Page 981 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

956 CHAPTER 7

VetBooks.ir 7.42 7.43

Fig. 7.42 Drainage of urine from the abdomen in a Fig. 7.43 Surgical repair of the bladder wall tear via
foal with uroperitoneum. laparotomy.

insulin (0.1–0.2 U/kg s/c) or sodium bicarbonate 7.44
(1–2 mEq/kg) may be used concurrently. Fluid ther-
apy and abdominal drainage are usually successful
in reducing the potassium level in most cases.
Abdominal drainage is required in most cases
(Fig. 7.42). A catheter should be placed in the abdo-
men and left in place until the defect is corrected.
Abdominal drainage should be performed gradually.
Intravenous fluid therapy should match the amount
of fluid removed from the abdomen to prevent acute
hypotension following expansion of previously col-
lapsed capillary beds. Peritoneal lavage can be help-
ful although the catheter can be readily blocked by
omentum and fibrin deposits.
Broad-spectrum antimicrobial therapy is indi-
cated. Nephrotoxic drugs such as aminoglycosides Fig. 7.44 Laparoscopic repair of a bladder wall tear
should be avoided initially in azotaemic, hypotensive in a foal.
and dehydrated animals. Ceftiofur sodium (2.2 mg/
kg i/m or i/v q12 h) is a reasonable first-choice anti-
microbial. A combination of penicillin (sodium Surgical repair of the bladder defect should be
penicillin 20,000 IU/kg i/v q6 h or procaine peni- performed after the animal’s metabolic status has
cillin 20,000 IU/kg i/m q12 h) and an aminoglyco- been corrected (Fig. 7.43). The abdomen should
side (gentamicin 6.6 mg/kg i/v q24 h or amikacin be lavaged, especially if cytology of peritoneal fluid
15 (adults)/21 (foals) mg/kg i/v q24 h) can be used suggests infection. In foals, internal umbilical rem-
when there is no concern about renal function. nants are often a source of infection and should be
Alternatively, an aminoglycoside could be combined removed during surgery. Laparoscopic repair of a
with ceftiofur postoperatively if there is a concern bladder is less invasive and decreases time to recov-
about gram-negative sepsis. ery (Fig. 7.44).