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A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report.

Stephen J, Harty M, Hollis A, Yeomans J, Corley K - Ir Vet J (2009)

Bottom Line: Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid.Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina.A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern.

View Article: PubMed Central - HTML - PubMed

Affiliation: Anglesey Lodge Equine Hospital, The Curragh, Co, Kildare, Ireland.

ABSTRACT
An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.

No MeSH data available.


Related in: MedlinePlus

Endoscopic view of the dorsal cranial bladder. There is an area of intraluminal purple discolouration leading to a rent in the bladder wall.
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Figure 1: Endoscopic view of the dorsal cranial bladder. There is an area of intraluminal purple discolouration leading to a rent in the bladder wall.

Mentions: Endoscopy of the bladder showed a large rent in the dorsal-cranial part of the bladder (Figure 1). A 28F chest drain was placed midline in the most ventral part of the abdomen and 15 L of proteinaceous fluid was drained off. The abdomen was then lavaged with 12 L of warm sterile Hartman's solution through the chest drain (Figure 2). The mare was treated with flunixin meglumine (1.1 mg/kg IV BID), cefquinome (2 mg/kg IV SID) and intravenous fluids (Hartmann's solution at 1.7 L/hr). A 30 ml Foley catheter was placed into the bladder and secured to the perineum with a urine collection bag to monitor urine production (Figure 3).


A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report.

Stephen J, Harty M, Hollis A, Yeomans J, Corley K - Ir Vet J (2009)

Endoscopic view of the dorsal cranial bladder. There is an area of intraluminal purple discolouration leading to a rent in the bladder wall.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3113760&req=5

Figure 1: Endoscopic view of the dorsal cranial bladder. There is an area of intraluminal purple discolouration leading to a rent in the bladder wall.
Mentions: Endoscopy of the bladder showed a large rent in the dorsal-cranial part of the bladder (Figure 1). A 28F chest drain was placed midline in the most ventral part of the abdomen and 15 L of proteinaceous fluid was drained off. The abdomen was then lavaged with 12 L of warm sterile Hartman's solution through the chest drain (Figure 2). The mare was treated with flunixin meglumine (1.1 mg/kg IV BID), cefquinome (2 mg/kg IV SID) and intravenous fluids (Hartmann's solution at 1.7 L/hr). A 30 ml Foley catheter was placed into the bladder and secured to the perineum with a urine collection bag to monitor urine production (Figure 3).

Bottom Line: Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid.Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina.A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern.

View Article: PubMed Central - HTML - PubMed

Affiliation: Anglesey Lodge Equine Hospital, The Curragh, Co, Kildare, Ireland.

ABSTRACT
An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.

No MeSH data available.


Related in: MedlinePlus