Standing laparoscopic abdominal lavage using a suction-irrigation device in 2 horses with primary suppurative peritonitis.

The use of a laparoscopic suction-irrigation device in 2 standing horses for lavage of the abdomen for the treatment of primary suppurative peritonitis is reported. Two horses were presented with a 1- to 2-week history of weight loss. Abdominocentesis revealed highly elevated total nucleated cell count. Peritoneal lavage systems were placed in both horses, but complications prevented adequate lavage. Both horses underwent standing laparoscopy; the dorsal abdomen was explored and the abdomen was profusely lavaged, using a suction-irrigation device. The procedure was efficient and allowed adequate visualization of the dorsal abdomen and lavage. A successful outcome was achieved in both cases. Key clinical message: Lavage of the abdomen of horses with peritonitis can be achieved under standing sedation, using a laparoscopic technique. In appropriately selected cases, this allows for adequate visualization of the dorsal abdomen and efficacious abdominal lavage.

Lavage abdominal laparoscopique debout à l'aide d'un dispositif d'irrigation par aspiration chez deux chevaux atteints de péritonite suppurée primaire. L'utilisation d'un dispositif laparoscopique d'irrigation par aspiration pour le lavage de l'abdomen pour le traitement d'une péritonite suppurée primaire chez deux chevaux debout est rapportée. Deux chevaux ont été présentés avec une histoire de 1 à 2 semaines de perte de poids. L'abdominocentèse a révélé un nombre total de cellules nucléées très élevé. Des systèmes de lavage péritonéal ont été placés chez les deux chevaux, mais des complications ont empêché un lavage adéquat. Les deux chevaux ont subi une laparoscopie debout; l'abdomen dorsal a été exploré, et l'abdomen a été abondamment lavé à l'aide d'un dispositif d'irrigation par aspiration. La procédure était efficace et permettait une visualisation adéquate de l'abdomen dorsal et un lavage. Une résolution positive a été obtenue dans les deux cas.Message clinique clé:Le lavage de l'abdomen de chevaux atteints de péritonite peut être réalisé sous sédation debout, en utilisant une technique laparoscopique. Dans des cas bien choisis, cela permet une visualisation adéquate de l'abdomen dorsal et un lavage abdominal efficace.(Traduit par Dr Serge Messier).

Effect of peritoneal lavage on bacterial isolates in 40 dogs with confirmed septic peritonitis.

OBJECTIVE: To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis. DESIGN: Prospective observational study. SETTING: Private practice referral hospital. ANIMALS: Forty client-owned dogs with confirmed septic peritonitis requiring surgical intervention. INTERVENTIONS: All dogs had perioperative abdominal lavage following source control with 200 to 300 mL/kg 0.9% sterile saline. Pre- and post-lavage aerobic and anaerobic culture samples were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-five of 40 dogs (87.5%) survived to hospital discharge. The likelihood of an aerobic organism to have multidrug resistance (resistance to 3 or more antimicrobial classes) post-lavage was a third of that pre-lavage (odds ratio [OR] 0.34, 95% CI [0.17-0.68], P = 0.01). Thirty-nine of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge. The single dog with inappropriate antimicrobial therapy survived to discharge. The most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis. The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for 59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture (P = 0.09). CONCLUSIONS: This study suggests that there is a significant decrease in the likelihood of isolating a multidrug resistant organism following peritoneal lavage, and aerobic and anaerobic culture results have the potential to change following peritoneal lavage, although this cannot be confirmed without further studies. Overall survival rates were higher than previously reported in the literature for septic peritonitis.

Comparison of Initial and Postlavage Bacterial Culture Results of Septic Peritonitis in Dogs and Cats.

Septic peritonitis is a common, life-threatening condition encountered in dogs and cats. Efficacy of peritoneal lavage has not been proven in veterinary studies. Our objective was to evaluate differences in bacterial identity and susceptibility in samples obtained pre- and postlavage in animals who underwent laparotomy for treatment of septic peritonitis and to assess the effect of empirical antimicrobial selection on survival. Culture samples were collected from the peritoneal surface pre- and postlavage from dogs and cats treated surgically for septic peritonitis. Culture results were compared for each patient with regard to bacterial isolates and bacterial susceptibility profiles. Survival to discharge was evaluated. Microbial growth occurred in at least one culture in 88.6% of patients. There was no significant difference in bacterial isolates or susceptibility profiles pre- versus postlavage. Positive culture pre- or postlavage and appropriate antimicrobial selection did not significantly affect survival. For individual animals, culture results differed between pre- and postlavage samples, although no definitive effect of peritoneal lavage was seen for the population as a whole. Antimicrobials most commonly effective against isolates were Cefotaxime, Ceftazidime, and Imipenem. If prompt surgical source control is employed, antibiotic choice may not affect clinical outcome.

Effect of peritoneal lavage solution temperature on body temperature in anaesthetised cats and small dogs.

A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body mass undergoing coeliotomy. A standardised anaesthetic protocol was used. Oesophageal and rectal temperatures were measured at various time points. At the end of surgery, group 1 patients (n=10) were lavaged with 200 ml/kg sterile isotonic saline at 34±1°C and group 2 (n=10) at 40±1°C. Groups were similar with respect to age, mass, body condition and surgical incision length. Duration of anaesthesia, surgical procedures and peritoneal lavage was similar between groups. Linear regression showed no significant change in oesophageal temperature during the lavage period for group 1 (P=0.64), but a significant increase for group 2 patients (P<0.0001), with mean temperature changes of -0.5°C (from (36.3°C to 35.9°C) and +0.9°C (from 35.4°C to 36.3°C), respectively. Similar results were found for rectal temperature, with mean changes of -0.5°C and +0.8°C (P=0.922 and 0.045), respectively. The use of isotonic crystalloid solution for peritoneal lavage at a temperature of 40±1°C significantly warms small animal patients, when applied in a clinical setting, compared with lavage solution at 34±1°C.

Peritonite séptica em fêmea canina - relato de caso / Septic peritonitis in female canine - case report

A inflamação do peritônio é denominada peritonite e pode ser classificada d e acordo com a origem (primária ou secundária), com o grau de contaminação (asséptica, séptica ou mista) e com a extensã o (localizada ou generalizada) (ZIMMERMANN et al., 2006). A peritonite generalizada bacteriana é a forma predominante em cães e geralmente surge por contaminação pelo trato gastrointestinal, secundária a uma deiscênc ia de ferida cirúrgica (FOSSUM, 2008) , ma s também por perfurações do trato gastrintestinal, neoplasias, ulcerações, ferimentos por armas de fogo e intussuscepção ( ZIMMERMANN et al., 200 6). O diagnóstico de peritonite basea - se na anamnese, nos sinais clínicos, nos dados laboratoria is e no diagnóstico por imagem . Este trabalho tem o objetivo de relatar o caso de uma peritonite séptica, ocorrida após enterectomia, realizada devido a um caso de intu ssuscepção, em uma fêmea canina.

[Septic peritonitis: treatment and prognosis]. / Therapie und Prognose der septischen Peritonitis.

Septic peritonitis is an inflammatory condition of the peritoneum that has a wide variety of clinical courses. The etiology and pathophysiology of this condition and its diagnosis in small animals are reviewed in a companion article. This article addresses the treatment of septic peritonitis and prognosis in small animals.

Evaluating the effect of intraoperative peritoneal lavage on bacterial culture in dogs with suspected septic peritonitis.

This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery.This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery.

RésuméÉvaluation de l'effet d'un lavage péritonéal intra-opératoire sur la culture bactérienne chez des chiens atteints d'une péritonite septique suspectée. Cette étude pilote décrit l'effet d'un lavage péritonéal intra-opératoire sur les numérations bactériennes et les résultats dans des cas cliniques de péritonite septique. Des échantillons intra-opératoires ont été cultivés avant et après un lavage péritonéal intra-opératoire. Trente-trois chiens atteints d'une péritonite septique présumée basée sur la cytologie ont été gérés par chirurgie durant la période de l'étude. Des cultures bactériennes positives avant le lavage ont été trouvées dans 14 cas, dont 13 étaient le résultat d'une fuite intestinale. Les cultures après le lavage ont montré moins d'isolats dans 9 cas et dans 1 cas étaient négatives. Le nombre de chiens présentant une baisse de la concentration des bactéries cultivées d'échantillons avant le lavage et après le lavage n'était pas statistiquement significatif. Il n'y a eu aucun effet significatif du changement dans la culture avant et après le lavage, d'un type unique par rapport à des types multiples d'espèces bactérinnes, du choix empirique d'un antimicrobien approprié sur la survie ou le besoin d'une chirurgie subséquente.(Traduit par Isabelle Vallières).

Quantitative real-time polymerase chain reaction for the accurate detection of Toxoplasma gondii in amniotic fluid.

Infection with Toxoplasma gondii during pregnancy is often asymptomatic and may cause severe fetal damage. A quantitative TaqMan minor groove binder real-time polymerase chain reaction (PCR) assay was developed for the specific and sensitive detection of the previously described 529-bp repeat element occurring up to 200 to 300 times in T. gondii genome. The qualitative and quantitative detection limits determined were 6 and 20 marker copies (1/30 to 1/50 of 1 parasite) per PCR, respectively. In addition to standard PCR cycling conditions, 3 different fast PCR protocols were evaluated to minimize run time. A higher variability but no loss of specificity was observed. For the evaluation of clinical applicability, a total of 135 amniotic fluid samples were analyzed targeting both 529-bp and B1 gene. The sensitivity and specificity were 88.0% and 100.0% for B1, and 100.0% and 98.2% for 529-bp PCR assay (positive predictive value and negative predictive value: 100.0% and 97.4%, and 92.6% and 100.0%, respectively). Our results demonstrated an increased sensitivity of the 529-bp PCR assay even in a faster protocol.

Diagnostic peritoneal lavage for identification of blastomycosis in a dog with peritoneal involvement.

A 6-year-old castrated male Dalmatian was evaluated because of hematemesis. The dog had lived its entire life in South Dakota and Wyoming and had never traveled outside of these states. Results of laboratory testing were compatible with iatrogenic acute renal failure and gastrointestinal tract ulceration secondary to previous nonsteroidal anti-inflammatory drug and corticosteroid administration. Differential diagnoses for clinical signs and laboratory abnormalities that existed prior to these treatments included multisystemic infectious or inflammatory disease and neoplasia. Four-quadrant abdominocentesis did not yield any fluid, but because intra-abdominal disease was still suspected, diagnostic peritoneal lavage was performed. Fluid that was obtained was markedly cellular, and there were numerous extracellular structures with a round to oval shape; a 1-microm-thick, clear-staining capsule; a basophilic interior; and broad-based budding. Organisms were consistent with Blastomyces spp, and fungal culture yielded Blastomyces dermatitidis. Treatment with liposomal amphotericin B and itraconazole was recommended but could not be initiated because of the client's financial constraints. At necropsy, disseminated blastomycosis involving the stomach, small intestines, urinary bladder, omentum, mesentery of the small intestine, and abdominal wall musculature was seen. To our knowledge, peritoneal involvement has not been reported in dogs with blastomycosis, and gastrointestinal tract involvement has only rarely been reported. Findings in this dog suggest that diagnostic peritoneal lavage may be a useful technique in determining the cause of infectious peritonitis when the amount of abdominal fluid is below the limit of detection for abdominocentesis.

Abdominal paracentesis and diagnostic peritoneal lavage.

Abdominal paracentesis, the percutaneous removal of abdominal fluid for diagnostic and therapeutic purposes, provides a rapid, easy, and safe method of diagnosing diseases with abdominal effusion. Commonly diagnosed diseases include peritonitis, hemoperitoneum, uroabdomen, and neoplasia. Other indications for abdominal paracentesis include shock without a known apparent cause, undiagnosed disease within the abdominal cavity, suspicion of postoperative gastrointestinal wound dehiscence, blunt or penetrating abdominal injury, and refractory abdominal pain for which a cause cannot be determined. In such cases, simple abdominal paracentesis or four-quadrant paracentesis can be performed and requires minimal equipment. Diagnostic peritoneal lavage is indicated when peritonitis or other effusive disease is suspected, but other techniques have failed to provide a diagnostic sample. Both abdominal paracentesis and diagnostic peritoneal lavage are effective methods for the early detection of disease before overt clinical signs are present.

Cytology and fluid analysis of the acute abdomen.

In patients with acute abdominal pain, abdominal paracentesis and diagnostic peritoneal lavage often yield fluid samples for cytologic and biochemical evaluation. Cytology of the effusion from a patient with acute abdominal disease can be a crucial tool for the rapid diagnosis necessary for initiation of timely and appropriate therapy. Appropriate sample collection, handling, and preparation are essential to obtain an accurate diagnosis. Analysis of the fluid sample should include gross examination of the effusion, measurement of total nucleated cell count, packed red blood cell volume, and protein concentration, as well as examination for the presence of other cells, bacteria, food particles, or plant material. Biochemical evaluation should proceed based on the clinician's index of suspicion for a particular disease process. Abdominal effusions are generally classified as transudate, modified transudate, or exudate, depending on the total nucleated cell count and protein concentration. Cytology of all fluids collected should be performed systematically, utilizing progressively higher magnifications with a microscope. Specific diseases with associated abdominal effusions include septic peritonitis, nonseptic peritonitis, hemoabdomen, uroabdomen, pancreatitis, bile peritonitis, chylous effusion, and neoplasia. A complete description of sample preparation and evaluation is reviewed.

Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions.

OBJECTIVE: To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses. STUDY DESIGN: Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery. ANIMALS OR SAMPLE POPULATION: 12 horses. METHODS: Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions. RESULTS: All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less (P < .0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain. CONCLUSIONS: Peritoneal lavage reduced the frequency of intraabdominal adhesions. CLINICAL RELEVANCE: When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.

Effects of postoperative peritoneal lavage on pharmacokinetics of gentamicin in horses after celiotomy.

OBJECTIVE: To evaluate the effect of peritoneal lavage on pharmacokinetics of gentamicin sulfate in healthy horses after experimental celiotomy. ANIMALS: 13 clinically normal horses. PROCEDURE: Horses were randomly assigned to control or experimental groups. All horses received gentamicin (6.6 mg/kg of body weight, IV, q 24 h) before surgery, underwent experimental abdominal surgery, and had abdominal drains placed percutaneously. Horses of the experimental group received postoperative peritoneal lavage; horses of the control group did not receive peritoneal lavage. The day after surgery, 24 hours after the preoperative dose of gentamicin, a second dose of gentamicin was administered. Three and 15 hours after this second dose of gentamicin, horses of the experimental group received peritoneal lavage. Venous blood was obtained, for determination of concentration of gentamicin, immediately before and at specified intervals during the 24-hour period after the second dose of gentamicin. RESULTS: There were no differences in any of the pharmacokinetic values of gentamicin between horses of the control and experimental groups. CONCLUSIONS: Peritoneal lavage had no effect on pharmacokinetics of gentamicin in healthy horses after abdominal surgery, in which localized nonseptic peritonitis was induced. CLINICAL RELEVANCE: Peritoneal lavage in horses with localized nonseptic peritonitis or for the prevention of intra-abdominal adhesions should not necessitate alteration of the dosage of gentamicin to maintain predictable serum concentrations.

Isolation of feline eosinophils via peritoneal lavage.

Fourteen cats were inoculated orally with 1 of 2 infective doses of Toxocara canis to induce eosinophilia. Cats were subsequently challenge exposed twice via intraperitoneal injection with 1 of 2 T canis antigen preparations. Peritoneal lavage was performed 2 days after antigenic challenge exposure, and eosinophils in the peritoneal lavage fluid were quantified. None of the cats developed clinical signs of disease after infection. All cats developed peripheral eosinophilia after infection. Significant (P < 0.05) difference in mean eosinophil count from the lavage fluid was observed between lavage 1 (prechallenge exposure) and lavages 2 and 3 (postchallenge exposure) in both groups of cats. Significant difference in eosinophil count was not found between cats given different doses of eggs. After initial challenge exposure, significantly (P < 0.05) more eosinophils were obtained from cats given antigen preparation 2 (prep-2) than from those given antigen prep-1. This difference was no longer observed after the second challenge exposure with higher doses of either antigen prep-1 or prep-2. In cats given antigen prep-2, significant difference was not found between lavages 2 and 3. However, in cats given antigen prep-1, eosinophil count was significantly (P = 0.005) greater in fluid obtained from lavage 3, compared with eosinophil count from lavage 2. Mean +/- SEM percentage of eosinophils in the fluid from lavage 3 in all cats was 70.8 +/- 2.2%. Other cell types included macrophages, neutrophils, lymphocytes, and mast cells. Gross postmortem findings were mild. One- to 3-mm nodular white foci of inflammation were observed on the serosal surfaces of the liver, spleen, kidneys, and omentum.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical care surgical techniques.

A veterinarian dealing with critical and trauma patients must be proficient with techniques for tracheostomy, thoracostomy tube placement for chest drainage, diagnostic peritoneal lavage, and autotransfusion. The utilization of these techniques may be life-saving in the critical patient. A tracheostomy is indicated in any patient with upper airway obstruction that cannot be managed with supplemental oxygen and/or orotracheal intubation. A tracheostomy tube with an inner cannula is preferred. Tracheostomy tubes should be cleaned at 3- to 4-h intervals, and methods should be employed to decrease thick tracheal secretions and to remove them from the trachea. A patient with a tracheostomy tube should be monitored continuously. A thoracostomy tube is indicated in any patient with large and/or continuous accumulation of air, blood, fluid, or chyle in the pleural space. The thoracostomy tube should be at least the same size as the patient's main stem bronchus. The thoracostomy tube is placed aseptically at the seventh intercostal space at the junction of the upper one third and lower two thirds of the lateral chest wall. Fluid or air may be removed from the chest intermittently with a three-way stopcock attached to the thoracostomy tube and a 60-ml syringe. If continuous drainage is needed, a continuous underwater seal and suction system should be used. Diagnostic abdominal paracentesis and peritoneal lavage are useful techniques in the determination of abdominal trauma, hollow viscus rupture, peritonitis, hepatic trauma, and urinary system trauma. When a multiholed catheter and lavage are used, the accuracy of detecting abdominal trauma is 95 per cent. When only needle paracentesis is used, the accuracy drops to 47 per cent. Abdominal lavage fluid can be analyzed for bacteria, whole blood, white blood cells, free bilirubin, creatinine, blood urea nitrogen, amylase, alkaline phosphatase, and alanine aminotransferase. Large volumes of whole blood recovered from abdominal or thoracic paracentesis can be reinfused into the patient if needed, providing it is not contaminated or markedly hemolyzed. The blood should be collected aseptically into blood bottles or bags. If the bleeding is ongoing or the blood only a few hours old, anticoagulants should be used. If the hemorrhage is several hours old, then clotting and defibrination has already occurred and the blood can be collected into "dry" bags or bottles. Before use, abdominal blood should be analyzed for urine, bile or fecal contamination. Blood collected from the thoracic cavity is much less likely to be contaminated. Autotransfused blood is administered through a standard blood administration set.

Management of the patient with generalized peritonitis.

Peritonitis is a serious disease requiring aggressive therapy in the hope of effecting a cure. Stabilization of the patient's condition is important; immediate fluid therapy and systemic antibiotics are essential. Surgery is indicated, not only to locate and correct the causative lesion, but to mechanically cleanse the peritoneal cavity by debridement and copious irrigation. Establishment of drainage is also necessary. The drainage method chosen is dictated by the source and the extent of peritoneal contamination, the patient's condition, and the experience of the surgeon.

Response of pony peritoneum to four peritoneal lavage solutions.

Peritoneal lavage was performed on ponies to determine the effect on peritoneal surfaces. Lavage solution (20 L) was introduced into each pony's peritoneal cavity through catheters placed in the paralumbar fossa, and the solution was removed by drainage from the ventral portion of the abdomen. Six ponies each were lavaged with sterile saline (0.9% NaCl) solution, sterile saline solution containing 5 X 10(6) U of potassium penicillin and 3 g of neomycin or povidone-iodine diluted to 3% by volume with sterile saline solution, and 3 ponies were lavaged with povidone-iodine diluted to 10% with sterile saline solution. Peritoneal lavage catheters were inserted in 3 control ponies, but lavage fluids were not administered. Peritoneal fluid specimens were collected at 6, 24, 48, and 96 hours after lavage. Nucleated cell counts, RBC counts, total protein determinations, and cytologic analysis were performed. The ponies were euthanatized at 96 hours, and representative sections of the peritoneum were examined. Lavage with saline solution and saline solution with antibiotics induced a mild, transient inflammatory response in the peritoneal fluid, with minimal or no changes observed at necropsy. Solutions containing povidone-iodine induced chemical peritonitis, which was severe in ponies lavaged with 10% povidone-iodine solution. Peritoneal lavage with povidone-iodine solutions as dilute as 3% cannot be accomplished without causing inflammation of peritoneal surfaces.