Wednesday, June 24, 2009


One early morning, Princess, a female shih-tzu was taken to me. Apparently she was vomiting with decreased appetite on the day of presentation, feverish and unable to defecate about 4 days after surgery. She was subjected to a cesarian section from another clinic 4 days prior. The owner also noticed dehiscence of the wound area and decided to put a bandage around to prevent Princess from licking the area or further dehiscence. The area upon my inspection is wet and the sutures are slowly eating through the skin.
I took a radiograph to check for continuity of the abdominal muscle area. It seemed dehisced though i was doubtful since she was just subjected to surgery which means the area would still be cloudy, hazy and probably in diasrray due to healing and inflammatory reaction.
In the meantime, we stabilized her through fluids and medications and blood profiling was done revealing elevated wbc, slightly decreased rbc, normal kidney and liver functions. Cleaning of the area and changing the dressing was done to avoid contamination and further infection.
Further assesment and repair of the area should be done deemed necessary and a night after, we have a go signal.
Since the sutures were already cutting through the skin, I decided to first remove it and here's how it looks... (by the way she also has an umbilical hernia)

With the owner's consent, we prepared Princess for her surgical repair.
When we parted the skin and subcutis, we noticed a suture from which I am still unable too see where it came from. Aside from that, a fleshy material or organ is staring directly at me. At first i thought it was the subcutaneous fat but it wasn't.
It was the intestine! Thus this also means that the abdominal muscle sutures were also dehisced. Abdominal fluids were also seeping out. I am worried that infection can or could have entered the dehiscence.

Thankfully, the intestinal loop is still normal and vital. Careful examination of other organs was done and were replaced with care.

I decided to close the muscle only on that night leaving the subcutaneous area and skin open but with a wet-antibiotic treated bandage to keep the wound from infection.

After 24 hours, I was sure that there are no signs of infection on the outside, closure of the subcutis and skin was done.

Ten days later, Princess is back but for sutre removal only. See it on the next two pictures. one still with the suture and the next after removal.

You may also noticed that her left eye (she has no right eye due to trauma years ago) is cloudy. Antibiotic treatment plus cyclosporine was prescribed and positive change is noticed. Could be keratoconjunctivitis sicca (KCS) but that's another story.

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