Acute colonic impaction and faecaloma due to canine benign prostatic hyperplasia – Case report

The present case report describes the clinical signs and case resolution of an intact 9-year-old male crossbreed dog with spontaneous constipation. The dog presented with abdominal pain, lack of appetite, tenesmus and without signs of defecation in the last 4 days. No important alterations were observed in the complete blood count and biochemistry. A substantial obstruction caused by a faecaloma and a prostate with increased size was observed on X-rays. Benign prostatic hyperplasia (BPH) was confirmed by ultrasonography (size: 48.29 cm3) and by testing the serum canine prostate-specific arginine esterase concentration (105.97 ng/mL). Colon impaction was resolved with rectal enemas within two days. BPH was treated with osaterone acetate. Ultrasonographic checks were performed after 60 and 180 days from the demission and a concrete constant reduction of prostatic volume and of the clinical signs was established. Faecaloma is an uncommon finding in male dogs, and it occurs especially as a consequence of BPH. Colon impaction in patients with BPH is usually subclinical, but it is important to underline how, in severe cases, perforation of the colon and faecal peritonitis can occur, leading to fatal conditions for the animal. In conclusion, prostatic enlargement should always be considered in male dogs suffering from colonic impaction.

Vacuum-Assisted Abdominal Closure in Surgical Emergency: A Single Institution Experience Treating a Cohort with a Prevalence of Faecal Peritonitis

Vacuum-assisted abdominal closure (VAAC) has evolved as a promising method for treatment of emergent surgical patients. The aim of the study was an assessment of the complication rate and outcomes following routine application of VAAC in a cohort of patients suffering predominantly with peritonitis of the lower gastrointestinal tract (GIT) origin. The prospectively collected data was analysed retrospectively, including demographic data, aetiological factors, comorbid conditions and severity of the disease. The indications for VAAC included complicated intra-abdominal infection, purulent peritonitis with sepsis and/or risk of increased intra-abdominal pressure. In total, 130 patients were managed with VAAC. The median age was 63.5 years, with a predominance of male patients (61.5%). Systemic inflammatory response was present in 68.5%, the median C-reactive protein (CRP) was 239.58 mg/l, Procalcitonin (PCT) level 7.02 ng/ml, and lactate 1.84 mmol/l before intervention. The median Sequential Organ Failure Assessment (SOFA) score was 4 and the Mannheim Peritonitis Index was 26. Sepsis developed in 87.0% of patients, and 43.8% had septic shock. VAAC was applied in 58.5% due to a perforation of the lower GIT, in 26.1% due to perforation of the upper GIT, and in 15.4% for other reasons. A median of two (interquartile range, IQR 1–3) VAAC system changes were performed in a period of 7 (IQR 4–11) days. In 88.6% of cases, multiple types of microorganisms were present. The application of VAAC resulted in a significant decrease of the postoperative SOFA score, and CRP, PCT and lactate levels (p < 0.001). The complications included a “frozen abdomen”, enterocutaneous fistula, intraabdominal abscess and bleeding in 7.7%, 5.4% and 6.0% cases, respectively. Primary abdominal closure was accomplished in 76.2%, resulting in a 23.1% mortality rate. VAAC was found to be safe in the treatment of abdominal sepsis including in patients with faecal peritonitis. Complete abdominal closure can be achieved in the majority of patients resulting in a lower mortality rate.

Experimental faecal peritonitis alters response to 5-hydroxytryptamine in mesenteric lymphatic vessels

Aim. To compare the reactions to 5-hydroxytryptamine (5-HT, serotonin) in the mesenteric lymphangions upon endothelial denudation and during experimental faecal peritonitis as compared with the control lymphangions. Materials and Methods. Experiments were performed on the intestinal lymph trunk lymphangions of rats using a pressure myograph system. We examined the changes in contraction frequency and amplitude as well as tonic reactions upon the addition of 5-HT (10-8-10-4 M). Experimental peritonitis was caused by an intraperitoneal injection of feces. Results. Faecal peritonitis reduced contraction frequency and amplitude in mesenteric lymphangions. 5-HT increased contraction amplitude only at low concentration (10-8 M) and did not alter the tonic reactions. Upon endothelial denudation, serotonin inhibited contraction frequency and amplitude in the lymphangions. As 5-HT stimulates motility through 5-НТ2 receptors and α2-adrenoceptors on endothelial cells, faecal peritonitis abates the sensitivity of such receptors to 5-HT. Conclusion. In experimental faecal peritonitis, alterations in lymphatic vessels are reminiscent of those in blood vessels. Endothelial dysfunction disturbs the response of lymphatic vessels to 5-HT.