Successful resolution of urothorax secondary to non-traumatic uroabdomen in a cat managed with peritoneal dialysis as a bridge to surgery

Abstract

Case summary A 9-year-old neutered male domestic shorthair cat was presented for evaluation of severe hemodynamic collapse and suspected lower urinary tract disease. On admission, severe metabolic acidosis, hyperkalemia and azotemia, and electrocardiographic findings consistent with cardiotoxicity were identified. The diagnosis of uroabdomen was made based on abdominal fluid to plasma concentration ratios of creatinine and potassium. A central line catheter was placed percutaneously into the abdomen for peritoneal drainage and used for peritoneal dialysis as a bridge to surgery. Retrograde contrast cystography confirmed rupture of the urinary bladder. Point-of-care ultrasound of the chest postoperatively revealed the presence of mild pleural effusion. Echocardiography was then performed showing no evidence of cardiac disease. Pleural fluid analysis revealed a transudate with a creatinine ratio of 2.38 ([Creatinine]pleural fluid/[Creatinine]plasma), consistent with the diagnosis of urothorax. The cat recovered uneventfully from surgery and was monitored for signs of respiratory distress during the rest of its stay in hospital. The cat was discharged 4 days later and the pleural effusion resolved without further medical intervention. Relevance and novel information There is limited information on the causes of urothorax and uroabdomen management of feline patients. Pleural effusion is a complication observed in critically ill cats secondary to fluid overload, underlying cardiomyopathy, primary thoracic pathology or a combination of these. To our knowledge, this is the first report of urothorax in a cat secondary to non-traumatic uroabdomen. Careful monitoring of respiratory signs consistent with pleural space disease is recommended in cases of uroabdomen.

A small‐bore wire‐guided chest tube for the initial stabilisation of septic uroperitoneum in a dog

“…Stamey prepubic percutaneous catheters or central venous catheters have previously been used in veterinary medicine and may be applied in an emergency setting using mild sedation together with a local anaesthetic block. 1,7 In a recent study, Crosby and colleagues described the use of small-bore wire-guided chest tube (SBWGCT) catheters in dogs and cats for the management of several types of peritoneal effusion, specifically uroperitoneum, haemoabdomen, peritonitis and ascites. 8 The aim of this report was to describe the use of an SBWGCT as a temporary abdominal drain for the initial clinical stabilisation of a dog with septic uroperitoneum.…”

“…However, in veterinary medicine, the application of a temporary percutaneous abdominal drain has infrequently been reported as a part of the preoperative stabilisation; therefore, little information is available regarding the different types of devices used for this purpose. Stamey prepubic percutaneous catheters or central venous catheters have previously been used in veterinary medicine and may be applied in an emergency setting using mild sedation together with a local anaesthetic block 1,7 . In a recent study, Crosby and colleagues described the use of small‐bore wire‐guided chest tube (SBWGCT) catheters in dogs and cats for the management of several types of peritoneal effusion, specifically uroperitoneum, haemoabdomen, peritonitis and ascites 8 …”