after 24 h. The histopathological analysis of the limb revealed that it was an infiltrative lipoma, which showed infiltration of superficial and deep muscle tissue and marked degenerative lesions in the hip and femoro-tibio-patellar joints. In the macroscopy, the extension of the neoplastic mass was evident and when cutting, the loss of bone architecture. Radiographic images were also compatible with invasion and destruction of the bone delimitation. The patient was evaluated 10, 30, and 120 days post-operatively, and the animal presented a quick recovery. However, 161 days after surgery it was necessary to remove the polypropylene mesh due to its contamination. Discussion: Invasion of infiltrative lipoma into bones has been reported in only 3 dogs. Furthermore, due to the difficult macroscopic differentiation between infiltrative lipoma and normal tissue, the reported recurrence rate after surgical resection varies between 36 and 50%. Hemipelvectomy is a radical surgical procedure indicated for the management of tumors and functional abnormalities involving the pelvis or adjacent soft tissue. In canine patients diagnosed with infiltrative lipoma, surgery is reported to increase life expectancy. In studies, median survival time of 4 patients was 940 days and 13 dogs treated with cobalt radiation 60, of which 10 also underwent cytoreductive surgery, survived from 6 to 94 months. The patient in the current report survived for 21 months after the postoperative period, which is in agreement with the researchs. A case of atypical infiltrative lipoma and consequent joint destruction was highlighted in this work. However, partial hemipelvectomy was effective in the treatment, curing the alteration, despite contamination of the mesh which led to the need for surgical intervention.Keywords: surgery, complications, hemipelvectomy, polypropylene mesh

Right Laparoscopic Adrenalectomy in a Bitch

Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudalvena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma.Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC,we recommended the execution of total right adrenalectomy execution. The videosurgery used four accesses arranged in the right hypogastric region; the diameters were 10 (two), 5, and 3mm. The adrenal gland was carefully dissected with the aid of laparoscopic forceps; during the intraoperative period, there was a small laceration of the abdominal phrenic vein that resulted in bleeding, which was overcome with two titanium clips. The dog had an excellent recovery, and the teamdischarged it 48 h after the procedure. The signs of hyperadrenocorticism disappeared about two weeks after surgery. One year after having the procedure, the animal remainswell and has no signs of tumor recurrence or Cushing’s syndrome.Discussion: The choice laparoscopic approach provided less invasiveness in surgical access, reduced animal convalescence, and provided image magnifcation for the more accurate dissection of the adrenal gland. Some reports that middle-aged to older bitches were the most predisposed to present adrenal neoplasm-dependent HAC, and generally, in unilateral form, characteristics which are presented in this report. Among the clinical signs and observed in this report, are polydipsia, polyphagia, tachypnea, alopecia, and skin hyperpigmentation. That recommended the low-dose dexamethasone suppression test to diagnose Cushing’s syndrome and the endogenous ACTH test to distinguish hypophysary from adrenocorticotrophic HAC. The same tests were performed in the case reported here, as these are also important to establish the fnal diagnosisand refer the total adrenalectomy realization. In the current case report, access to the right hypogastric region using four videosurgery portals provided good surgical access. Towards the hospital convalescence time, the animal was discharged early, just 48 h post-operatively; remission of HAC clinical signs occurredwithin three weeks, and the survival alreadyreached 12 months.To the best of the authors’ knowledge, this is the frst successful case of total right adrenalectomy without caudal vena cava invasion via the laparoscopic route as treatment for adrenocortical carcinoma in the national literature.Keywords: adrenal gland, neoplasm, videosurgery, dogs