Tuesday, October 18, 2011

Weird Stuff

Note: This post was intended for Tuesday evening but weather interfered with it being posted.

There were a couple of interesting things that happened at work today that I thought y'all might enjoy hearing about. It was a very, very busy day; I overslept and was 30 minutes late then hit the ground running as soon as I arrived with only a pause for "Boss's Day" lunch ( a day late, methinks but it's the thought that counts and they wanted me to be there. Awww, how sweet.) and left about 45 minutes after closing time which isn't too bad for me.

The most interesting cases of the day are as follows:
Approximately 4 month old male "stray" kitten that the new owner had only managed to catch about 5 days ago. The kitten was reportedly normal until early in the weekend when he began to lay around and just not act right while his 2 littermates were playing like crazy. On examination, he was pale and icteric with increased lung sounds. FeLV / FIV negative, CBC within normal ranges, Chemistry showed an elevated total bilirubin (2.8), low albumin and total protein, and a whopping ALT at 1536!! I think that is the highest ALT I've seen thus far in my career. Differentials such as FIP or toxins were floating through my mind. During the exam and bloodletting, the kitten got upset then started to breathe very hard and never really slowed back to a normal respiration rate. The owner opted to euthanize and send him in for a necropsy at the state diagnostic lab. The owner is very concerned about toxins since they have a crazy neighbor just down the street with a history of suspected poisonings. I encouraged him to try to do something and told him the necropsy would be the best bet for proof although we may strike out. I also told him not to get his hopes too high since I remember the case during my first year where we tested a cat and a food dish that was sitting just outside a neighbor's door and found both to be positive for antifreeze. Nothing ever came of it. Of course it was a different state...

The other case was a first for me and should go in the record books I think. Had I not been there, I would have thought it was made up. A 1.5 year old spayed female Himalayan got out of her house and returned home lame on the left hind leg with a wound on her hip area and blood in her urine. On examination of the wound, it appeared to be a pellet entrance wound. The bones were palpably fine and the muscle beneath was noticeably swollen and tender. I couldn't locate an exit wound. At the time I was thinking of bruising of the bladder or perhaps an unrelated infection or stone. For all of the above reasons, I recommended a radiograph to include both the abdomen and the leg. The results are below.

After this shot, I still was trying to convince myself that I was seeing things and the pellet might actually be lodged in the leg muscle so I took a second lateral.

Then, like a good little veterinarian, I took a VD (orthogonal view) just to finally prove to myself I wasn't insane.

An exploratory surgery followed during which I was expecting to find a uroabdomen or a loose BB pellet. Nope. The pellet was truly inside the urinary bladder and there was no leakage that I could appreciate. I performed a cystotomy, removed the pellet, explored the lumen of the bladder for obvious defects looking for an entrance wound and could find none. I closed my cystotomy site then obsessively examined the outer surface of the bladder for that entrance wound. Nada. I found a bruised area with some hemorrhage but no hole that I could close. Puzzled, I had my assistant inject saline into the bladder while I leak checked both my incision site as well as the rest of the bladder; no leaks. Hmmmmmm...... I'm still puzzled by that one especially since I could trace the path of the pellet past the inguinal ring and through the body wall. Not sure how to explain that one but even I am satisfied that the bladder wasn't leaking when I closed the body wall.

That certainly puts a new twist on "cystic calculi"...

1 comment:

Anonymous said...

How long had the bladder cat been missing from home? I'm a 3rd year vet student, and we learned in our lower urinary surgery lecture that the bladder is one of the fastest healing tissues. Is is possible that by the time you saw her, the bladder had already healed the entrance wound?