Intestinal dehiscence and mortality in cats undergoing gastrointestinal surgery

Objectives The aim of this study was to determine the incidence of and risk factors for both gastrointestinal (GI) incisional dehiscence and mortality in a large cohort of cats undergoing GI surgery. We hypothesized that cats with preoperative septic peritonitis (PSP), systemic inflammatory response syndrome (SIRS) or sepsis would have higher GI dehiscence and mortality rates than unaffected cats. Methods A medical records search identified cats with surgically created, full-thickness incisions into their stomach, small intestines or large intestines. Preoperative data, including signalment, clinical signs, comorbidities, surgical history, current medications, presenting physical examination findings, complete blood counts and serum biochemistry values, were collected. It was determined whether or not cats had PSP, SIRS or sepsis at admission. Intraoperative data, final diagnosis and postoperative variables such as vital parameters, bloodwork and (if applicable) the development of GI dehiscence or mortality were noted. Postoperative follow-up of at least 10 days was obtained in survivors. Results In total, 126 cats were included. One cat developed GI dehiscence following complete resection of a jejunal adenocarcinoma. Twenty-three cats (18.2%) died within 10 days of surgery. Cats with PSP ( P = 0.0462) or that developed hypothermia 25–72 h postoperatively ( P = 0.0055) had higher odds of mortality in multivariate analysis. Cats with PSP had 6.7-times higher odds of mortality than cats not diagnosed with PSP. Conclusions and relevance In cats receiving GI surgery, the incidence of GI incisional dehiscence was <1%. Cats with PSP had a higher likelihood of mortality. SIRS was a common finding in cats with septic peritonitis, but was not associated with mortality. Postoperative mortality during the home recovery period might be significant in cats. Future studies evaluating postoperative mortality in cats should consider extending the research period beyond the date of discharge.

Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: a case report

Background Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis. Case presentation A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis. Discussion Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases. Conclusion Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene.

Intestinal perforation involving the Dacron cuff of nephrostomy tubes following subcutaneous ureteral bypass system implantation for ureteral obstructions in two cats

Case summary This case report describes two cats that had subcutaneous ureteral bypass (SUB) systems implanted and subsequently developed duodenal perforations and septic peritonitis associated with the Dacron cuff of the nephrostomy tube. One cat recovered following surgical explantation of the SUB system with intestinal resection and anastomosis of the perforated small intestine, and – at the time of writing – is still alive. The other cat was humanely euthanased intraoperatively at the owner’s request owing to its perceived prognosis. Relevance and novel information To our knowledge this is the first time this complication has been reported following SUB device placement.

Gluttony during pregnancy. (On the issue of ovariotomy and conservative myomotomy during pregnancy)

Despite the fact that pregnancy is one of the physiological conditions of a woman, only about half of the cases, according to the studies of modern statistics, reach a happy end for the mother and fetus. Along with such reasons as constitutional diseases, acute infectious diseases, suffering of the respiratory and circulatory organs, contributing to premature termination of pregnancy and requiring purely therapeutic intervention, there are complications that require serious surgical care for a successful pregnancy outcome. These are mainly complications of pregnancy with tumors of the pelvic organs, for the removal of which one has to resort to the most serious operation - gluttony. And while earlier surgeons with extreme fear decided to open the abdominal cavity in non-pregnant women, risking always losing the patient from the seemingly inevitable septic peritonitis during this operation, while earlier surgeons talked about "happiness in surgery" and attributed the successful outcome of any often unimportant operation to a clean case, - now it is boldly performed on pregnant women with a certain certainty to save life not only existing, but also emerging life.