Caudal mediastinal paraesophageal abscesses in 7 dogs.

OBJECTIVE: To report clinical, imaging, and surgical findings associated with caudal mediastinal paraesophageal abscesses (CMPA) in dogs and outcome after surgical treatment. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 7) with CMPA. METHODS: Medical records (April 2005-January 2010) were reviewed for dogs with CMPA treated surgically. Retrieved data were signalment, history, clinical findings, diagnostic investigations, surgical findings, surgical procedures performed, and postoperative recovery. Long-term follow-up information was obtained by telephone questionnaire of owners and referring veterinarians. RESULTS: Median sternotomy (5 dogs) or lateral thoracotomy (2 dogs) was used for access to CMPA, which were drained and partially debrided surgically. In 5 dogs, omentalization of the abscess cavity was performed through a diaphragmatic incision. Foreign material was not identified within any abscess. All dogs were discharged from the hospital and had full recovery. CONCLUSIONS: CMPA should be suspected when there is regurgitation and pyrexia associated with a mass or enlargement in the caudal mediastinum. CMPA appears to have a good prognosis after aggressive surgical therapy.

Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hernia in 41 dogs.

OBJECTIVE: To evaluate the value of laparotomy as the initial step in the treatment of bilateral or complicated perineal hernia (PH) in dogs. STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: Forty-one dogs with PH. METHODS: Dogs with bilateral or complicated PH treated by a 2-step approach between November 1997 and December 2001 were studied. Inclusion criteria for complicated PH were: recurrence of PH, unilateral PH with a major rectal dilatation, PH with a concurrent surgical prostatic disease, and PH with retroflexed bladder. Colopexy, vas deferens pexy, cystopexy, and prostatic omentalization were performed during laparotomy as needed. Later, PH was performed by internal obturator muscle flap (IOMF) or if there was a perineal rent or weakness on the contralateral side, appositional herniorrhaphy was performed. Outcome was followed for >/=6 months. RESULTS: PH were bilateral (20 dogs) or unilateral (21). Twenty-one (51%) dogs had prostatic disease (clinical or ultrasonography diagnosis; 17 confirmed histologically) and 12 (29%) had urinary bladder retroflexion. Forty-one colopexies, 32 vas deferens pexies, 6 cystopexies, and 9 prostatic surgeries (omentalization or perineal cyst resection) were performed. PH was performed 2-20 days (median, 6 days) later: 61 IOMF transpositions, 13 appositional. Mean follow-up time was 26.6 months (range, 6-54 months, median, 27 months). PH was resolved in 37 (90%) dogs; 4 dogs had recurrence, and all occurred within 6 months. Thirty-eight (92%) dogs had an improved quality of life (good in 34 dogs, fair in 4 dogs). Wound complications occurred in 7 dogs (17%). Postoperative urine dribbling occurred in 15 dogs (37%) and was irreversible in 7 dogs (17%). Postoperative fecal straining persisted in 18 dogs (44%), and was permanent in 4 dogs (10%). Fecal incontinence did not occur. CONCLUSIONS: In bilateral or complicated PH, fixation of the urinary bladder and colon, and treatment of prostatic disease increase the chances of resolution. Emptying of the perineal space by organ pexy allows improved observation during herniorrhaphy. Despite a 90% clinical resolution, dogs with complicated PH treated by a 2-step protocol may have persistent urinary and fecal disorders. CLINICAL RELEVANCE: To improve the prognosis of bilateral or complicated PH, investigation and treatment of concomitant lesions (rectal, prostatic, bladder) should be part of a rational surgical strategy using a 2-step protocol.

Thoracoscopic treatment of bullous emphysema in 3 dogs.

OBJECTIVE: To report thorascopic partial lobectomy for treatment of bullous emphysema in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Three dogs with spontaneous pneumothorax. METHODS: Thoracoscopy without pulmonary exclusion was used to identify bulla. The thorascope was introduced into the thorax lateral to the xyphoid process, and instrument portals were made at different levels along the thoracic wall between the third and tenth intercostal spaces. The thorascope was passed through the mediastinum to view the opposite pleural cavity. After identification of bullae, the affected lung was excised using an endoscopic stapler, and the incision line was checked for air leakage. Thoracic drains were used for air aspiration for 2 days after surgery. RESULTS: Bullae were confirmed histologically as emphysematous lesions. Lung inflation did not interfere with identification of bullae or with surgery. All dogs had full recovery without recurrence for 18 to 29 months after surgery. CONCLUSIONS: Identification and ablation of bulla can be performed thoracoscopically without pulmonary exclusion in dogs. CLINICAL RELEVANCE: Thoracoscopy offers several advantages compared with thoracotomy for treatment and diagnosis of idiopathic pneumothorax, including ease of identification of bullae and reduced postoperative pain and morbidity.