Thursday, January 14, 2010

Update on : Lessons in bladder control (see bottom)

A 9 month old puppy presented to me on Sunday night around 9pm. She was down-in-the -dumps sick: dehydrated, vomiting, and passing a large amount of very, very bloody diarrhea. She looked like your typical parvo puppy. The parvo test was negative, and the white blood cell count was a whopping 60,000 (normal up to 13,000 or so). I discussed starting aggressive treatment with fluids and antibiotics to the owners (coincidentally, these are the same owners whose cockatoo I treated a month or so ago).

We started treatment, but the puppy continued to deteriorate despite aggressive fluid replacement. I palpated her abdomen again carefully, and I could swear I felt a mass that kept moving - disappearing momentarily and then coming back. After really mulling it over, I decided to call the owners back and tell them that I thought exploratory surgery was warranted. It was a hard call to make. The xrays didn't show an obvious foreign body, but they were UGLY. I had a hunch something was seriously wrong. As a sidenote: one of the things vets hate most is doing a negative exploratory (not finding anything obvious to explain the clinical signs - such as a foreign body or strangulated bowel loop). The owners, despite financial concerns, opted to go for it.

I was not quite prepared for what I found (although I should have been, as what I found is a big differential for bloody diarrhea in a puppy). The intestines were kind of a knot, and there was fibrin in the abdomen. The omentum (membrane that covers and nourishes the guts) was adhered to the big knot in the middle. I gently pulled it out and stared at it, not quite sure what I was looking at. As I teased the omentum away slowly, I finally understood. I was staring at my first GI intussusception.

That big fancy word describes when the intestines become hyper-motile and telescope in on themselves. Essentially, the large intestines try to eat the small intestines. Often, it becomes stuck that way - as this puppy's had - probably a couple of days ago. If it's a fresh intussusception, you can milk the intestines out of themselves and presto majesto finito. In this case, the problem had been present for at least 2 days. I could slide my finger into where the guts telescoped, and feces came back out. There was a hole inside. That meant only one thing: a resection and anastamosis.

I had to cut out the bad part and sew the good ends together. In the small intestines, this isn't hard - they heal great. In this case, however - I had to cut the colon/large intestine. It DOES NOT heal well. You never cut into the colon unless you have no other choice. I had none.

I cut it out, sewed it back together, debated whether it looked healthy, and finally, took a deep breath, tried not to pee on myself in fear, and closed up the dog.

Four days later, she is doing great. No more vomiting, she's eating, wagging her tail, and totally normal. The first 48-72 hours are critical, but I think we can safely say that we're out of the woods now.

That surgery was a huge rush for me. It was my first of that kind, and I was very proud of the way I handled it. 2 hours from start to finish, and my patient is doing GREAT.

Ahh! Sometimes I love my job.

Update: My patient recovered beautifully (this is an old post from September) and to this day, is growing like a weed and healthy as a horse!

9 comments:

DrSteggy said...

Well done--good job! :D

Mara said...

Awesome!

Hermit Thrush said...

I'm impressed! Nicely done.

Elizabeth said...

Keep that in your Atta Girl file for future reference!

Beloved Parrot said...

Great job!

Beloved Parrot said...

How is your returned-home cat doing? Did he/she say where her/his travels took her/him?

Nicki said...

I still have not done a resection. Which is good for the patient I guess! My FB have been pretty easy

Beloved Parrot said...

Hi! I deleted a couple you sent (I think), and lost one you/someone sent, so please check to be sure.

And thank you for the condolences.

Mary said...

Great job!