Cody Sherwood, a 2 year old neutered male smooth coat collie, presented to IVS on a Wednesday night shortly after 10. He was vomiting and not eating since the day before. Ed Sherwood described an odd event that occurred over the weekend at Clear Lake. Cody somehow fell in between the boat and the dock and was suspended for 10 to 15 seconds by his collar as Ed was hanging onto the leash. This event left a noticeable impression upon the family. Ed was worried about the choking aspect of it, but Cody appeared to be breathing easily and there was no appreciable swelling around the neck. Immediately after this event at the lake, Cody was weak, wobbly and not quite himself. Monday morning, he developed diarrhea. He was seen by his regular veterinarian and was started on metronidazole for the diarrhea. He was also given an injection of Metacam, an anti-inflammatory, for his discomfort. Since Monday morning, Cody had not passed any stool and had not urinated. The family also thought Cody's abdomen was becoming distended.
A physical exam revealed bright pink mucus membranes (gums), actually brighter than normal. His abdomen was moderately distended and painful. He was depressed, but responsive - didn't appear to have any neurologic deficits related to the choking. He also didn't have any scleral hemorrhages (bruising on the whites of the eyes) which are typically found with choking or severe hypertension.
At this point, we needed to run some tests to see how best to help Cody.
Abdominal radiographs revealed a generalized loss of contrast consistent with a significant amount of fluid in the peritoneal cavity. There was also no distinct border for the urinary bladder. Blood work revealed severe azotemia (elevation in wastes normally gotten rid of by the kidneys via the urine) as well as hyponatremia (low sodium), hypochloridemia (low chloride) and hyperkalemia (high potassium). Excess potassium is also normally excreted via the urine.
Abdominocentesis (tapping the abdomen with a needle) confirmed my suspicions: A uroabdomen (urine in the peritoneal cavity).
The Sherwoods were brought back into the discussion. Cody likely had a ruptured urinary bladder and needed surgery. The family agreed, but were clearly shaken and worried.
Cody had already been started on IV fluids and pain medication. He was anesthetized and taken to surgery. Three liters of urine were suctioned out of his abdomen. A large defect was found in the urinary bladder. The damaged tissue was cut away. The bladder was sutured closed. The abdomen was lavaged (rinsed out with sterile saline) and was closed finishing surgery at 3am. A urinary catheter was placed to keep pressure off the freshly sutured edges for at least 24 hours.
Recheck of blood work Thursday afternoon revealed normal kidney function tests.
By Saturday morning, he was no longer on IV fluids, was eating and drinking and ready to go home.
Ruptured bladders don't have to happen all at once. If there is trauma one day, the bladder may only be weakened only to have a bruised area give way a few days later. These things do take time to show themselves. One of the interesting aspects of this case is that Cody had no outward bruising.
The next Wednesday night, the Sherwoods floored me with THE Card. Notes and cards and thank you's of any kind are always appreciated, but this was something extra special. The time, effort and care taken to create it really hit home. Talk about making one's day!! This made my whole summer. Thank you.
Published on October 4, 2016