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Dog was seen on 6/8/18 for gastrotomy/enterotomy due to GI foreign body obstruction. On 6/13 (today)- dog was seen again for possible abdominal wall incisional dehiscence. Owners surrendered dog to MACC today after vet visit at Camden- where an abdominal bandage was applied after the finding of serosanguinous drainage from either end of intact skin incision and ~2cm palpable hernia at mid-incision. Currently taking 37.5mg Carprofen PO BID and 625mg Clavamox PO BID- and on a bland diet. Plan: run CBC and chem here to check for signs of peritonitis/intestinal incision dehiscence- and if bloodwork is WNL proceed with exploratory/herniorrhaphy tomorrow. CBC - results all WNL WBC = 12.8 (6-17) Lym = 1.7 (0.9-5.0) Mono = 0.9 (0.3-12.0) Gran = 10.2 (3.5-12.0) HCT = 44.9 (37-55) MCV = 63.3 (60-72) RDWa = 47.6 (35-65) HGB = 17.2 (12-18) C = 38.3 (32.0-38.5) RBC = 7.09 (5.5-8.5) PLT = 387 (200-500) MPV = 7.7 (5.5-10.5) Serum chemistry - Mild hypoproteinemia/hypoalbuminemia; other results essentially WNL/unremarkable TP (low) = 4.7 (5.5-7.6) ALB (low) = 2.0 (2.5-4.0) ALP = 108 (0-140) GLU (high) = 133 (75-125) TBIL = 0.1 (0.0-0.5) IP = 5.0 (1.9-5.0) TCHO = 218 (120-310) GGT < 10 (0-14) ALT = 27 (0-120) Ca (low) = 8.9 (9.0-12.2) CRE = 0.8 (0.4-1.4) BUN = 10.6 (9.0-29.0)
This dog had had surgery about a week ago for removal of a peach pit. It was surrendered to MACC yesterday afternoon due to continuous drainage from the closed incision. No other history was available. This morning there was a considerable amount of serosanguinous drainage when external bandaging was removed. Following induction and surgical prep DVMs and 099 commenced an exploratory of the original suture area and abdomen. Both ends and a 1 cm area in the middle of the original closure were open. External sutures appeared to be a continuous mattress pattern- with no breaks in the suture; knots and suture tags were visible at either end of the closure. After removal of this suture the remaining skin closure was easily reversed with mild tension along the suture line. The SQ had been closed using what appeared to be gut in a simple continuous pattern. This tissue was extremely thickened and appeared inflamed. The body wall itself appeared to have been closed with unknown black suture material in apparently a continuous mattress- but there was a 1 cm open area slightly anterior to the midpoint of the original closure. In the abdomen immediately below this area were several large blood clots. Copious amounts of dark serosanguinous fluid drained from the abdominal opening as the original incision was enlarged. Also noted was a small amount (~1 ml) of brownish-yellow- slightly granular material on the surface of one of the blood clots. Immediately below this- three loops of intestine were firmly adhered together into a clump about 12 cm in diameter. At the center of this- there was an approximately 4-5 cm very thickened portion of intestine where the lumen was not palpable. After a gentle disruption of the adhesion around this thickened area several suture knots were visualized- between which more of the brownish-yellow material became evident. This material proved to be intestinal contents- as it could be seen to ooze through the sutures from the lumen. An attempt to sweep the intestinal walls revealed that much of the abdominal contents was adhered to the body wall on both sides of the incision. Several spots along the involved intestines were friable and the mesentery was abnormally dark in color. The dog was humanely euthanized while still under anesthesia. Dx: Dehiscence of the enterotomy closure with resulting extensive fibrous adhesions involving about 2/3 of the small intestine- failure of the body wall closure- +/- perotonitis.
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