Small Animal Surgical Emergencies , 2nd Edition

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Small Animal Surgical Emergencies

Second Edition

Edited by

Lillian R. Aronson
Professor of Surgery
School of Veterinary Medicine
University of Pennsylvania
Philadelphia, PA, USA
This second edition first published 2022
© 2022 John Wiley & Sons, Inc.

Edition History
John Wiley & Sons, Inc. (1e, 2016)

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Library of Congress Cataloging-­in-­Publication Data

Names: Aronson, Lillian R., editor.
Title: Small animal surgical emergencies / edited by Lillian R. Aronson.
Description: Second edition. | Hoboken, NJ : Wiley-Blackwell, 2022. |
Includes bibliographical references and index.
Identifiers: LCCN 2022000548 (print) | LCCN 2022000549 (ebook) | ISBN
9781119658535 (cloth) | ISBN 9781119658610 (adobe pdf) | ISBN
9781119658627 (epub)
Subjects: MESH: Surgery, Veterinary–methods | Pets–surgery |
Emergencies–veterinary | Animal Diseases–surgery | Wounds and
Injuries–veterinary
Classification: LCC SF914.3 (print) | LCC SF914.3 (ebook) | NLM SF 914.3
| DDC 636.089/7–dc23/eng/20220209
LC record available at https://lccn.loc.gov/2022000548
LC ebook record available at https://lccn.loc.gov/2022000549

Cover Design: Wiley

Cover Images: Courtesy of Hunter Piegols, Courtesy of Marie Burneko

Set in 9.5/12.5pt STIXTwoText by Straive, Pondicherry, India

10 9 8 7 6 5 4 3 2 1
 March 3, 1963

This textbook is dedicated to my amazing parents, Raphael and Dorothea Aronson. Growing up, my parents created a wel-
coming home filled with warmth, love, and constant laughter. They stressed the importance of family and community and
have always been incredible role models, instilling in me the importance of honesty, respect, to always remain humble and
to do the right thing even when it is not popular. From a very young age, my parents supported and encouraged me to
follow my passion for veterinary medicine. I wouldn’t be where I am today if it wasn’t for their love and support. I consider
myself the luckiest girl in the world, to be their daughter.
 vii

Contents

Contributors xii
Preface xvii
Acknowledgements xviii
About the Companion Website xix
Daisy’s Story xx

1 Triage and Initial Stabilization of the Emergency Small Animal Surgical Patient 1
Dana Clarke

2 Operating Room Nursing Tips for Emergency Surgical Procedures 20

Cami Elliott, Michelle Capps, and Michael McCallum

Section I Gastrointestinal System 49

3 Emergency Stabilization of the Acute Abdomen Patient 51

Nyssa Levy and Matthew Beal

4 Esophageal Foreign Bodies 58

Ivan Doran

5 Gastrointestinal Foreign Bodies 70

Amie Koenig and Mandy L. Wallace

6 Intussusception 81
Janet Kovak McClaran and Yekaterina Buriko

7 Rectal Prolapse 88
Jennifer L. Huck

8 Gastric Dilatation and Volvulus 93

Michael S. Tivers and Sophie Adamantos

9 Intestinal Volvulus 108

Elizabeth LaFond and Kristina Kiefer

10 Colonic Torsion 115

Chloe Wormser

11 Peritonitis 119
Adrienne Bentley and Anusha Balakrishnan
viii Contents

12 Surgical Intervention Post-­Celiotomy 141

Michael B. Mison

13 Biliary Emergencies 146

Lori Ludwig and Sean Smarick

14 Hemoperitoneum 164
Cassie N. Lux, William T. N. Culp and Steven E. Epstein

15 True Abdominal Hernias 178

Daniel D. Smeak

16 Traumatic and Incisional Hernias 190

Todd Hamilton

17 Perineal Hernias 199

Karen M. Tobias

18 Pancreatic Abscessation 216

F. A. (Tony) Mann

19 Hepatic Emergencies 226

James A. Perry, Steven E. Epstein, and William T. N. Culp

20 Bleeding Gastrointestinal Ulcers 238

Yekaterina Buriko, David Holt, Laura Ateca, and Lesley King

21 Enteral Feeding Tubes 251

Aarti Kathrani

Section II Urinary System 263

22 Stabilization of the Uremic Patient 265

Kari Beer and Kenneth Drobatz

Section IIa Urinary System - Urinary Tract Trauma 277

23 Renal and Ureteral Injury 279

Dan Degner and Chloe Wormser

24 Approach to the Uroabdomen 285

Sara Colopy, Adam Townsend, and Dale Bjorling

25 Urethral Injury 297

Sara Colopy, Adam Townsend, and Dale Bjorling

Section IIb Urinary System – Urinary Obstruction 311

26 Ureteral Obstruction 313

Daniel Degner, Dana Clarke, and Chloe Wormser

27 Urethral Obstruction 331

Heidi Phillips and Sara Colopy
 Contents ix

Section III Respiratory System 351

Section IIIa Respiratory System – Upper Airway Disease 353

28 Stabilization Techniques for Patients with an Upper Respiratory Obstruction 355

Meredith Maczuzak and Deborah C. Silverstein

29 Tracheostomy 364
Nathaniel Lam

30 Brachycephalic Airway Syndrome 372

Mike Schlicksup

31 Laryngeal Paralysis 383

Georga T. Karbe

32 Laryngeal Trauma 391

Eric Monnet

33 Tracheal Collapse 395

William T. N. Culp and Matthew D. O’Donnell

Section IIIb Respiratory System – Pleural Space Disease 405

34 Stabilization Techniques for Patients with Pleural Space Disease 407

Erica Reineke and Jen Savini

35 Diaphragmatic Hernia 417

MaryAnn Radlinsky

36 Pyothorax 425
Lori S. Waddell and David A. Puerto

37 Hemothorax 433
Chad W. Schmiedt and Benjamin M. Brainard

38 Pneumothorax 441
David A. Puerto and Lori S. Waddell

39 Lung Lobe Torsion 451

Jacob A. Rubin and Jaime Green

40 Surgical Approach to the Thoracic Cavity 459

David A. Puerto and Jacob A. Rubin

Section IIIc Respiratory System – Chest Wall Disease 467

41 Stabilization Techniques for Patients with Chest Wall Disease 469

Nolan Chalifoux and Deborah Silverstein

42 Pectus Excavatum 475

Krista N. Adamovich-­Rippe and William T. N. Culp
x Contents

43 Flail Chest 483

Eric Monnet

Section IV Cardiovascular System 487

44 Pacemaker Therapy 489

Caryn Reynolds and Katrine Saile

45 Pericardial Effusion 501

Augusta Pelosi and Amy Koenigshof

46 Open-­Chest Cardiopulmonary Resuscitation 514

Jasper Burke and Deborah Silverstein

Section V Reproductive System 525

47 Cesarean Section 527

Stephen D. Gilson

48 Pyometra 534
Jacqueline Davidson and Dorothy Black

49 Penile and Testicular Emergencies 541

Susan P. Gregory

50 Prostatic Abscessation 553

Richard A. S. White

51 Uterine and Vaginal Prolapse 565

Pieter Nelissen

Section VI Wound Management 573

52 Bite Wounds 575

David Holt and Vincent Thawley

53 Burn Injury 586

Caroline Garzotto and Dana Clarke

54 Penetrating Injury in the Dog and Cat 600

Steve J. Mehler

55 Necrotizing Fasciitis 613

Karol A. Mathews and Ameet Singh

56 Degloving and Shear Injuries 626

Bryden J. Stanley and Susan W. Volk

57 Skin Flaps and Grafts: Managing Complications 645

Michael B. Mison
 Contents xi

58 Incisional Infections 652

Brandy A. Burgess

Section VII Ocular Emergencies 659

59 Ocular Emergencies 661

Deborah C. Mandell and Rosalie M. Atkins

Section VIII Oral Surgical Emergencies 685

60 Oral Surgical Emergencies 687

Alexander M. Reiter

Section IX Orthopedic Emergencies 701

61 Approach to the Septic Joint 703

Samuel P. Franklin

62 Surgical Management of Open Fractures 715

Kimberly Agnello

63 Traumatic Joint Luxation and Reduction 725

Anna Massie and Po-­Yen Chou

Index 739
xii

Contributors

Sophie Adamantos BVSc CertVA DACVECC DECVCC Adrienne Bentley DVM DACVS
MRCVS FHEA Staff Surgeon
Clinical Director Cornell University Veterinary Specialists
Paragon Veterinary Referrals Stamford, CT, USA
Wakefield, UK
Dale Bjorling DVM DACVS
Krista N. Adamovich-­Rippe DVM DACVS Professor of Small Animal Surgery
Associate Surgeon University of Wisconsin-­Madison
Central Texas Veterinary Specialty and Emergency Hospital School of Veterinary Medicine
Austin, TX, USA Madison, WI, USA

Kimberly Agnello DVM DACVS Dorothy Black DVM MPVM DACVECC

Associate Professor of Surgery Criticalist and Owner
University of Pennsylvania, School of Veterinary Medicine Rex Vet, Inc., San Mateo, CA, USA
Philadelphia, PA, USA
Ben Brainard VMD DACVAA DACVECC
Laura Ateca VMD DACVECC Professor of Small Animal Critical Care
Attending Criticalist Director of Clinical Research
Emergency and Critical Care Service, Guardian Veterinary Department of Small Animal Medicine and Surgery
Specialists University of Georgia, College of Veterinary Medicine
Brewster, NY, USA Athens, GA, USA

Rosalie M. Atkins DVM DACVO Brandy A. Burgess DVM MSc PhD DACVIM-­LA DACVPM
VCA Northwest Veterinary Specialists, Associate Professor, Director of Infection Control
Clackamas, OR, USA University of Georgia, College of Veterinary Medicine
Athens, GA, USA
Anusha Balakrishnan BVSc DACVECC
Triangle Veterinary Referral Hospital, Kate Buriko DVM DACVECC
Durham, NC, USA Assistant Professor, Emergency and Critical Care
University of Pennsylvania, School of Veterinary Medicine
Matthew Beal DVM DACVECC Philadelphia, PA, USA
Head of Interventional Radiology Services,
Head of Emergency and Critical Care Medical Services Jasper Burke VMD
Department of Small Animal Clinical Sciences Resident in Emergency and Critical Care
Michigan State University, College of Veterinary Medicine University of Pennsylvania, School of Veterinary Medicine
East Lansing, MI, USA Philadelphia, PA, USA

Kari Santoro Beer DVM DACVECC Michelle Capps CVT

Emergency and Critical Care Specialist Surgical Nursing Staff Supervisor
Oakland Veterinary Referral Services University of Pennsylvania, School of Veterinary Medicine
Bloomfield Hills, MI, USA Philadelphia, PA, USA
 Contributors xiii

Nolan Chalifoux DVM Cami Elliot CVT

Resident in Emergency and Critical Care Nashville Veterinary Specialists and Animal Emergency
University of Pennsylvania, School of Veterinary Medicine Nashville, TN, USA
Philadelphia, PA, USA
Steven E. Epstein DVM DACVECC
Po-­Yen Chou BVM MVM DACVS Professor of Emergency and Critical Care
Assistant Professor of Small Animal Orthopedic Surgery Department of Surgical and Radiological Sciences
Department of Surgical and Radiological Sciences University of California-­Davis, School of Veterinary
University of California-­Davis, School of Veterinary Medicine
Medicine Davis, CA, USA
Davis, CA, USA
Samuel P. Franklin DVM MS PhD DACVS DACVSMR
Dana Clarke DVM DACVECC ACVS Founding Fellow, Minimally Invasive Surgery,
Assistant Professor, Interventional Radiology and Small Animal Orthopedics
Critical Care Kansas City Canine Orthopedics, Kansas City, KS, USA
University of Pennsylvania, School of Veterinary Medicine
Philadelphia, PA, USA Caroline Garzotto VMD DACVS
Staff Surgeon
Sara Colopy DVM, PhD, DACVS Mount Laurel Animal Hospital
Clinical Assistant Professor, Small Animal Surgery Mount Laurel, NJ, USA
University of Wisconsin, School of Veterinary Medicine
Stephen D. Gilson DVM DACVS
Madison WI, USA
ACVS Founding Fellow in Surgical Oncology
Indigo Veterinary Specialists
William T.N. Culp VMD DACVS
Phoenix, AZ, USA
Professor of Small Animal Surgery
Department of Surgical and Radiological Sciences
Jaime Green DVM, DACVS
University of California-­Davis, School of Veterinary
Maine Veterinary Medical Center
Medicine
Scarborough, ME, USA
Davis, CA, USA
Susan P. Gregory BVetMed PhD DVR DSAS (Soft Tissue)
Jacqueline Davidson DVM MS FHEA MRCVS
Clinical Professor Professor of Veterinary Nursing (retired)
Veterinary Medical Teaching Hospital, Texas A and M Royal Veterinary College, Department of Clinical Science
College Station, TX, USA and Services
North Mymms, Hatfield, Hertfordshire, UK
Daniel Degner DVM DACVS
Animal Surgical Center of Michigan Todd Hamilton VMD DACVS
Burton, MI, USA Maine Veterinary Medical Center
Scarborough, ME, USA
Ivan Doran BVSc CertSAS DSAS(Soft Tissue) MRCVS
RCVS Specialist in Small Animal Soft Tissue Surgery David Holt BVSc DACVS
Highcroft Veterinary Referrals Professor of Small Animal Surgery
Bristol, UK University of Pennsylvania, School of Veterinary Medicine
Philadelphia, PA, USA
Kenneth Drobatz DVM DACVECC
Professor of Small Animal Emergency and Critical Care Jennifer L. Huck DVM DACVS
University of Pennsylvania, School of Veterinary Assistant Professor of Surgery
Medicine University of Pennsylvania, School of Veterinary Medicine
Philadelphia, PA, USA Philadelphia, PA, USA
xiv Contributors

Georga T. Karbe Dr Med Vet MRCVS DACVS Mike McCallum CVT

Department Head: Soft Tissue Surgery Director of Operations
University of Veterinary Medicine Hannover, University of Pennsylvania, School of Veterinary Medicine
Hannover, Germany Philadelphia, PA, USA

Aarti Kathrani BVetMed PhD DACVIM DACVN FHEA MRCVS Meredith Maczuzak DVM DACVECC
Senior Lecturer in Small Animal Internal Medicine Emergency Medicine Specialist
Royal Veterinary College, Clinical Science and Services Pittsburgh Veterinary Specialty and Emergency
Department Center – BluePearl
Hatfield, Hertfordshire, UK South Hills, PA, USA

Deborah C. Mandell VMD DACVECC

Kristina Kiefer DVM PhD CCRP DACVSMR
Professor, Clinical Emergency and Critical Care
Surgical Coach
University of Pennsylvania, School of Veterinary Medicine
VetSSMART LLC
Philadelphia, PA, USA
St Paul, MN, USA
F.A. (Tony) Mann DVM MS DACVS DACVECC
Amie Koenig DVM, DACVIM DACVECC
Professor and Small Animal Soft Tissue Surgeon
Professor of Emergency and Critical Care
Director of Small Animal Emergency and Critical Care
Department of Small Animal Medicine and Surgery
Services
University of Georgia, College of Veterinary Medicine
University of Missouri-­Veterinary Medical Teaching
Athens, GA, USA
Hospital
Columbia, MO, USA
Amy Koenigshof DVM MS DACVECC
Two by Two Animal Hospital Anna Massie DVM DACVS
Berrien Springs, MI, USA Assistant Professor of Surgery
University of Pennsylvania, School of Veterinary Medicine
Janet J Kovak McClaren DVM DACVS DECVS MRCVS
Philadelphia, PA, USA
Staff Doctor
London Veterinary Specialists
Karol A. Mathews DVM DVSc DACVECC
London, UK
Professor Emeritus of Emergency and Critical Care
Ontario Veterinary College, University of Guelph
Elizabeth LaFond DVM DACVS DACVSMR
Guelph, ON, Canada
Veterinary Specialists of Sydney
Miranda, NSW, Australia Steve J. Mehler DVM DACVS
Main Line Veterinary Specialists
Nathaniel Lam DVM DACVS Devon, PA, USA
Chief of Surgery
VCA Oahu Veterinary Specialty Center Michael B. Mison DVM DACVS
Pearl City, HI, USA Surgery – MedVet Salt Lake City
Salt Lake City, UT, USA
Nyssa Levy DVM MS DACVECC
Assistant Professor, Emergency and Critical Care Medicine Eric Monnet DVM PhD FAHA DACVS ECVS
Department of Small Animal Clinical Sciences Professor of Surgery
Michigan State University, College of Veterinary Medicine Department of Clinical Sciences
East Lansing, MI, USA College of Veterinary Medicine and Clinical Sciences
Colorado State University
Lori Ludwig VMD MS DACVS Fort Collins, CO, USA
Mobile Veterinary Surgery
Charleston, SC, USA Pieter Nelissen DVM CertSAS DECVS MRCVS
European Specialist in Small Animal Surgery, RCVS
Cassie N. Lux DVM DACVS Recognized Specialist in Small Animal Surgery (Soft Tissue),
Associate Professor of Surgery Founder and Director, Department Head of Surgery
Department of Small Animal Clinical Sciences Frontier Veterinary Specialists
College of Veterinary Medicine, University of Tennessee Munich, Germany
Knoxville, TN, USA
 Contributors xv

Matthew D. O’Donnell DVM DACVS Katrine Saile DVM, MS, DACVS

Central Texas Veterinary Specialty and Emergency Associate Surgeon
Hospital Blue Pearl Pittsburgh Veterinary Specialty and
Austin, TX, USA Emergency Center
Pittsburgh, PA, USA
Augusta Pelosi DVM DACVS DACVIM (Cardiology)
Cardiologist Jennifer Savini DVM DACVECC
Veterinary Heart Institute Emergency and Critical Care Specialist
Boca Raton, FL, USA VRC Specialty Hospital
Malvern, PA, USA
James A. Perry DVM PhD DACVIM (Oncology) DACVS
Veterinary Cancer and Surgery Specialists Mike Schlicksup DVM DACVS
Milwaukie, OR, USA Columbia Veterinary Emergency Trauma and Specialty
Columbia, SC, USA
Heidi Phillips VMD DACVS
Associate Professor of Small Animal Surgery Chad Schmeidt DVM DACVS
University of Illinois, College of Veterinary Medicine Professor of Small Animal Surgery
Urbana, IL, USA University of Georgia, College of Veterinary Medicine
Athens, GA, USA
David A. Puerto DVM DACVS
Center for Animal Referral and Emergency Services Deborah Silverstein DVM DACVECC
Langhorne, PA, USA Professor of Critical Care
University of Pennsylvania, School of Veterinary Medicine
MaryAnn Radlinsky DVM MS DACVS Philadelphia, PA, USA
Founding Fellow, Minimally Invasive Surgery
Small Animal Soft Tissue Ameet Singh BSc DVM DVSc DACVS
Salt River Veterinary Specialists Associate Professor of Surgery
Scottsdale, AZ, USA Ontario Veterinary College, University of Guelph
Guelph, ON, Canada
Erica Reineke VMD DACVECC
Associate Professor of Emergency and Critical Care Sean Smarick DVM DACVECC
University of Pennsylvania, School of Veterinary Independent Consultant
Medicine North Huntingdon, PA, USA
Philadelphia, PA, USA
Daniel D. Smeak DVM DACVS
Alexander M. Reiter Dipl Tzt Dr med vet DAVDC DEVDC Vice President, Surgical Models, Inotiv; Fort Collins
FF-­AVDC-­OMFS Emeritus Professor of Surgery
Professor of Dentistry and Oral Surgery Colorado State University
University of Pennsylvania, School of Veterinary Medicine Fort Collins, CO, USA
Philadelphia, PA, USA
Bryden J. Stanley BSc BVMS MACVSc MVetSc DACVS
Caryn Reynolds DVM DACVIM (Cardiology) Emeritus Professor
Cardiologist Michigan State University, College of Veterinary Medicine
Dove Lewis Emergency Hospital East Lansing, MI, USA
Portland, OR, USA
Vincent Thawley VMD, DACVECC
Jacob Rubin DVM DACVS Assistant Professor, Clinical Emergency and Critical Care
Maine Veterinary Medical Center University of Pennsylvania, School of Veterinary Medicine
Scarborough, ME, USA Philadelphia, PA, USA
xvi Contributors

Michael S. Tivers BVSc PhD CertSAS DECVS MRCVS Lori S. Wadell DVM DACVECC
Head of Surgery Professor of Clinical Critical Care Medicine
Paragon Veterinary Referrals University of Pennsylvania, School of Veterinary Medicine
Wakefield, UK Philadelphia, PA, USA

Karen M. Tobias DVM MS DACVS Mandy L. Wallace DVM MS DACVS

Institute Professor, Department of Small Animal Assistant Professor
Clinical Science University of Georgia, College of Veterinary Medicine
University of Tennessee, College of Veterinary Medicine Athens, GA, USA
Knoxville, TN, USA
Richard A.S. White BVetMed PhD DSAS DVR FRCVS
DACVS ECVS
Adam Townsend DVM
European and RCVS Specialist in Small Animal Surgery,
Resident, Small Animal Surgery
RCVS Specialist in Veterinary Oncology, ACVS Founding
University of Wisconsin-­Madison, School of Veterinary
Fellow, Surgical Oncology
Medicine
Clinical Director, Smart Paws GmbH
Madison, WI, USA
Special Professor of Small Animal Surgery
University of Nottingham, Nottingham, UK
Susan W. Volk VMD PhD DACVS
Associate Professor, Small Animal Surgery Chloe Wormser VMD DACVS
University of Pennsylvania, School of Veterinary Elite Veterinary Surgery
Medicine Northway Animal Emergency Clinic
Philadelphia, PA, USA Gansevoort, NY, USA