Manage bite wounds: not just skin deep - DVM
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Manage bite wounds: not just skin deep
Inspiratory stridor common clinical sign with laryngeal paralysis


DVM360 MAGAZINE


A 2 year-old, 4 kg male intact Yorkshire Terrier was attacked by a large-breed dog two hours prior to presentation. The referring veterinarian provided very good initial stabilization with a hetastarch bolus, an intravenous enrofloxacin and ampicillin. On presentation, the dog was laterally recumbent, hypothermic (95.4F), tachycardic (180 bpm), hypotensive (70 mmHg) and had grey/pink mucous membranes. Multiple puncture wounds were present along the dorsum and ventral abdomen. A body-wall hernia was palpable on the ventral abdominal wall. The PCV had decreased from 35 percent to 19 percent, and total protein had decreased from 4.2 dl/L to 2.5 dl/L over two hours. Persistent abdominal hemorrhage was suspected. Diagnostics were performed including a complete blood count, chemistry screen, PT/PTT and blood type. The albumin was too low to register, the leukocyte count was low (5.6 x 109/L), and the PTT was prolonged at 162 seconds (normal 71-102). We were concerned about hemorrhage, sepsis and DIC. An emergency abdominal exploratory was planned. Fresh frozen plasma was started prior to induction of anesthesia. Warmed crystalloid fluids had been started on presentation.

A ventral midline laparotomy revealed a perforation in the duodenum at the duodenocolic ligament and a perforation in the mid-jejunum. The mesenteric adventitia was not present, and there was only a denuded web of mesenteric vessels visible. The distal portion of the right limb of the pancreas was avulsed from its blood supply and cyanotic. The right dorsal body wall and the epaxial muscles were significantly devitalized, actively hemorrhaging and the wounds penetrated the abdominal cavity and retroperitoneal space. There was retroperitoneal hemorrhage surrounding the right kidney. The right ureter and blood supply to the right kidney appeared intact. There were three additional large abdominal wall hernias.

Treatment consisted of two intestinal resections and anastomoses, a partial pancreatectomy, debridement of devitalized muscle and repair of the multiple hernias. A J-vac drain was inserted in the abdominal cavity and a urinary catheter was placed. A stockinette was placed over the patient's body.

Post-operatively, the dog was managed with ampicillin, enrofloxacin, intermittent plasma doses (four doses over two days), hetastarch, crystalloids with postassium supplementation, metoclopramide CRI, famotidine and warm compresses. Urine output was recorded. The dog had yellow liquid diarrhea and was regurgitating bile for eight to nine days post operatively. He also had hemo-globinuria for four days post incident. The J-vac drain was removed five days after surgery when the volume of fluid accumulation had decreased. After seven days, he would eat small pieces of boiled chicken when hand-fed. His blood glucose, packed cell volume, total protein and electrolytes were monitored routinely. At discharged from the hospital 14 days after being bitten, he was ambulatory, eating and drinking without regurgitation, and had a soft, normal-colored stool. One month later the owners reported that he was resuming normal activity and doing well.

Unfortunately, not all bite-wound stories end this well. Thanks to the excellent care by the referring veterinarian, rapid treatment by our emergency and surgical teams, and the willingness of the owners to allow us to pursue aggressive treatment, this was a success story.

Tara Britt graduated from the University of Pennsylvania School of Veterinary Medicine in 2002. She completed a rotating internship in small animal medicine and surgery at Red Bank Veterinary Hospital and is currently a resident in small animal surgery at Red Bank Veterinary Hospital in Tinton Falls, New Jersey.

Dr. Thacher, a dipl. of the American College of Veterinary Surgeons, is section head for the Department of Surgery at Red Bank Veterinary Hospital. He served as Chief of Staff of Affiliated Animal Health, a consortium of 17 small animal hospitals in the NY/NJ area and is former chairman of the Animal Medical Center's (AMC) Department of Surgery. Dr. Thacher has delivered numerous presentations on surgery throughout the United States and Europe. He received his DVM from the University of California, Davis in 1980.


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Source: DVM360 MAGAZINE,
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