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Peritonitis, Septic 779

PROGNOSIS & OUTCOME

VetBooks.ir • Excellent prognosis with effective surgical Diseases and Disorders
correction; resolution of clinical signs in 85%
of cases
• Postoperative mortality rates of 5%-14%
• Left uncorrected, the patient may remain free
of clinical signs, but the risk of complications
persists.

PEARLS & CONSIDERATIONS
Comments
• PPDH is the most common congenital
A B pericardial disorder in dogs and cats.
• PPDH is a congenital defect, in contrast to a
PERITONEOPERICARDIAL DIAPHRAGMATIC HERNIA Lateral (A) and dorsoventral (B) thoracic
radiographs of a 1-year-old cat with PPDH. Note cardiomegaly, irregular soft tissue, fat, and gas opacities over pleuroperitoneal diaphragmatic hernia, which
the heart, indistinct diaphragm, and dorsal mesothelial remnant (arrows). (Courtesy Dr. Stephanie Nykamp.) may be congenital or the result of trauma.
• PPDH is important to rule out for cardio-
megaly, particularly in young animals with
cranial abdominal or sternal defects.
• Additional testing is rarely needed. Upper Acute General Treatment
GI barium series or contrast peritoneography • Oxygen supplementation Technician Tips
(1-2 mL/kg of water-soluble, nonionic, • Surgical correction by laparotomy: return • Ventilation techniques allowing slow
iodinated radiopaque contrast agent injected of all abdominal organs to correct locations and controlled re-expansion of the lungs
aseptically into peritoneal cavity, followed and closure of diaphragmatic defect. Caudal postoperatively may diminish the risk of
by elevation of the caudal end and thoracic sternotomy may be required for adhesions re-expansion pulmonary edema.
radiography) may confirm PPDH if other or reconstruction of a large defect. • For the uncorrected PPDH patient, it is
tests are inconclusive, but false-negatives are • Assessment of liver function before general critical to educate clients about monitoring
common. anesthesia for signs of respiratory, GI, or circulatory
compromise as listed above.
TREATMENT Possible Complications
• Left uncorrected, the risk of hepatic or splenic SUGGESTED READING
Treatment Overview incarceration, bowel obstruction, or cardiac Burns CG, et al: Surgical and non-surgical treatment
Surgical correction is indicated to eliminate tamponade and right-heart failure persists. of peritoneopericardial diaphragmatic hernia in dogs
clinical signs and prevent vascular com- • Surgical complication rate is low but may and cats: 58 cases (1999-2008). J Am Vet Med
promise or obstruction of organs. It may include difficulty ventilating, hypotension, Assoc 242:643-650, 2013.
be appropriate not to pursue surgical re-expansion pulmonary edema, and pleural AUTHOR: M. Lynne O’Sullivan, DVM, DVSc, DACVIM
repair in some cases (e.g., animal without effusion. Postoperative pericardial cyst and EDITOR: Meg M. Sleeper, VMD, DACVIM
clinical signs, small incidentally discovered constrictive pericarditis have each been
PPDH). reported in one cat.

Peritonitis, Septic Client Education
Sheet

BASIC INFORMATION urinary tract obstruction with urinary tract infec- • Lethargy, anorexia, collapse
tion, severe colitis, trauma (blunt or penetrating) • Vomiting, regurgitation
Definition • Owners may notice abdominal distention
Peritonitis is local or generalized inflammation Clinical Presentation or pain.
of the peritoneum. A diagnosis of bacterial DISEASE FORMS/SUBTYPES
septic peritonitis is based on identification of • GI tract perforation or dehiscence PHYSICAL EXAM FINDINGS
intracellular bacteria or other infectious agents • Leakage or translocation of bacteria from • Tachycardia (bradycardia possible in cats)
(e.g., Candida) in abdominal effusion. other abdominal organ (e.g., pyometra, and signs of hypovolemic or septic shock
prostatic or hepatic abscesses, cholecystitis, (p. 907)
Epidemiology urinary tract) • Abdominal pain indicated by tension,
SPECIES, AGE, SEX • Penetrating abdominal trauma guarding, or prayer position (may be
Younger animals prone to ingesting foreign disproportionately subtle for the degree of
material, older animals with gastrointestinal HISTORY, CHIEF COMPLAINT inflammation or be mimicked by apprehen-
(GI) neoplasia or biliary disease, and intact • History suggestive of precipitating cause: sion or back pain)
animals are predisposed. ○ Medications predisposing to GI ulceration • Abdominal effusion
(e.g., nonsteroidal antiinflammatory drugs, • Fever or hypothermia
RISK FACTORS glucocorticoids) • Altered mentation
GI surgery, GI ulcer/necrosis, liver lobe torsion ○ Penetrating wounds, foreign object inges- • Other findings related to cause (e.g., dis-
or neoplasia, closed pyometra, septic prostatitis, tion, or prior GI surgery tended uterus ± purulent vaginal discharge if

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