Uroperitoneum - 763

Case Presentation

• Patient: 2 year 2 day old Quarter horse colt

• Symptoms:

  • Depression

  • Failure to nurse

  • Signs of colic

  • Abdominal distension

Differential Diagnoses

• Neonatal Maladjustment Syndrome: Condition affecting newborns, leading to various clinical signs.

• Sepsis: Infection that can result in systemic illness.

• Ruptured Bladder: Common in foals; results in fluid accumulation and electrolyte imbalances.

• Clostridial Enteritis: Potential cause of diarrhea which can lead to dehydration and colicky signs.

• Meconium Impaction: A common cause of colic in foals, leading to abdominal discomfort.

Initial Diagnostics

• Physical Exam: Comprehensive assessment to check vital signs and overall health.

• Rectal Exam: Useful for palpating structures like the intestines and assessing for impactions.

• Abdominal Ultrasound: Visual assessment for fluid and organ integrity.

• Blood Work: To evaluate for infections (CBC) and check serum electrolytes and metabolic status.

Ultrasound Findings

• Location: Ventral midline near pubic bone.

• Observations:

  • Presence of anechoic (black) fluid indicating non-cellular fluid accumulation.

  • Possible bladder thickening.

• Implication: Suggests ruptured bladder due to fluid accumulation.

Fluid Analysis

• Sample Taken: Clear pale yellow fluid obtained via abdominal tap.

• Tests to Conduct:

  • Total protein assessment.

  • Lactate levels.

  • Cytology (optional).

  • Creatinine to compare fluid versus serum levels.

Blood Work Results

• Findings:

  • Hyperkalemia (high potassium levels).

  • Hyponatremia (low sodium).

  • Hypochloremia (low chloride).

  • Metabolic acidosis.

• Interpretation: A significant sign of complications typically associated with ruptured bladder.

Radiographic Findings

• Observations:

  • Loss of serosal detail due to fluid accumulation.

  • Presence of normal gas patterns in the intestines.

  • Indication of sand or foreign material in the gastrointestinal tract.

Diagnosis

• Uroperitoneum: Confirmed when the creatinine level in peritoneal fluid is more than 2-fold higher than blood creatinine.

• Common Cause: Most frequently due to ruptured bladder in foals, particularly in the dorsal aspect of the bladder.

Treatment Protocol

• Fluid Therapy: Initial treatment with isotonic saline to correct electrolyte imbalances and hydrate the patient.

• Surgical Intervention:

  • Ventral midline laparotomy to repair bladder defects.

  • Ensure thorough closure to prevent leakage.

  • Monitor bladder function post-surgery to avoid complications.

• Electrolyte Management: Address hyperkalemia, particularly critical in the acute setting to prevent cardiac arrest.

Prognosis

• Expected Outcome: Generally very good, with foals recovering well post-surgery, often showing significant improvement quickly.