Sunday, December 9, 2012

1214. Follow-up. "Closed pyometra" case

Two days ago, this 11-year-old female Maltese was operated by Dr Daniel and me. This was a strange case. Total white cell count was very high in the blood test.. A swollen abdomen with a globular lump. I said it was a very full bladder on first palpation but Dr Daniel said the dog had peed all urine. An X-ray showed a big globular swelling and I was quite sure it was the bladder.

BLOOD TEST ON DEC 6, 2012
Serum urea 22 (4.2 to 6.3), creatinine 188 (89-177).
RBC 4.8 (5.5-8.5), Haemoglobin 9.9 (12-18).
Total WCC  62 (6-17),  N=98%, L 1.7%, M, E, B.
Platelets 131 (200-500) was low suggestive of toxaemia


SURGERY ON DEC 7, 2012
The biggest bladder ever seen. Like 3/4 of a Thai mango. The dog had been given IV drip 12 hours ago to pep her up for surgery and increase her chances of survival.  More than 15 cm long. I aspirated the urine with a sterile syringe from the apex of the bladder and sent for urine analysis.

Urine colour: Colourless.
Clarity: Slight turbid.
pH 5.0 (5-8).
SG 1.012 (1.005-1.030)>2250. RBC 90 (Possible haemolysis of RBC in urine).
Bacteria 2+. Crystals Nil.
"Urinary stones might not be radio-dense and so would not be seen in the X-rays," I said to Dr Daniel who was operating. "Flush out the bladder, irrigate it. Put a catheter into the bladder and pass it out through the urethra from the bladder." There was cystitis. Negative crystals in urine do not mean no urinary stones.

When Dr Daniel tried to pass the catheter out from the neck of the bladder, there was obstruction. "It is possible that there could be a urinary stone stuck inside the short urethra and not visible on the X-ray," I said. After 2 minutes, he managed to pass the catheter out of the urethra and the vulval lips. "There could be a urethral obstruction in the female dog as well." Most vets don't pass the urethral catheter via the vulval vestibule as they deem it difficult to do it, unlike in the dog.

"Check the neck of the bladder for tumours," I said. "Extend the incision of the skin caudally. There was a large reddish lump at the neck of the bladder on the outside. I took an image for the owner to see.


DISCUSSION WITH THE OWNERS
Today was the first time I met the father and two young adult daugthers.
"Did the dog have difficulty passing urine?" I asked.
"Yes," one daughter said. "She took a long time to pee and only a few drops of urine came out."
I reviewed the record on Dec 6 when the dog was admitted. "Urine sticky. Stools red and yellow past 2 weeks. Appetite decreased. Vomited once."  Pyometra was suspected but the onset of heat was unknown.
 

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