SURGICAL DISEASES OF THE ABDOMEN OF THE DOG AND CAT Under this heading there will be dealt with a series of operations which are of practical value in the case of the smaller animals, and which have been performed successfully (thanks to our improved knowledge of the use of anaes thetics and the value of antiseptics) a very large number of times.
Tumours of the abdominal wall are not un common, but are dealt with like tumours else where. Commencing with the cavity of the abdomen itself we have the operation of simple puncture (paracentesis abdominis) for ascites. This is performed for aseites, an ailment much more common in the dog or cat than in any other of the domesticated animals.
In so far as the actual operation itself is concerned, provided the usual antiseptic pre cautions are taken, there need be no fear of performing it, but the proportion of cases of permanent recovery is small. The life of the animal can be prolonged, and, if the patient is not old and the liver and kidneys are not severely diseased, there is always the chance that the ascites may not return; and as it offers the only chance of cure and the operation is not a painful one, it is always worthy of a trial at least once, or even two or three times.
The linea alba is in my opinion the best situation in which to perform the operation.
Accidental Wounds.These are of common occurrence in dogs and cats, the combative nature of these animals, together with their pro clivities for jumping over palings and other things, and getting in the way of vehicles, being common causes. Gunshot wounds, too, are not infrequent in sporting dogs. Formerly the majority of such animals would at once have been destroyed as painlessly as possible, but experience has taught that nowadays, with modern appliances and up-to-date knowledge, the patient stands an excellent chance of re covery if attended to at once, and provided that the internal organs are not dirty or too severely damaged. Peritonitis is the sequel to be dreaded, but many cases have been recorded during the past ten or fifteen years in which the intestines have been exposed by injury and the patient has afterwards made a good recovery.
The treatment to be adopted is at once to anaesthetize the animal, shave and thoroughly cleanse the wound, cleanse and replace any intestine or other organ which may be pro lapsed separately, draw the muscles and skin together with sutures and support with a bandage. Afterwards treat as an ordinary surgical case.
Food should always be given sparingly and care taken that the animal is kept perfectly quiet until firm union has taken place.
Laparotomy may be performed as an explora tory measure with a view to finding out the condition of things in the interior of the abdomen, and it is, of necessity, the preliminary step to any operation involving attention to the organs inside.
The situation in which to enter the abdomen must depend somewhat upon the operation to be performed, but wherever it is possible I prefer to perform abdominal section in the dog through the linea alba. The incision is blood less and the edges of the wound lend themselves very satisfactorily to the application of sutures and to primary union afterwards. In the cat, however, experience has taught me that the flank situation gives the best results, because of the crouching position assumed by this animal when kept in a cage. Adhesion between the wound and the internal organs is not so likely to take place as when the linea alba site is employed. It is astonishing how much ex ploration the abdomen will stand, provided ordinary care is taken when handling the organs, and strict attention has been paid to antiseptic details.
With gunshot wounds, if extensive but not yet fatal, the patient is usually in such agony that it is better to be destroyed. If slight, it is questionable whether it is wise to do much exploration, the external wounds being anti septically dressed and rest and dietary attended to. If the stomach, intestine, or liver is injured the prognosis is grave, and exploratory laparo tomy alone can reveal the amount of injury sustained. Repair of the injured organs may be possible, especially in the case of the stomach, but if any quantity of contents of either the stomach or intestine has escaped into the peri toneal cavity the probability is that fatal peritonitis will ensue and the most humane way is to allow the patient to pass away before coming out of the anaesthetic.
Foreign Bodies in the Stomach and Intestines. —Dogs frequently swallow foreign bodies such as stones, rubber balls, meat-skewers, hat-pins, needles, nails, corks, coins, pieces of stick, and many other curious things too numerous to mention. Kittens (and cats too) often swallow pins, and even ladies' hat-pins, cotton thread, beads, tape, bits of cork, and fish-hooks have been found in the intestine on many occasions.
The greed of the animal is well characterized by its successful endeavour to swallow the wooden skewer together with the horse-flesh impaled upon it, when another animal tries to take away the dainty morsel. The finding of the"cat's-meat skewer"in canine patients is so well known amongst practitioners in London that it is always inquired about before dia gnosing certain classes of cases; and as regards stones the author had one patient (an Aberdeen terrier) who swallowed on one occasion no less than 114 stones, all of which were eventually got rid of. In another instance a dog was seen to swallow a peculiar-shaped stone on December 13, and the same stone was vomited back in the owner's presence on February 12 following. The author on one occasion removed a two shilling piece from the stomach of a dog, the coin having been swallowed two years pre viously. It had made a small sac for itself at one end of the stomach.
In all patients suspected of swallowing foreign bodies a thorough manual examination should always be made before any operation is under taken. The history given by the owner cannot always be relied upon and should always be questioned in every detail, as it is very annoying to make an unsuccessful laparotomy for a lost ball and then find it afterwards in a corner of the room. The Röntgen rays are of especial value in these cases and are utilized freely in all places where the apparatus is accessible.
The chief signs exhibited are: attempts at vomiting, capricious appetite or total disin clination to feed, general dulness and depression, and, in a later stage, unthriftiness of the coat, irregularity of the bowels, dysentery, and emaci ation.
Treatment. For small bodies, such as nails, etc., after a dose of aponiorphine or some emetic medicine, some solid dietary (such as suet pudding) of the stodgy variety, which will surround the foreign body and gradually pass it along the intestine, is required. This is followed up by a dose of aperient medicine, castor or olive oil being the best.
With skewers, hat-pins or needles, if the patient is not suffering any great inconvenience, the better plan is to await developments as the point will in a few days make its way to the surface, causing an abscess. This is lanced when ready and the foreign body extracted. The head of such a substance as a lady's hat pin may either be cut off close and allowed to fall back into the stomach or intestine (from which it will eventually be passed) or the orifice carefully enlarged and the head withdrawn. The former is preferable; as a rule adhesion has already taken place between the internal organ and the peritoneum, so that the peritoneal cavity proper is not really opened, and if the abscess cavity is carefully cleansed the patient usually makes a rapid recovery. If a major operation is necessary either the stomach or the bowel may have to be incised and either a gastrotomy or an enterotomy performed.
For gastrotomy an incision is made about two or three inches below the cartilage of the sternum under, of course, an anesthetic and the usual antiseptic precautions.
The stomach is drawn up outside the abdo minal wall and allowed to rest on a piece of sterilized mackintosh (or jaconet) and care fully packed around with sterile lint or cloths, the foreign body being sought for and brought close up against a portion of the wall where the blood-vessels are small or absent, and an in cision is made directly over it. If the stomach is at all distended with gas, a small trocar and cannula should first be used to allow this to escape.
The foreign body is extracted, the internal edges of the wound carefully cleansed with anti septic solution, and a close row of silk sutures (Czerny-Lembert or Lembert pattern) inserted with a small, round, milliner's needle. The stomach is then carefully replaced and the laparotomy wound of the skin and bowels treated in the usual way.
Sometimes a foreign body which has become stuck fast in the lower part of the esophagus can be reached through an incision in the stomach by the aid of a pair of long forceps, and can be removed in this way when all attempts to get it away by the mouth have failed.
For the removal of a foreign body fixed in the intestine the latter is exposed in exactly the same way as the stomach, an incision being made in the longitudinal axis. After the foreign body has been extracted and the intes tinal wall sutured after Lembert's method, the intestine is carefully returned to the abdomen and the muscles and skin are sutured in the usual way.
Intussusception of the Intestine.This is a common condition amongst puppies, and it usually follows as a sequel to the violent peri stalsis set up by some irritant such as indigest ible food or worms. It can be felt quite readily in a thin dog as a sausage-like swelling which rolls about between the finger, and the dia gnosis is helped by the symptoms shown by the dog. The eyes are bright, but the patient withdraws out of sight away from its companions and is continually straining. There may even be jaundice as a complication.
Surgical Interference.The performance of laparotomy and the actual straightening out of the bowel gives most excellent results if adhesion has not already taken place. If the latter has occurred and it is very firm enteros tomy is the only solution.
Faecal Impaction of the Intestine.Obstinate constipation and impaction of the intestine by hardened faces are very common troubles in the dog and cat, especially those of unclean habits and belonging to inattentive owners. Aperients and enemas of warm oil and water will usually put matters right, but occasionally surgical help has to be obtained. Over-indulgence in game and rabbit bones is a fruitful cause, and these, matted together with fur or hair, form a mass which is very hard to dislodge.
In each of two cases met with by the author the animals (retrievers) had passed no faeces for three weeks before the mass was removed.
The colon is usually the part of bowel affected, the mass being felt from the exterior by palpa tion of the abdomen or per rectum. The patient is capricious in appetite, finally refusing food altogether and being persistently sick, frequently attempting to pass faeces with no result. After
an attempt the poor beast will look around at its flanks and stand rigidly still. The coat is unthrifty, and after a few days the animal gets visibly weaker.
If all efforts to remove the mass by medicinal means fail, laparotomy should be performed, and the obstructed bowel kneaded gently by the ends of the fingers until the contents are broken up and able to be passed on into the rectum. The greatest patience is required, and care must be taken not to injure the bowel wall with the nails during the kneading process, as it is easily ruptured. It is a good plan to try first at one end and then the other, gradually working towards the centre or any place which seems softer than its surroundings. If relief cannot be obtained in this way the operation of enterotomy (opening the bowel) or that of enterectomy (removing a piece of gut) and subsequent anastomosis must be resorted to.
Once the obstruction has been removed the attention of the surgeon has to be directed to an attempt to make the bowel resume its normal tone and become strong again. For this purpose the diet must be of easily digestible materials, such as milk or broth or finely-minced raw meat, given in small quantities and often. Rectal feeding is also a help, and when once convalescence has commenced recovery is usu ally rapid.
Stricture of the Bowel.This is not a common condition in the dog or cat, but has been observed on several occasions. Enterostomy is the only thing which is likely to give relief, but as a general rule the most humane course is to put the animal painlessly away.
Strangulation of the Intestine.This accident is always to be dreaded in hernia cases and fre quently follows a greedy full meal. Sometimes it can be relieved by gentle massage, but if that fails an operation should be done without delay. Under anaesthesia the strangulated bowel is cut down upon and manipulated care fully until it can be returned.
Tumours of the Stomach and Intestine.These are comparatively rare in the dog and cat, but carcinoma and sarcoma have each been recorded.
Prolapse of the anus and bowel is a condi tion which is frequently met with in young dogs and cats, and is very troublesome to deal with.
It may consist merely of inverted rectum, or the colon may be protruded through the anus.
Treatment consists in returning it carefully, and, if necessary, a purse - string suture may be applied. Light dietary and keeping the patient quiet are essential, for at least a fortnight or three weeks afterwards.
Notwithstanding all precautions one some times meets with a case in which the intestine is persistently protruding; and for this operative interference is necessary. Three courses are open: one is to apply Gersury's operation, and insert four pillars of paraffin wax subcutaneously around the anus, and a second is to perform amputation. The former is preferable to com mence with, for its results in the dog have been splendid, and in a high proportion of cases it will prove successful.
The third course is to perform laparotomy, and suture the bowel to the interior of the abdominal wall. The results of this operation are very good.
Imperforate anus and the presence of a cloaca are congenital deformities sometimes met with. Each is cured only by operative interference.
Obstruction of the Anal Glands.This con dition is a very common one in the dog, and its removal gives almost instantaneous relief. The anal glands are two pouches, one on either side of the rectum, opening into the latter by small orifices which are found just inside the anus.
The patient continually licks or rubs along the ground, and examination of the part reveals it to be swollen and sore. Temporary relief can be obtained by the application of gradual pressure between the thumb and finger. For obtaining permanent relief the better plan is to remove the whole of the affected gland, or at all events to curette the interior thoroughly. It is a simple operation under an anaesthetic, and the relief given to the dog is simply enormous.
Tumours of the Abdomen and Abdominal Organs.Sarcoma and carcinoma are most commonly met with, and as each is malignant the patient should (when the diagnosis is con firmed) be at once humanely destroyed.
A lipoma or any tumour which is non-malig nant and can be got away should be removed under anaesthesia either by ligature or by the ecraseur.
Hernia.All varieties of hernia are met with in the dog—scrotal, inguinal, umbilical, ventral, perineal, and femoral. The first three are hereditary, but the last two are often caused by an accident.
In young animals it is astonishing how much can be done by constant manipulation and rest, but operative interference is undoubtedly the quickest method of making a permanent reduc tion. This has been dealt with in another section (see"Hernia").
Cystitis.Cystitis or inflammation of the bladder is particularly common in old dogs, and in cats it is most frequently met with in the castrated male. Tumours, calculi, and the deposit of sabulous material are the most fre quent causes; and septic organisms may gain access through the passage of a dirty catheter. Overdoses of irritant medicines (such as can tharides) will cause bladder irritation and cystitis.
The symptoms shown are continual restless ness and constant attempts at urination, during which a few drops only are passed. This may be discoloured or blood-stained, and if relief is not obtained the appetite becomes capricious, and the patient feverish and emaciated. Ex amination by palpation through the abdominal wall and by means of a flexible metal sound or a catheter should be made, especially in order to detect the presence of calculus, when operative interference is necessary. If septic organisms are suspected the bladder must be washed out with warm boric acid, chinosol, or weak formalin, and urotropine, buchu, creolin, hyposulphite of soda, hyoscyamus, potassium carbonate, or some other drug at the selection of the prac titioner, administered by the mouth.
Tincture of cantharides in small doses some times gives relief at once in hzematuria, whilst pearl - barley or linseed - tea forms a useful demulcent.
Tumours of the Bladder.The most common are papilloma, sarcoma, and carcinoma. Myx oma and fibroma have also been met with. They may be suspected by the presence of hzematuria, by pain and irritation when urine is passed, and by the fact that urination is more frequent.
In the later stages the patient becomes emaciated, and the urine may be fcetid or purulent.
The bladder should be washed out with a warm solution of boric acid, eusol, chinosol, or some non-irritating antiseptic containing a little sedative such as belladonna or opium, and internal sedatives such as urotropine or hyo scyamus administered. Failing relief from these, surgical aid must be invoked.
Calculi.These are frequently met with in old dogs, and may be as large as a large walnut, one calculus only being present, or there may be numerous small ones. In one instance the author found no less than eighty-four stones in the bladder of a dog. Small calculi often give trouble by getting into the urethral passage.
Experience has taught that as a rule calculi grow to a larger size in the bitch than in the dog. They may be round or oblong in shape, or triangular and facetted by rubbing against one another. In any case surgical methods are essential to give permanent relief, and lithotomy or lithotrity should be practised.
In the bitch it is frequently possible to dilate the urethral orifice sufficiently to remove the calculus without opening the abdomen. It may be removed whole or after being crushed with a lithotrite.
Sand or sabulous matter is frequently met with in the castrated cat, and is apt to give trouble, and even to cause cystitis and death if not removed.
It can readily be felt per rectum, as a two lobed body, about one or two inches from the anus. When inflamed it gives rise to excessive pain, especially when there is constipation present; the patient looking very anxious, with capricious appetite, and having difficulty in passing urine. Warm opiate enemas, com bined with gentle laxatives followed by the administration of urotropine or hyosoyamus, will give temporary relief, but the best per manent results are obtained from castration. The relief given is observable within ten days or a fortnight, and in course of time the lobes of the prostate will atrophy. The result, too, is permanent.
Under anaesthesia and existent antiseptic precautions the surgery of the ovaries and uterus can be practised with most successful results.
In cases of dystokia, purulent metritis, tumours of the uterus or ovaries, for ovariotomy or otiphorectomy the surgeon nowadays re moves the whole (or a part) of the generative organs of the bitch or cat without the slightest hesitation.
For further details see"Ovariotomy"and "Ovaro-hysterectomy." _ _ _