Computed tomography of a canine omental torsion secondary to a chronic abdominal gossypiboma and concurrent incidental broad ligament torsion.

A 5-year-old female spayed Dogue de Bordeaux was referred for concerns of an abdominal mass and peritoneal effusion. Abdominal radiographs identified a mid-ventral abdominal soft tissue opaque mass containing a radiopaque marker consistent with a gossypiboma. Contrast-enhanced abdominal CT identified two whirl signs associated with the abdominal gossypiboma. Exploratory laparotomy confirmed an omental torsion with encapsulated gossypiboma and concurrent incidental torsion of the remnant of the right broad ligament. Based on a literature review, omental torsions are an unreported complication of gossypibomas in canids.

Ultrasonographic appearance of retained surgical sponges and gauzes in the acute postoperative period: a phantom and cadaveric study.

Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The purpose of this two-part, prospective, descriptive study was to describe the previously uncharacterized ultrasonographic appearance of RSS in phantom and cadaveric models of the acute postoperative period (24-48 h). For the first part of the study, a gelatin phantom containing a woven gauze with a radiopaque marker (radiopaque gauze), a woven gauze with no marker (nonradiopaque gauze), and a laparotomy sponge with a radiopaque marker (radiopaque sponge) was evaluated with ultrasonography. For the second part of the study, a total of 23 gauzes and sponges (of the aforementioned three types) were placed within the peritoneal cavity of 20 cadavers in one of three randomized locations during an exploratory laparotomy laboratory. The cadavers were imaged with ultrasonography 17 h later and still images and video clips were reviewed. The retained surgical sponges and gauzes in the gelatin phantom displayed multiple hyperechoic layers and variable degrees of distal acoustic shadowing. In cadavers, 100% (23/23) of the retained surgical sponges and gauzes displayed a single hyperechoic layer of variable thickness and distal acoustic shadowing. In 95.6% (22/23) retained sponges and gauzes, there was a thin hypoechoic layer noted superficially to the hyperechoic layer. An improved understanding of the ultrasonographic appearance of retained sponges or gauzes in the acute postoperative period may assist in the identification of these objects.

Evaluation of factors associated with retained surgical sponges in veterinary patients: a survey of veterinary practitioners.

OBJECTIVES: To evaluate factors that could be associated with retained surgical sponges in veterinary patients. MATERIALS AND METHODS: A survey was distributed to 322 veterinarians attending a national veterinary conference in the UK. The survey included questions about the staff, scheduling, type of surgical procedure, surgical sponges, methods to track surgical sponges and details of clinical cases with retained surgical sponges. RESULTS: The response rate was 64 of 322 (19%). Lack of designated scheduled time for surgical procedures was reported by 30% of respondents and was variable for 31%. More than half of respondents (66%) had two people involved in each surgical procedure. The majority of respondents sterilised their own surgical sponges (91%) and used non-radiopaque surgical sponges (56%). Sponges were not counted by 27% of respondents and only occasionally by 20%. Sponge count was not recorded by 70% of respondents. The majority (66%) did not use or have a surgical checklist. Lack of awareness of gossypibomas was reported by 11% of respondents. In all, 27% of respondents were aware of at least one case of retained surgical sponge. Of the 17 cases reported, 14 were small animals. The abdomen was the most common anatomical location for retained surgical sponges and followed elective neutering. CLINICAL SIGNIFICANCE: Despite the low-response rate, our results suggest that methods of surveillance might reduce the incidence of retained surgical sponges. Lack of specifically scheduled time for surgery, few theatre staff and lack of sponge counting and documentation may have contributed to the 17 retained surgical sponge cases reported.

Effect of tear collection on lacrimal total protein content in dogs and cats: a comparison between Schirmer strips and ophthalmic sponges.

BACKGROUND: Quantification of lacrimal total protein content (TPC) is an important tool for clinical scientists to understand disease pathogenesis, identify potential biomarkers and assess response to therapy, among other applications. However, TPC is not only affected by disease state but also by the method used for tear collection. Thus, the purpose of this study is to determine the impact on TPC of two methods of tear collection in dogs and cats: Schirmer strips and polyvinyl acetal (PVA) sponges. METHODS: (i) In vivo - Ten healthy dogs and 10 healthy cats were examined. Each animal underwent two sessions, separated by 10 min, in which a Schirmer strip was placed in one randomly selected eye until the 20-mm mark was reached, while a strip of PVA sponge was placed in the other eye for 1 min. (ii) In vitro - Schirmer strips and PVA sponges were spiked with various volumes of four bovine serum albumin solutions (0.5, 4, 10, and 20 mg/mL). In both experiments, the wetted absorbent materials were centrifuged for 1 min, and the TPC was quantified on the extracted fluid using Direct Detect™ infrared spectroscopy. RESULTS: Lacrimal TPC in dogs and cats ranged from 5.2 to 14.6 mg/mL and from 6.2 to 20.6 mg/mL, respectively. In cats, TPC was significantly lower with Schirmer strips vs. PVA sponges (P < 0.001). In dogs, the volume absorbed by PVA sponges was negatively correlated with TPC (r = - 0.48, P = 0.033). The inter-session coefficient of variation was significantly lower with Schirmer strips vs. PVA sponges in both species (P ≤ 0.010). In vitro, both absorbent materials resulted in a 'concentrating effect' of the TPC obtained post-centrifugation, which was most pronounced when the volume absorbed was low, especially for Schirmer strips. CONCLUSION: Schirmer strips provide a repeatable method to quantify lacrimal TPC in dogs and cats, although care should be taken to absorb sufficient volumes of tears to minimize the concentrating effect from the absorbent material.

IMAGING DIAGNOSIS-COMPUTED TOMOGRAPHY FINDINGS IN A DOG WITH SPONTANEOUS TRANSMURAL MIGRATION OF A TEXTILOMA INTO THE CECUM.

A 3-year-old spayed female dog was presented with 3-month history of severe bilateral uveitis subsequent to previous ovariohysterectomy. Physical examination revealed moderate abdominal pain. Computed tomography showed a nonobstructive heterogeneous mass-like lesion with a speckled gas pattern (spongiform pattern) within the cecum. Exploratory laparotomy revealed a surgical swab in the lumen of the cecum with severe adhesions. Histopathological examination demonstrated a chronic inflammatory pyogranulomatous reaction to the retained swab embedded within the intestinal wall, consistent with transmural migration of the swab from the peritoneal cavity into the cecum.

Intra-articular implantation of gentamicin impregnated collagen sponge causes joint inflammation and impaired renal function in dogs.

OBJECTIVE: Gentamicin impregnated collagen sponge (GICS) can be used to treat intra-articular surgical site infections. High local concentrations of gentamicin can be reached for short periods; however the collagen vehicle may persist for much longer periods. We wished to determine the effect of sponge implantation on joint inflammation and renal function. METHODS: Eighteen medium sized mixed breed research dogs of hound type were randomized to two groups; arthroscopic implantation of GICS at gentamicin dose = 6 mg/kg (n = 9) or sham operation (n = 9). Endpoints consisted of joint inflammation measured by synovial fluid cell counts and cytokine concentrations; lameness measured by force plate asymmetry indices; and renal function measured by glomerular filtration rate (GFR) study. The prevalence of lesions associated with aminoglycoside nephrotoxicity was assessed by renal biopsy and transmission electron microscopy. RESULTS: Gentamicin impregnated collagen sponge implantation caused joint inflammation (p <0.01), lameness (p = 0.04), and decreased GFR (p = 0.04). No difference was observed in the prevalence of renal lesions on biopsy between the treatment and control groups (p = 0.49). CLINICAL SIGNIFICANCE: Gentamicin impregnated collagen sponge implantation causes joint inflammation and lameness as well as GFR reductions at the dose assessed. Gentamicin impregnated collagen sponge are not recommended for intra-articular implantation in dogs.

Effects of bilayer gelatin/ß-tricalcium phosphate sponges loaded with mesenchymal stem cells, chondrocytes, bone morphogenetic protein-2, and platelet rich plasma on osteochondral defects of the talus in horses.

Osteochondrosis (OC) is a common and clinically important joint disorder in horses. However, repair of the OC region is difficult because of the avascular nature of cartilage. This study aimed to evaluate the efficacy of bilayer gelatin/ß-tricalcium phosphate (GT) sponges loaded with mesenchymal stem cells (MSCs), chondrocytes, bone morphogenetic protein-2 (BMP-2), and platelet rich plasma (PRP) for the repair of osteochondral defects of the talus in horses. Full-thickness osteochondral defects were created on both the lateral trochlear ridges of the talus (n = 6). In the test group, a basic GT sponge loaded with MSCs and BMP-2 (MSC/BMP2/GT) was inserted into the lower part of the defect, and an acidic GT sponge loaded with chondrocyte, MSCs, and PRP (Ch/MSC/PRP/GT) was inserted into the upper part of the defect. In the control group, the defect was treated only with bilayer GT sponges. Repair of osteochondral defects was assessed by radiography, quantitative computed tomography (QCT), and macroscopic and histological evaluation. The test group showed significantly higher radiographic, QCT, macroscopic, and histological scores than the control group. This study demonstrated that the bilayer scaffolds consisting of Ch/MSC/PRP/GT for the chondrogenic layer and MSC/BMP2/GT for the osteogenic layer promoted osteochondral regeneration in an equine model. The bilayer scaffolds described here may be useful for treating horses with OC.

Retained surgical swabs in 13 dogs.

To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats that were referred to four referral centres were reviewed. Cases in which a retained surgical swab was identified during surgery at the referral hospital were selected for further study. The signalment, history, clinical signs, diagnostic and surgical findings and outcome in these cases were reviewed. Thirteen dogs with retained surgical swabs were included in the study. Bodyweight ranged from 9 to 45 kg. The initial surgery was a 'non-routine' abdominal procedure in seven dogs, ovariohysterectomy in five dogs and perineal hernia repair in one dog. Time from initial surgery to presentation at the referral centre ranged from four days to seven years. Treatment involved major surgery in eight of the 13 dogs. Outcome was excellent in 12 of 13 cases, one dog was euthanased.

Surgical sponges in small animal surgery.

Sponges are commonly used in veterinary practice. Uses for sponges in the operative arena include hemostasis, retraction, protection, dissection, and general wound management. Blood loss can be quantitated by counting blood-soaked sponges. Complications may arise when sponges are retained in the patient. Sponge retention is a risk whenever sponges are used during surgery, regardless of surgical procedure. This article reviews physical characteristics and proper uses of sponges, complications of sponge retention, and techniques to avoid retained sponges.

Treatment of lumbosacral discospondylitis by surgical stabilisation and application of a gentamicin-impregnated collagen sponge.

This report describes a case of lumbosacral discospondylitis in a two-year-old boxer dog. The dog had been presented with chronic hindlimb lameness and signs of lumbar spinal pain. The diagnosis was confirmed with a magnetic resonance imaging scan and positive blood culture. Following unsuccessful conservative management, the dog was treated with surgical stabilisation using screws and polymethylmethacrylate, and implantation of a gentamicin-impregnated collagen sponge into the L7-S1 disc space. This technique has not previously been described. The dog had a successful long-term outcome with complete resolution of clinical signs.

Ex vivo evaluation of the effect of tibial plateau osteotomy on the proximal tibial soft tissue envelope with and without the use of protective gauze sponges.

OBJECTIVE: To investigate the effect of tibial plateau leveling osteotomy (TPLO) on the proximal tibial soft tissue envelope with and without use of protective gauze sponges, and to determine whether the action of an oscillating saw blade on the gauze sponges would result in retention of particulate cotton debris. STUDY DESIGN: Cadaveric study. ANIMALS: Medium to large breed dog cadavers (n=10; 20 pelvic limbs). METHODS: TPLO was performed using the currently recommended technique involving dissection of the proximal tibial soft tissue envelope and its protection using cotton gauze sponges. In paired limbs, the procedure was repeated but no attempt was made to retract and protect the proximal tibial soft tissue envelope. Damage to the soft tissue envelope and presence of gross particulate cotton debris were investigated by direct observation and photographic analysis. Presence of microscopic cotton debris was investigated using light microscopic analysis of wound lavage fluid. RESULTS: No soft-tissue trauma was found in gauze sponge-protected specimens. When protective gauze sponges were not used, full-thickness (sagittal plane) lacerations to the caudoproximal tibial muscle group occurred in all specimens with a mean craniocaudal width of 9.5 mm (range 2-12 mm). The cranial tibial muscle was traumatized in only 1 specimen without protective gauze sponges. Trauma to the popliteal vessels was not identified in any specimen. No gross cotton debris was identified, but microscopic cotton fibers (diameter, 7-35 microm) were identified in lavage fluid from all gauze sponge-protected specimens. CONCLUSIONS: Use of protective gauze sponges is effective in protecting the proximal tibial soft tissue envelope from an oscillating TPLO saw blade, but results in retention of microscopic cotton particulate debris within the operative site. Significant soft tissue trauma is seen only in the caudoproximal tibial muscle group if protective gauze sponges are not used. CLINICAL RELEVANCE: Retraction and protection of the caudoproximal tibial soft tissue envelope is recommended during TPLO; however, to prevent retention of microscopic particulate cotton debris, alternatives to cotton gauze sponges should be considered as protective devices.

What is your diagnosis? Intra-abdominal mass aspirate from a spayed dog with abdominal pain.

An 8-year-old, spayed female Labrador Retriever was presented for evaluation of unwillingness to exercise. On clinical examination abdominal pain was elicited, and a midabdominal mass was detected in survey radiographs. Ultrasound-guided fine-needle aspiration of the intra-abdominal mass was done. The cytologic findings indicated chronic granulomatous inflammation with reactive fibroplasia, cholesterol crystals, and extracellular foreign material. The foreign material consisted of opaque, basophilic fragments of uniform width (5-10 mum) and variable length (30-180 microm) and was observed extracellularly and within macrophages. The material was birefringent under polarized light. Histologic examination of the excised mass confirmed the cytologic findings and a diagnosis of gossypiboma (textiloma) was made, consistent with retention of a surgical sponge. This case provides a unique example of the utility of fine-needle aspiration for the diagnosis of gossypiboma.

Enterocutaneous fistula in a dog secondary to an intraperitoneal gauze foreign body.

A 6-year-old, spayed female German shepherd crossbreed had a 6-month history of a draining fistula in the left flank. Fistulography demonstrated an enterocutaneous fistula. Surgery revealed a granuloma that was enveloping the left ureter and caudal mesenteric artery and adhering to multiple loops of bowel. The granuloma centered on a gauze sponge inadvertently retained at time of ovariohysterectomy. Retained surgical foreign bodies can be avoided, and their frequency is likely underestimated. Risk factors identified in human medicine include emergency surgery, changes in surgical procedure, and obesity. A foreign body should be considered a potential cause of draining tracts in veterinary patients.

Extravesical textiloma (gossypiboma) mimicking a bladder tumor in a dog.

Sponges can be inadvertently left behind during surgery. A retained surgical sponge is called a textiloma, gossypiboma, or gauzoma. This complication is rare and rarely reported. These foreign bodies can lead to postoperative infection or abscess formation, while others remain asymptomatic for many years before leading to a granuloma with adhesions. This paper reports a case of extravesical textiloma in a spayed female dog with severe hematuria and a thickened bladder wall, mimicking a tumor on ultrasound. Clinical signs occurred >8 years after sterilization.

Extraskeletal osteosarcoma associated with retained surgical sponge in a dog.

Retained surgical sponges are usually discovered in the abdominal cavity, sometimes years after the surgical procedure, and the typical reaction is formation of a foreign-body granuloma, often called gossypiboma or textiloma. In this instance, an extraskeletal osteosarcoma, associated with the granulomatous reaction to a retained surgical sponge adjacent to the stifle, was diagnosed in an 11-year-old Labrador Retriever 9 years after repair of a ruptured cranial cruciate ligament. Radiographic detection of linear foreign material in the soft tissue mass was the basis for a diagnosis of gossypiboma. The mass was surgically excised. Histologically, fibers consistent with those of cotton gauze were associated with the granulomatous inflammation and the osteosarcoma. Amputation or radiation therapy was declined; the dog was treated conservatively with doxycycline and deracoxib. Three months after surgical excision, the dog was euthanized because of local recurrence of the mass along with lameness and decreased appetite.

Play-Doh and water-soaked gauze sponges as alternative bolus material for cobalt-60 teletherapy.

A study was performed to determine if carefully made boluses of either Play-Doh, or water-soaked cotton gauze sponges differed from the commercial bolus material, Superflab, in producing maximum radiation dose when irradiated with cobalt-60 photons. The radiation doses were measured with thermoluminescent dosimeters calibrated to be accurate for cobalt-60 photon energies at doses less than 10.0 cGy. The resulting radiation doses were similar when using Play-Doh, water-soaked sponges, or Superlab. Doses resulting from Play-Doh boluses more consistently approximated those of Superflab. The results of this study suggest that either Play-Doh or water-soaked cotton gauze sponges can suffice as material for carefully made bolus for cobalt-60 teletherapy.