Species: dog
Breed: Bernese Mountain Dog
Sex: f, not neutered
Weight: 32.9 kg & 41.7 kg
Birth date: 2023-07-24 00:00:00
Primary diagnosis: Intrapelvic and subcutaneous abscesses, discospondylitis, left renal pelvic and proximal ureteral dilation, cavitary lesions filled with corpuscular fluid in caudal to right abdomen in close association to the uterus
Situation: elective surgery
Time since surgery: 2-4 hrs
Recovered from anesthesia: mild sedation (1)
Medical history: Back pain and stiff gait since a month, after a few weeks start lameness of the right hind leg. Multiple Dexamethason injections and Onsior treatment but the symptoms continue to come back. After a few weeks + fever and exercise intolerance. Tolfedine injection without improvement of the symptoms -> referal to the clinic on the next day. Pelvic abscesses on MRI. The dog went home after 5 days, came back after 2 days (dysorexia, kyphosis, uncomfortable, blood culture positive). The dog was presented to the Internal Medicine Department on 7 August 2024 for re-evaluation of a Staphylococcus pseudintermedius infection with positive blood culture, abscess, T4-T5 discospondylitis, humeral physitis, sacroiliac arthritis and sacral osteomyelitis diagnosed on 25 April. Since her last visit on 5 June, Daria had been in very good general condition and has a good level of energy. She had an excellent appetite and is putting on weight. The owners sometimes notice stiffness in the hindquarters (more marked on the right) when walking, but the pace is normal when running. No back pain. No vomiting or diarrhoea. No PU/PD. She went into heat for the first time in June. Excellent compliance with treatment. Gabapentin was gradually weaned off as agreed and stopped on 31 July. On the 07.08.2024 radiographs were taken and an ultrasound was performed. X-rays report: T4-T5 discospondylitis with mildly progessive new bone formation ventrally; Proximal humeral physis appears normal. Ultrasound report: Two cavitary lesions filled with corpuscular fluid situated in the caudal to right abdomen, in close association to the uterus; Stationary left renal pelvic and proximal ureteral dilation with tapering at the level of its retrocaval course -> Differential diagnoses for cavitary lesions are: intrauterine, representing compartmentalisation with e.g. pus filling, parauterine or extrauterine abscessation or hematomas; Focal infammatory fluid dilation of the uterus alone considered less likely; Given the patients previous history abscess is considered most likely despite the fat surrounding the lesions being mostly normal; A CT may be helpful to better evaluate the structures and organs involved. In this context, a CT scan of the abdomen and an exploratory laparotomy were planned and performed on the 12.08.2024.
Medication: Gabapentin 10 mg/kg PO TID, Marbofloxacine 4 mg/kg IV SID, Metacam 0.1 mg/kg IV SID, Buprenorphine 0.015 mg/kg IV TID, Ondansetron 0.3 mg/kg IV TID, (Augensalbe bds q4h, RA 2 ml/kg/h). Before presentation on 12.08.2024 & observation 4: Cefalexin 18 mg/kg PO BID. After surgery: before obervation 5 Methadon 0.2 mg/kg IV & Metamizol 30 mg/kg IV, before observation 6 Buprenorphin 0.015 mg/kg IV.
Anesthesia: Intervention on 12.08: CT and exploratory laparatomy with ovariohysterectomy. Premedication at 10:10: Acepromazin 0.005 mg/kg IM, Medetomidin 0.01 mg/kg IM, Methadon 0.3 mg/kg IM. Induction: Propofol 1.5 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: Bolus Methadon 0.2 mg/kg IV, IV Infusion Fentanyl 0.002-0.005 mg/kg (90 min), IV Infusion Lidocain 1.8 mg/kg (90 min), Local anaesthesia rectus abdominis sheet block Ropivacain 0.5 mg/kg (4 ml). Antibiotics: Cefazolin 22 mg/kg IV. Complications: hypotension -> Bolus RA 5 ml/kg IV. Wake up phase: Bolus Methadon 0.2 mg/kg IV, Bolus Buprenorphin 0.015 mg/kg IV. Intervention duration: 709 min. Anaesthesia duration: 175 min.
Neurologic exam: Done a week before. Mentation: normal. Posture: no weight bearing of the right hind limb, nerve root sign, often puts the leg underneath the body. Gait: lameness right hind limb. Postural reactions: slightly delayed hind right limb. Cranial nerves: normal. Spinal reflexes: normal. Sensibility: very painful when moving tail upwards and with palpation of lumbosacral transition. Neuroanatomical location: L4-S3.
Pain type: acute, inflammatory, visceral, somatic
Pain origin: Abdomen, Uterus excision site
Estimated pain severity: 35