A challenging case: Abdominal effusion in a dog
Leakage of intestinal contents and a common contrast medium into a dog's abdominal cavity proved to be a fatal combination.
May 01, 2009
INITIAL PRESENTATION AND EVALUATION
At presentation, the dog had normal vital signs but was lethargic with a tense abdomen and palpable abdominal fluid. The combination of the presenting signs with the history of a recent cystotomy raised suspicion for a possible uroabdomen secondary to surgical complications. An abdominocentesis yielded 12 ml of an opaque straw-colored fluid with a protein concentration of 3.2 g/dl, a red blood cell (RBC) count of 190/μl, and a white blood cell (WBC) count of 46,150/μl.Cytologic examination
Additional diagnostic tests
The complete blood count (CBC) results revealed a normal packed cell volume (PCV) of 45% (reference range = 37% to 54%) and a normal total WBC count of 14,230/μl (reference range = 6,000 to 17,000/μl) that was characterized by a mild left shift and 2+ toxic neutrophils. The serum chemistry profile revealed increased alkaline phosphatase (ALP) (496 U/L; reference range = 16 to 111 U/L) and aspartate aminotransferase (AST) (68 U/L; reference range = 10 to 46 U/L) activities and decreased concentrations of albumin (2 g/dl; reference range = 2.9 to 3.7 g/dl) and calcium (8.9 mg/dl; reference range = 9.5 to 11.6 mg/dl). The CBC results, increased liver enzyme activities, and decreased albumin concentration indicated active inflammation with possible infection. The hypocalcemia was attributed to the low albumin concentration.
Glucose concentrations measured in the serum (143 mg/dl; reference range = 70 to 122 mg/dl) and abdominal fluid (80 mg/dl) and lactate concentrations measured in the serum (2.1 mmol/L; reference range = 0.22 to 1.44 mmol/L) and abdominal fluid (6.1 mmol/L) were consistent with a septic peritoneal exudate. A difference of > 20 mg/dl between serum and abdominal fluid glucose concentrations and a difference of < -2 mmol/L between serum and abdominal fluid lactate concentrations are suggestive of a septic exudate in the abdomen.1 Consequently, a presumptive diagnosis of septic barium peritonitis secondary to gastrointestinal perforation, source unknown, was made.