Clinical Connections  –  Autumn 2023

A three-year-old longhaired male entire Chihuahua was mauled by a large dog, leading to severe injuries, including pelvic fractures, body wall rupture, testicular avulsion and acute kidney injury (AKI). He has bounced back and is enjoying his life, thanks to the specialist teams working together at RVC Small Animal Referrals.

Interventions Rocco received included critical care in the ICU, a blood transfusion and extensive emergency surgery overnight, including limb amputation and repair of his traumatic body wall rupture. He was an inpatient on two occasions, totalling almost three weeks, on top of outpatient reviews.

First admission

Rocco, at RVC Small Animal Referrals

Rocco received immediate measures to stabilise his condition and, shortly after arrival, underwent general anaesthesia, a CT scan and a positive contrast retrograde urethrocystogram to further evaluate the extensive trauma. This identified multiple right pelvic fractures, right coxofemoral luxation, right abdominal wall rupture with bladder herniation and poor contrast enhancement of his right pelvic limb musculature.He underwent immediate surgery to explore the wounds. Rocco required exploratory coeliotomy, body wall repair and right pelvic limb amputation due to the severity of injury to the limb, acetabular fracture, coxofemoral luxation, and severed femoral artery and thigh musculature.

Some viable pelvic limb muscles were spared and used to augment his body wall rupture. Fortunately, no other severe intra-abdominal injury was noted, although there was concern about the viability of the vascular supply to his right testicle. Rocco’s family had expressed reluctance to pursue castration, so the decision was made to monitor his testicular viability.

Due to the traumatic and contaminated nature of his trauma, an active suction drain was also placed at the amputation site. Rocco had suffered marked blood loss due to the trauma and received a blood transfusion during the procedure, enabled by the RVC’s pioneering Blood Donor Service.

Rocco initially recovered well from his emergency surgery. A few days post-operatively his right testicle and scrotum became markedly inflamed and swollen, due to the previously suspected testicular artery injury. Rocco’s family consented to castration. He underwent continued close monitoring and management of his AKI and once his azotaemia had stabilised, Rocco underwent castration with scrotal ablation. The opportunity was also taken to place an oesophageal (feeding) tube.

He recovered well and over the subsequent days the critical care team continued to manage his AKI carefully, while the surgery team evaluated the progress of his surgery sites and drains. The wound drain was removed a few days post-operatively.

Rocco was fit for discharge approximately two weeks following injury. The team elected to keep his o-tube in place for discharge to ensure adequate caloric intake. The primary care practice was asked to repeat biochemistry monthly in order to monitor Rocco’s ongoing kidney function.

Rocco’s returns

Three days after discharge, Rocco was re-presented to the RVC Emergency Referral Service. He had been vomiting and had a reduced appetite. On presentation, he was quiet but alert and responsive on physical examination. Emergency assessment including point of care ultrasound scanning did not reveal any emergent abnormalities.

Rocco, enjoying his life after his recovery and doing well on three legs

His oesophageal tube site was inspected and was unremarkable and the o-tube was removed. The surgical site appeared unremarkable, although a mild pyrexia was noted, and Rocco was diagnosed with an abscess of his amputation site. Rocco had open wound management, with daily wound flushing and antibiotic treatment based on culture results.

Rocco’s owners said they felt confident continuing wound management at home. They were provided with instructional videos and were able to take Rocco home for continued care from the comfort of his own home.

Clinical Connections spoke to Rocco’s owner, Benjamin Wong, some time after discharge, who said: “Rocco’s been doing really well. The experience didn’t change his personality and he’s been fine on three legs. He had kidney issues for a while and so we had to monitor his diet, but his kidneys and liver are okay now. He’s lively, happy and back to his normal self.”

Rocco sustained numerous and severe injuries as a result of his bite wounds. His recovery was made possible by the committed and collaborative efforts of the services at the QMHA. Rocco undoubtedly benefitted from emergency admission and stabilisation and immediate out of hours care from the anaesthesia, imaging and surgery teams. He also received input from the transfusion medicine team and on-going management with the critical care and surgical teams.
Rocco was a patient that required true transdisciplinary care and it was a pleasure for all teams to contribute to Rocco’s extraordinary outcome. All of those involved are delighted with his progress.

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