Kafkas Univ Vet Fak Derg 15 (3): 473­476, 2009 CASE REPORT DOI:10.9775/kvfd.2009.053-G Multiple Thoracic and Thoracoabdominal Trauma: Case Report Hakan SALCI *  Göksen ÇEÇEN * O. Sacit GÖRGÜL * İbrahim AKIN * * Uludağ Üniversitesi Veteriner Fakültesi Cerrahi Anabilim Dalı, Bursa - TÜRKİYE Makale Kodu (Article Code): 2009/053­G Summary Two dogs were presented with the history of wild boar attack during hunting. Clinical and radiological examination revealed thoracic and thoracoabdominal pathologies. Perioperatively, hemothorax, ruptured right middle lung lobe and pericardium, right partial caudal lung lobe contusion and rib fractures were determined in case 1. Hemoabdomen, caudal liver lobe rupture, diaphragmatic hernia, hemothorax, right caudal and accessory lung lobe rupture and rib fracture were observed in case 2. Pathologies were treated with emergency operative approaches. Postoperative at the end of 1st and 6th month, owners informed that the dogs were healthy. It is expressed considering these cases that mortal traumas can be caused by wild boar attacks in dogs and these can be treated with correct emergency surgery approaches. Keywords: Thoracic trauma, Thoracoabdominal trauma, Wild boar attack, Dog Multiple Torasik ve Torakoabdominal Travma: Olgu Sunumu Özet Av sürecinde yaban domuzu yaralaması öyküsü ile iki köpek kliniğimize sunuldu. Klinik ve radyolojik muayenede toraks ve torakoabdominal patolojiler tanındı. Perioperatif süreçte olgu 1’de; hemotoraks, sağ akciğer orta lobunda ve perikartta ruptür, sağ akciğer kaudal lobunun parsiyal kontüzyonu ve kosta kırıkları belirlendi. Olgu 2’de; hemoabdomen, karaciğerin kaudal lobu ruptürü, hernia diyaframatika, hemotoraks, sağ akciğer kaudal ve aksesor lobu ruptürü ve kosta kırığı saptandı. Patolojiler, acil operatif girişimler ile sağaltıldı. Postoperatif birinci ve altıncı ayın sonunda hasta sahiplerinden köpeklerin sağlıklı olduğu öğrenildi. Av sürecinde köpeklerde ölümcül travmaların yaban domuzlarınca oluşturulabileceği, ancak doğru ve acil cerrahi girişimlerle hastaların yaşam şansı bulacağı bu olgulara dayanarak ifade edilebilir. Anahtar sözcükler: Torasik travma, Torakoabdominal travma, Yaban domuzu vurması, Köpek INTRODUCTION Multiple thoracic and thoracoabdominal trauma case 2: 7 year-old) were presented in different times pathologies are commonly encountered in dogs 1­4. with the history of wild boar attack during hunting. These trauma cases are considered as critical cases, Clinical examination revealed open pneumothorax, and dogs with multiple trauma need emergency perforated thoracic wounds and rib fractures in case procedures and immediate veterinary attention 1,3,5­7. 1, and perforated thoracoabdominal wounds and Etiology of the multiple trauma are car accidents, blunt pancreas eventration in case 2. Both dogs were or penetrating subjects (stubbing, etc.), bite wounds, dyspneic and had cyanotic mucous membranes, up to falling down, projectiles or bullets, stabbing, kicks, 120/min pulsation, 2.5-3 seconds capillary refilling punches, human abuse and mistreatments 1,2,4,8­11. In time and hypothermic. this report, wild boar attack was determined as an etiology of multiple thoracic and thoracoabdominal Initial medical management was performed in the trauma and its results were described in two dogs. same manner in the dogs. Following intravenous catheter insertion, blood sample was obtained for analysis, and CASE HISTORIES lactated Ringer’s solution (Vacoliter®, Baxter, Eczacibasi, Turkey), tranecsamic acid (Transamine®, Fako, Turkey) Two male, Barak breed dogs (case 1: 5 year-old, (10 mg/kg, IV) and prednisolone (Prednisolon Linz®,  İletişim (Correspondence) ℡ +90 224 2940841 � hsalci@uludag.edu.tr 474 Multiple Thoracic and Thoracoabdominal... Fako, Turkey) (4 mg/kg, IV) were administered to prevent Respiration was ensured with mechanic ventilator, possible internal hemorrhage and shock. Ampiciline monitorization was provided by ECG, pulse oximeter sulbactam (Combisid® 1gr, Bilim Ilac, Turkey) (20 mg/kg, and capnograph. IV) and petidin HCl (Aldolan® ampoule 100 mg, Gerot In case 1: Lateral thoracotomy was carried out and Pharmacy, Austria) (5 mg/kg, IV) were given as antibiotic incisions were extended on the perforated thoracic and analgesic drugs, respectively. After stabilization, wounds. Intrathoracic exploration revealed hemothorax, thoracic and abdominal radiographs taken clearly ruptured middle lung lobe and partial collapsed demonstrated partially collapsed right lung lobes, caudal lung lobe (Figure 2). The middle lung lobe was mediastinal shift and open pneumothorax in case 1 removed (lobectomy), and the partially collapsed part (Figure   1) and diaphragmatic hernia, open pneumo- of the caudal lung lobe was resected by wedge resection thorax and pneumoabdomen in case 2. technique. Multiple pleural space lacerations and pericardial rupture were the other pathologies that were repaired with surgical suturing. The fractures on the ribs 5-7 were fixed with the cerclage wire, and thoracic incision was closed routinely. Fig 2. Perforated site (up arrows) of right middle lung lobe and collapsed apical site (left arrows) of right caudal lung lobe in case 1 Şekil 2. Olgu 1’de sağ orta akciğer lobunun perfore kısmını (yukarı oklar) ve sağ caudal akciğer lobunun kollabe olmuş apikal kısmı (sol oklar) In   case   2:  The perforated wounds were explored Fig 1. The preoperative radiogram shows partially collapsed through paramedian and paracostal incisions. Intra- right lung lobe on the right hemithorax (right arrows) and abdominal exploration revealed hemoabdomen, mediastinal shift (left arrows) in case 1. (R: right) caudal liver lobe rupture (Figure   3), right pleural Şekil 1. Preoperatif radyogram, olgu 1’de sağ hemitoraksta herniation of the small bowels and cranial liver lobes parsiyal kollabe olmuş sağ akciğer lobunu (sağ oklar) ve mediasten kaymasını (sol oklar) göstermektedir. (R: sağ) through right diaphragmatic rupture (diaphragmatic hernia). This ruptured caudal liver lobe was partially Taking the conditions of the dogs’ into consideration, removed (partial lobectomy) and excision side of this emergency surgery was decided. Isofluorane (Furane®, lobe was omentalized with omentum major. Small Abbott, UK) was used as general anesthetic agent bowels and cranial liver lobes were taken in situ, and after xylazine HCl (Alfazine® %2, Alfasan/Egevet, diaphragmatic rupture was sutured routinely. Fractured Turkey) (1 mg/kg, IM) and thiopental Na (Pentothal 13th rib was fixed with wire suture. After intra- Na® 1 gr, Abbott, UK) (15 mg/kg, IV) administration. abdominal surgery, median sternotomy was performed. 475 SALCI, ÇEÇEN, GÖRGÜL, AKIN In the postoperative period, radiological evaluation of the dogs did not show any intrathoracic and intra- abdominal pathology on day 7 (Figure   5). Thoraco- stomy tubes and skin sutures were removed post- operatively on day 5 and 7, respectively. Laboratory findings were within normal ranges on day 7 (Table 1), and dogs were discharged at this day (Figure   6). Communications with the dogs’ owners at the end of 1st and 6th month revealed that dogs were healthy and had normal hunting performance. Fig 3. Ruptured side of the caudal liver lobe Şekil 3. Kaudal karaciğer lobun yırtılmış kısmı Intrathoracic exploration revealed rupture of right caudal and accessory lung lobes and parenchymal air leakage (Figure   4). These lobes were removed with bilobectomy technique. Sternebreas and median sternotomy incision were sutured routinely. Fig 5. Lateral radiograph shows normal view of the thoracic structures and cercilage wire sutures of the sternebreas as a result of median sternotomy closure in case 2 Şekil 5. Lateral radyograf, olgu 2’de toraks yapılarının normal görünümünü ve median sternotomi kapatılması sonucu olan sternebralardaki serkilaj teli dikişlerini göstermektedir Fig 4. The view indicates the ruptured right accessory lung lobe (right arrows) and air leakage of perforated lung parenchyma in case 2 (up and down arrows) Şekil 4. Görünüm, olgu 2’de yırtılmış sağ akciğer aksesor lobunu (sağ oklar) ve perfore olmuş akciğer paranşimini (yukarı ve aşağı oklar) belirtmektedir A thoracostomy tube was inserted to pleural cavity of the dogs, and drainage was provided by Heimlich valve. Lactated Ringer’s solution was infused and ampiciline sulbactam and petidin HCl were administered postoperatively. In addition, aminoacide (Procalamine®, Baxter-Eczacibasi-Turkey) and lipid (Liposyn®, Abbott, UK) solutions were infused as supportive therapy in Fig 6. Standing view of case 1, one week postoperatively case 2. Şekil 6. Postoperatif 1 hafta sonra olgu 1’in ayakta görünümü 476 Multiple Thoracic and Thoracoabdominal... Tablo 1. Olguların laboratuar bulguları informed by owners that the dogs were healthy and Table 1. Laboratory findings of the cases had normal hunting performance. Case 1 Case 2 As a conclusion, wild boar attack in dogs can result Reference in multiple mortal pathologies in thorax and abdomen Parameter Ranges that should be treated with correct emergency surgery - procedures following clinical, radiological examinations and stabilization. WBC (x103/�l) 18.7 9.5 20.9 13.2 5.5­16.9 RBC (x106/�l) 4.2 5.66 3.90 6.89 5.6­8.5 REFERENCES Hematocrit (!) 30.2 37.3 27.2 42.6 37­55 Neutrophils (!) 88 73 92 68 60­77 1. Fossum TW: Small Animal Surgery. Mosby, St Louis, 2002. pO2 (mmHg) 71.2 90.1 74.3 93.3 90­100 pCO2 (mmHg) 47.5 38.2 45.6 37.5 36­44 2. Kirpensteijn J: The role of emergency surgery in thoracic pH 7.27 7.38 7.30 7.42 7.3­7.4 trauma. 27th WSAVA Congress. http://www.vin.com/proceedings ALT (U/L) ­ ­ 36.4 39.3 10­88 /Proceedings. plx>CID=WSAVA2002&PID=2701. Accessed: AST (U/L) ­ ­ 47.2 49.5 10­88 25.01.2009, 2002. 3. Martin DD: Trauma Patients. In, Thurman JC, Tranquilli WJ, Bensan GJ (Eds): Veterinary Anesthesia Lumb & Jones’. 835-836. DISCUSSION Williams & Wilkins, Maryland, 1996. 4. Spreng D: Preoperative stabilization of the abdominal trauma Multiple thoracic and thoracoabdominal trauma patient. ACVS Symposium Equine and Small Animal. http://www. iknowledgenow.com/search.cfm>keywordlist=+ Preoperative pathologies have been encountered as a result of many %20Stabilization%20of%20the%20Thoracic%20Trauma%20Pati different etiologies 1­4,10­13. Wild boar attacks are ent&searchtype=all&searchTitle=1&startmonth=10&startday=1&s occasionally encountered in dogs and they associate with tartyear=2003&endmonth=11&endday=1&endyear=2003&publi cationid=8&searchmode=Sea%20. Accessed: 25.01.2009, 2003. multiple mortal pathologies which necessitate veterinary 5. Salc> H: Kedi ve Köpeklerde Toraks Travmas� II: Klinik attention. Here, perforated thoracic and thoraco- Bulgular, Tan� ve Sağalt�m: Güncel Bilgiler. Veteriner Cerrahi abdominal wounds, intercostal space perforation, open Dergisi, 9, 71-80, 2003. pneumothorax, hemothorax, pericardial rupture, lung 6. Görgül OS, Topal A: Küçük Hayvan Pratiğinde Cerrahi Acil ve lobe ruptures, rib fractures, hemoabdomen, pancreas Kritik Olgu Hekimliği, 39-40. Uludağ Üniv Veteriner Fak eventration, liver lobe rupture and diaphragmatic hernia Yay�nlar�, Bursa, 2007. 7. Özayd>n İ: Toraks travmalar�. In, Özayd�n � (Ed): Veteriner Acil resulted from wild boar attack in dogs. Klinik. 159-162. Eser Ofset, Erzurum, 2004 Penetrated thoracic or abdominal traumas have 8. Hosgood G: Thoracic wall and cavity. In, Harari J (Ed): Small Animal Surgery. 105-106. Williams & Wilkins, USA, 1996. mortal internal organ damages; therefore, dog with 9. Shahar R, Shamir M, Johnston DE: A technique for penetrated trauma should be taken to the operation management of bite wounds of the thoracic wall in small dogs. following short assessment of life-threatening problem Vet Surg, 26, 45-50, 1997. and stabilization 2,4­7,9,14,15. In the presented dogs, 10. Shamir MH, Leisner S, Klement E, Gonen E, Johnston DE: penetrated wounds affected the intrathoracic and Dog bite wounds in dogs and cats: a retrospective study of 196 cases. J Vet Med A Physiol Pathol Clin Med, 49, 107-112, 2002. intraabdominal organs. Hence, emergency surgeries 11. Salc> H: Kedi ve Köpeklerde Toraks Travmas� I: Etiyoloji, were decided in dogs following clinical and radiological �nsidans ve Patofizyoloji: Güncel Bilgiler. Veteriner Cerrahi examination and stabilization. Intra-abdominal and Dergisi, 9, 78-82, 2003. intrathoracic surgical techniques given were performed 12. Davidson EB: Managing bite wounds in dogs and cats. Part I. as reported previously 1,5­7. In addition, as suggested in Compend Contin Educ Vet, 20, 811-820, 1998. a literature 16, omentalization was used on the excision 13. Fossum TW: Pneumothorax. 27th WSAVA Congress. http://www.vin.com/proceedings/Proceedings.plx>CID=WSAVA2 side of the liver to prevent the discharge in case 2, 002&PID=2696. Accessed: 25.01.2009, 2002. where suturing was impossible. 14. Brühl-Day R: Management of the trauma patient. 27th WSAVA Congress. http://www.vin.com/proceedings/Proceedings Postoperative care, radiological examinations, .plx>CID=WSAVA2002& PID=2535. Accessed: 25.01.2009, 2002. Heimlich valve drainage, and administration of 15. Plunkett SJ: Emergency Procedures for the Small Animal medications (antibiotics, analgesics and fluids) were Veterinarian. W.B. Saunders, Spain, 2001. maintained as suggested in the literature 1,4­7,9,10,14,17. 16. Gupta SS, Ahluwalia SM, Anantharam P: Liver trauma When the clinical, radiological and laboratory findings (management in 105 consecutive cases). J Postgrad Med, 36, 131-135, 1990. were normal (on day 7), the dogs were discharged. At 17. Heimlich HJ: Heimlich valve for chest drainage. Med the end of 1st month and follow up periods, it was Instrum, 17, 29-31, 1983. Preoperative Postoperative on day 7 Preoperative Postoperative on day 7