Littleton Equine Week 10

Week 10

 This week brought quite a few interesting cases! Early in the week, a gelding in his teens presented for incontinence- steady dripping of urine but not actually urinating. He was sedated, palpated, and ultrasounded. Ultrasound demonstrated a urolith and it was determined that he would need surgery to remove it as soon as possible. Dr. Hill wasn’t sure if he was passing his small urine dribble because the urethra had torn and some urine was escaping, or if the urolith had not completely blocked the urethra at that time. The horse remained standing for surgery and a temporary perineal urethrostomy was created to remove the stone. During the surgery, a large stream of urine was released from the site of the opening. On recheck the next day, the surgical site looked good, but when a scope was passed into the bladder, the bladder looked very irritated. Ultrasound confirmed that the bladder was very full. He was returned to his stall and after urinating, he was put on a bolus of fluids to encourage urination. Concerns at this point are that the bladder may have been stretched beyond repair and that the kidneys may have suffered some damage, as their values on bloodwork hadn’t come down as much as they should have 12 hours post-op. The stone was also rough and crumbled when it was being extracted, a portion of it was also adhered to the wall of the urethra. This raises the concern that when the urethra heals that it may form excessive scar tissue in a circumferential pattern and prevent urine flow. Should that happen, the horse would need a permanent perineal urethrostomy. Given some time to heal, we will have a better idea of prognosis and return to full urinary function.

Another interesting case from this week was an older gelding who presented for evaluation to remove a cancerous eye. There was not enough healthy tissue around the eyelids to suture the eye closed prior to removal, so it was clamped with hemostats and then routinely removed. He seems to be doing well post-op.

This week also brought a young mare with a laceration on her left lateral pastern. The wound was cleaned, probed, and radiographed to assess whether it had affected any synovial structures. The pastern joint was also distended with saline (and a small amount of amikacin) to assess whether the laceration had specifically entered the joint. Thankfully, the laceration did not affect synovial structures, but radiographs incidentally demonstrated a bone chip in the fetlock that can be removed arthroscopically. Surgical options for the bone chip will be discussed with the owner.

Friday, I went with Dr. Lori in the field. We saw suture removal, lameness rechecks, coffin and stifle injections, and a few pre-purchase exams. It’s always interesting to see how the different clinicians will perform the same task, there’s always something new to learn!