Midline Celiotomy Research Articles

SCROTAL HERNIATION AND STRANGULATION OF THE SMALL INTESTINE IN AN INTACT MALE 3-YEAR-OLD MIXED-BREED DOG

Importance: This case report describes a rare presentation of scrotal herniation and strangulation of the small intestine in a 3-year-old intact male mixed-breed dog. This condition is noteworthy due to its potential for severe complications and the scarcity of documented cases in the veterinary literature, contributing to the limited body of knowledge on scrotal hernias in dogs, especially those involving intestinal strangulation. Case Presentation: The dog presented with unilateral scrotal swelling, persistent vomiting and inappetence for 10 days. Physical examination revealed inflamed and tender scrotal regions, with the left side more prominently affected. Radiographic findings indicated dilated small intestines and increased radiopacity in the scrotal area. Surgical intervention revealed a swollen left testicle and a hemorrhagic loop of small intestines within the scrotum. A midline celiotomy was performed to resect and anastomose the devitalized intestinal segment, followed by herniorrhaphy. Conclusions and Relevance: The patient recovered uneventfully and resumed normal activities within a week post-surgery. This case highlights the clinical importance of timely diagnosis and surgical management of scrotal hernias in dogs to prevent life-threatening complications, underscoring the need for awareness of such presentations among veterinarians. The successful outcome in this case supports the efficacy of surgical intervention in similar scenarios, potentially guiding future clinical practices.

Patent urachus with subcutaneous communication and ventral abdominal swelling in a domestic short‐hair cat

AbstractA 3‐month‐old, male, entire, domestic shorthair kitten underwent investigations for stranguria and haematuria, and was diagnosed with a urinary tract infection secondary to a suspected extramural vesicourachal diverticulum. Lower urinary tract signs resolved with a 14‐day course of amoxicillin clavulanate. Three months later, the kitten re‐presented for investigation of acute onset ventral abdominal discomfort and bruising. On presentation, clinical examination revealed omphalitis and subcutaneous bruising, with no evidence of an umbilical stoma. Ultrasonography demonstrated a patent urachus communicating with the subcutaneous tissue space, resulting in accumulation of urine at the level of the umbilicus. A ventral midline coeliotomy was performed to allow resection of the urachal remnant, including a partial cystectomy. The cat was urinating normally within 10 hours postoperatively, and the wound healed without complication. No postoperative complications or recurrent lower urinary tract signs were reported at follow‐up (312 days).

Tensile testing in feline ventral abdominal coeliotomy closure with different sizes of polydioxanone suture material: a biomechanical study.

The aim of this study was to evaluate, in vitro, the load and type of failure of the sutured ventral abdominal fascia of cats with different sizes of suture material made of polydioxanone (PDX) (2-0, 3-0, 4-0, 5-0 USP). A total of 32 samples of the ventral abdominal wall from 16 cadaveric cats were harvested using an hourglass-shaped template. The samples were sectioned longitudinally along the linea alba and then sutured together in a continuous pattern using four different randomly assigned sizes of pdx suture material (2-0, 3-0, 4-0, 5-0 USP). A universal testing machine was used for linear distraction of the samples. The tensile strength and type of failure were recorded and analysed. Three types of failure were defined: suture material failure (S), suture line failure (T1) and failure of the abdominal wall further away from the linea alba (T2). The frequency of suture material failure decreased with increasing suture size. Suture size 5-0 failed due to a S failure in 6/8 samples, PDX 4-0 failed in 2/8 samples and PDX 3-0 failed in only 1/8 samples. However, PDX 2-0 failed due to only T1 or T2 failures, with both failures being almost equally represented. No statistically significant differences in the load to failure between PDX 2-0, 3-0 and 4-0 were noted (P >0.05). The risk of suture failure increased with decreasing suture size diameter. PDX 2-0 and 3-0 can be used without reservation for the closure of ventral midline coeliotomy in cats. Although there was no statistically significant difference between PDX 2-0, 3-0 and 4-0, PDX 4-0 showed a higher probability for suture breakage and should be used only after careful consideration of the patient while clinical evaluation is pending. Pdx 5-0 cannot be recommended as a safe suture size for this type of surgical closure.

Outcomes of horses undergoing ventral midline celiotomy for colic with dorsal mesenteric attachment abnormalities of the colon and cecum

Outcomes of horses undergoing ventral midline celiotomy for colic with dorsal mesenteric attachment abnormalities of the colon and cecum

Unusual left colon displacement and clockwise torsion in a 10‐month‐old Arab filly: A case report

In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10‐month‐old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention.A 10‐month‐old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon's length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length.To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post‐surgery and did not exhibit any complications during the recovery period.

Clinical and diagnostic features of a paraprostatic cyst of a true uterus masculinus in a male cat presented with tenesmus

AbstractA 5‐year 11‐month‐old, male, neutered, Bengal cross cat was examined for a 5‐week history of tenesmus. Positive contrast urethrocystography and computed tomography scan demonstrated a fluid‐filled structure occupying the pelvic canal. Midline coeliotomy and symphysiotomy revealed a large cystic structure dorsal to the urethra in the area of the prostate. This structure was communicating with the urethra via a duct and both vas deferens were inserting in it. The duct was ligated and partial ablation and omentalisation of the structure was performed. Histopathological examination identified features consistent with a true uterus masculinus. Bacteriology of the cystic fluid cultured Escherichia coli and Bacteroides fragilis. The cat recovered uneventfully and with no ongoing clinical issues.

Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment: 61 dogs (2018-2022).

To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management. 61 dogs. Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment. 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.

A rare case of an asymptomatic ovarian cystadenoma in a Labrador retriever

In this report, a clinical case of asymptomatic ovarian cystadenoma in a six-year-old, female Labrador retriever is described. The owner reported that the dog had been presented for routine spaying two weeks earlier in another clinic. During the operation, the veterinarian discovered a unilateral mass at the tip of the left uterine horn, which he could not remove and ovariohysterectomy was not performed. The patient was then referred to the Hospital of the Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria. Transabdominal ultrasonography revealed the presence of a hypoechoic mass in the region of the left ovary (50.0 × 71.8 mm). Complete blood cell counts and biochemical laboratory analysis showed no abnormalities. Caudal midline celiotomy was performed and a substantially altered left ovary was observed. The right ovary and uterus had a normal size and structure. Macroscopic changes in the other abdominal organs were not found. The histopathological finding of the neoplastic formation was characteristic of an ovarian cystadenoma. At follow-up one month after surgery, the dog had fully recovered, and at re-examination six months after surgery, she appeared healthy and all clinical findings were normal.

Incisional complications after skin closure with stainless‐steel skin staples compared to nylon sutures in horses undergoing colic surgery

SummaryBackgroundIncisional complications following ventral midline celiotomy represent a challenge for equine surgeons. Preventative measures to minimise risks of incisional complications are continuously being investigated. This includes the search for an ideal surgical closure method.ObjectiveTo compare the incidence of incisional complications after skin closure with nylon sutures versus stainless‐steel skin staples (SSS) following ventral midline celiotomy for colic surgery in horses and to assess additional risk factors for incisional complications.Study designProspective blinded randomised study (2012–2014).MethodsOne hundred and twenty‐three horses that underwent colic surgery between May 2012 and May 2014 and survived for >2 weeks were included in the study. Horses were allocated randomly to two groups—65 horses were closed with skin staples, and 58 horses were closed with skin sutures (nylon‐0). Patient records and a follow‐up questionnaire were used to record incisional complications that occurred during hospitalisation and after discharge.ResultsFollow‐up information was available in 119 of 123 horses. Four horses without follow‐up were excluded. With strict inclusion criteria, incisional drainage was recorded in 43% (49/115) of the horses, including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group. Pregnancy and large colon intestinal lesions were risk factors for incisional complications. Surgeon 3 was found to decrease the incidence of incisional infection. No association was detected between incisional complications and hernia development.Main limitationsThe non‐uniformity of the follow‐up examination; reliance on owners or caregiver of the horse for follow‐up information, horses lost to follow‐up, incomplete data. Another limitation was the single‐centre design of the study.ConclusionsAlthough not significantly superior, the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure.

Low incisional hernia incidence using a large-bite, low-tension technique for celiotomy closure

BackgroundIncisional herniae (IH) are reported in 5–>20 % of patients undergoing open celiotomy, and can be linked to closure technique. The STITCH randomized trial favors a small bite technique for midline celiotomy closure with a 1-year IH rate of 13 % over larger bites (23 %). MethodsA continuous musculofascial mass closure with absorbable looped #1 PDS suture with 2-cm bite size was used for all open celiotomies. IH frequency and associated clinicopathologic factors were retrospectively analyzed from prospective data in 336 consecutive patients undergoing visceral resections by a single surgeon. ResultsThe study population included 192 men and 144 women, 81 % of whom had a cancer diagnosis, who underwent hepatobiliary, pancreatic, gastroesophageal, and colorectal resections, or a combination. The majority of patients (84 %) had subcostal incisions, and 10 % received a midline incision. At a median follow-up of 19.5 months, the overall IH rate was 3.3 %. Hernia rates were 2.5 % for subcostal margin, 2.9 % for midline, and 5.5 % for other incisions (p = 0.006). Median time to hernia detection was 492 days. Factors associated with IH were increased weight, abdominal depth/girth, male sex, spleen size, visceral fat, and body height (p ≤ 0.04 for all), but not type of resection, prior operations, underlying diagnosis, weight loss, adjuvant chemotherapy or radiation, incision length or suture to incision ratio. ConclusionsThe described technique leads to a low IH rate of <3 % in subcostal or midline incisions, and can be recommended for routine use. The observed results appear superior to those of the STITCH trial, even for the smaller midline incision cohort.

Persistent hypoxaemia and pulmonary oedema in a horse anaesthetised for emergency exploratory laparotomy

AbstractA 16‐year‐old, 550 kg Connemara gelding was anaesthetised for resection of multiple small intestine strangulating lipomas via ventral midline celiotomy. Severe hypoxaemia, detected throughout the anaesthetic period (lowest PaO2 58 mmHg [7.6 kPa]), was unresponsive to the ventilatory strategies implemented. Flared nostrils and increased respiratory rate were present at recovery from anaesthesia. When the horse was returned to the yard, bilateral foamy nasal discharge and increased respiratory effort and rate were noticed, consistent with pulmonary oedema. The horse received oxygen supplementation and furosemide, which led to complete resolution within 24 hours.

Negative pressure wound therapy for the management of surgical site infections with zoonotic, drug‐resistant pathogens on the upper body of the horse

SummaryThis case series reviews the use of negative pressure wound therapy (NPWT) for surgical site infections (SSI) on the upper body of six horses at an academic referral institution between 2016 and 2020. The SSIs consisted of three ventral midline celiotomy incisions post‐abdominal exploratory, one paralumbar flank incision for removal of an ovarian abscess, an incision for resection of a septic jugular vein, and a large defect resulting from the resection of chronically abscessed skin and subcutaneous tissue on the shoulder and pectoral region. All SSIs contained zoonotic, polymicrobial, multi‐drug resistant pathogens (methicillin‐resistant Staphylococcus aureus or extended spectrum beta‐lactamase Klebsiella or Enterobacteriaceae) that were managed without systemic, regional, or topical antimicrobials. All horses were discharged from the hospital, and long‐term follow‐up revealed satisfactory functional and cosmetic outcomes according to owner questionnaires. Duration of NPWT ranged from 4 to 15 days in five horses, but one horse required NPWT for 70 days due to the large nature of the defect. The NPWT system was easy to use, well‐tolerated by patients, and produced acceptable functional and cosmetic outcomes for the clients. By containing wound exudate and reducing daily wound care, it improved hospital biosecurity and reduced exposure to hospital personnel.

Diagnosis and Clinico-Surgical Management of Secondary Laminitis due to Ovarian Tumour in a Kathiawari Mare

Granulosa cell tumours (GCTs) are the most common ovarian tumours in equine which involves around 2.5% of all tumours of horses and 85% of reproductive tract tumours (McCue et al. 2006). Tumours may originate from tissue present within the equine ovary. GCTs are most often first detected during either routine reproductive examination for breeding or when behavioral changes caused by the presence of the tumour in ovary requiring further investigation (McKinnon and Barker, 2010). Mares with GCTs remain infertile due to atrophy of the contralateral ovary, which has been variably associated with elevated serum inhibin, testosterone or anti-Mullerian hormone concentrations (Ball et al., 2012). Surgical removal is regarded as the treatment of choice for GCTs (McCue et al., 2006). Surgical removal of the affected ovary almost always results in the resumption of normal heat cycles and the ability to carry a normal pregnancy. Lameness in mare which suffered from GCT was also reported earlier by Meagher et al. (1977). Various scientists reported different technique for removal of affected ovary. Standing laparoscopic ovariectomy is associated with a lower complication rate than other surgical methods like colpotomy (Colbern and Reagan 1987), flank, paramedian or ventral midline celiotomy (Lee and Hendrickson, 2008; Azizi et al., 2014). Most of GCTs are benign and affect the left ovary (McCue et al. 2006; Korany et al., 2020). The present document reports clinical diagnosis and surgical management of secondary laminitis due to ovarian tumour in a Kathiawari mare by left flank ovariectomy of the affected ovary.

Surgical enlargement of the epiploic foramen in horses.

To assess the safety and efficacy of a method for digitally enlarging the caudal aspect of the epiploic foramen (EF). Healthy horses and clinical cases of EF entrapment (EFE). Fourteen healthy horses and three clinical cases. Through a ventral midline celiotomy under general anesthesia, the EF was enlarged by digital separation of the caudal attachments of the caudate lobe of the liver from right dorsal colon, right kidney, gastropancreatic fold, and pancreas. Healthy horses were euthanized under anesthesia, and the enlarged EF was measured at necropsy. The method used for enlarging the EF did not cause clinically relevant hemorrhage, as determined by visual inspection of the EF in 14 horses at necropsy and by vital parameters under anesthesia in all horses. In clinical cases, EFE was reduced following enlargement of the EF, and no intraoperative complications were encountered. In one clinical case, necropsy at 30 days confirmed partial closure of the enlarged EF. The method proposed enlarged the EF safely and effectively. Limitations of the study include the small number of clinical cases and the lack of postoperative follow-up on the healthy horses. Enlargement of the EF at its caudal extent should be considered in selected cases of EFE in which manual reduction is difficult or protracted. Although the procedure was safe in this study, knowledge of the anatomy, practice on cadavers, and careful selection of cases with greatest need are recommended before clinical use.

Transcutaneous Detection of Intramural Microchips for Tracking the Migration of the Equine Large Colon: A Pilot Study.

Colic remains the number one cause of mortality in horses, and large colon displacement including colonic volvulus is one of the leading causes for equine hospitalization and surgery. Currently, there is not an adequate model to study the pathophysiology of this condition. The objective of this proof-of-concept study was to determine if subserosal implantation of bioinert microchips in the large intestine would be detectable by a RFID (radio-frequency identification) receiver when the implanted microchips were adjacent to the body wall, thus identifying the location of the colon within the abdomen. A horse with no history of gastrointestinal disease underwent a ventral midline celiotomy to implant twelve bioinert microchips into the subserosa at predetermined locations within the large colon and cecum. A RFID scanner was used to monitor the location of the colon via transcutaneous identification 1-3 times daily for a one-month period. Following humane euthanasia, a postmortem examination of the horse was performed to assess microchip implantation sites for migration and histologic assessment. Eleven out of the 12 implanted microchips were successfully identified transcutaneously at occurrences as high as 100%. Odds ratios were calculated for the likelihood of identifying each chip in a location different from its most common location. Microchips implanted into the subserosa of the equine large colon can be used as a means of identifying the approximate location of the equine large colon via transcutaneous identification with an RFID scanner.

Pneumopericardium after peritoneopericardial diaphragmatic hernia repair in a dog

A one-year-old neutered, Goldendoodle presented for evaluation. One week prior to presentation, the surgical closure of a peritoneopericardial diaphragmatic hernia was performed via ventral midline celiotomy. Since the procedure, the dog had been lethargic and anorexic at home. Thoracic radiographs revealed a pneumopericardium. Pericardiocentesis was performed which evacuated approximately 100 mL of air from the pericardial sac. The dog recovered well and began eating in the hospital and resumed normal activity. This is the first reported case of a pneumopericardium post-peritoneopericardial diaphragmatic hernia repair requiring pericardiocentesis. Clinicians should be aware of this rare complication in patients with post-operative peritoneopericardial diaphragmatic hernia.

Successful management of gastroesophageal intussusception in an adult puma (Puma concolor)

AbstractA 7‐year‐old entire female puma (Puma concolor) presented with a history of regurgitation and diarrhoea of 2 weeks duration. Conventional medical management was initially attempted to alleviate the clinical signs, which were unsuccessful. Oesophagoscopy allowed for the diagnosis of gastroesophageal intussusception (GEI) through the observation of gastric mucosa in the lumen of the distal portion of the oesophagus. The intussusception was reduced using the endoscope, which did not result in resolution because the intussusception recurred within 24 hours. A ventral midline celiotomy was performed, followed by a left‐sided belt loop gastropexy. No postoperative complications related to the surgery were observed. The puma resumed eating within 48 hours following the surgery, and no regurgitation recurred for a period of 24 months following surgery. To the knowledge of the authors, this is the first report of GEI in a puma that was successfully resolved.

Ileal impactions: How to proceed when a ventral midline celiotomy is not an option?

Ileal impactions: How to proceed when a ventral midline celiotomy is not an option?

Comparison of the zip skin closure system with conventional suture for skin closure of ventral midline incisions in horses.

To compare the application and healing of the zip skin closure system (ZSCS) with sutured closure by use of a split-scar model of ventral midline incisions in horses in a prospective, randomized experimental study. 8 adult horses. All horses underwent an exploratory ventral midline celiotomy with a standardized 30-cm skin incision. Each horse was randomized to have either the cranial 15 cm closed with suture and caudal 15 cm with the ZSCS or vice versa (split-scar model). Skin closure time was recorded and compared. Photography and skin biopsies were taken preoperatively and 14 days postoperatively. Cosmetic appearance was assessed by use of a proposed equine celiotomy incision score. Healing at 14 days was assessed by histopathology. Skin closure times were faster with the ZSCS compared to sutured incisions. At 14 days postoperatively, the cosmetic appearance (equine celiotomy incision scores) for ZSCS incisions were better than sutured closure and histologic healing scores were not different between methods of closure. Subcuticular sutures were associated with deep dermal inflammation and necrosis independent of epidermal closure methods. While limitations to the utility of the ZSCS are recognized, the potential benefits of expedient closure, good cosmetic outcome, and satisfactory healing make this method viable for closure of linear wounds or incisions in horses.

Clinical, computed tomographic, surgical findings and outcome in dogs with sublumbar abscessation: 16 cases (2013-2019).

To describe the clinical presentation, CT imaging findings, surgical treatment and long-term outcome in dogs with sublumbar abscessation. Medical records of dogs treated for sublumbar abscessation between 2013 and 2019 were retrieved. Criteria for inclusion were a diagnosis of sublumbar abscessation, complete patient history, pre-operative CT imaging, blood work, bacteriology results, record of the surgical treatment, post-operative care and outcome. Sixteen dogs were included in this study with a median follow-up period of 36 months (15/16). Clinicals signs included flank or lumbar soft tissue swelling (12/16), lumbar pain (11/16), hyperthermia (8/16), a cutaneous discharging sinus (5/16) and lethargy (5/16). CT findings were: abscesses of varying size localised in the psoas muscles (16/16), spondylitis (12/16), vertebral osteomyelitis (6/16), discospondylitis (2/16) and epidural inflammation (8/16). Thoracic lesions were present in eight of 12 dogs. Exploratory surgery was performed in 16 dogs via a midline celiotomy in 15 of 16 and a lateral approach in one of 16 cases. The surgical approach was selected based on the location of the draining tracts detected on CT imaging. Vertebral body curettage was performed in five of 16 cases with lesions identified on CT. Vegetal foreign material was found in seven of 16 dogs. Of the 15 animals with long-term follow-up, 13 had no signs of recurrence. Surgical treatment of sublumbar abscessation resulted in a good long-term outcome when CT was used to guide the surgical approach and to plan the procedure. Our study highlights common vertebral and epidural lesions associated with sublumbar abscesses with a prevalence of 87.5%.