Page 4 - RVC Clinical Connections - Summer 2025

RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Soft tissue surgery
RECURRENT SUBLUMBAR ABSCESSES DUE
TO OCCULT GRASS SEED

Grace Thomas (Resident in Small Animal Surgery)

orman, a three-year-old cocker Second admission
spaniel, presented to our Emergency Almost a month later Norman was brought
NReferrals Service last October, back to the QMHA due to signs of lethargy
following a two-day history of lethargy, and pyrexia. CT of the thorax and abdomen
inappetence, pyrexia and a vomiting confirmed the suspected recurrence of a
episode. sublumbar abscess, but an inciting cause
Investigations performed on admission remained elusive.
confirmed a septic peritoneal effusion, Norman was taken to surgery for an
suspected to be secondary to right-sided exploratory laparotomy, where a large,
sublumbar abscessation. sublumbar abscess was identified, opened,
Norman was taken to surgery overnight explored, debrided and flushed. No foreign
for an exploratory laparotomy. Generalised material was identified in the abscess or
peritonitis was found and a large, leaking surrounding fibrous tissue.
sublumbar abscess was identified, The sublumbar abscess and abdomen
explored and flushed. No perforations of were copiously lavaged. As previously, an
the gastrointestinal tract were found, and active suction abdominal drain was placed, Norman's CT scan
no foreign material was identified in the and the abdomen was closed routinely.
abscess or the surrounding fibrous tissue. Norman recovered well and the Further abdominal surgery would likely
After the sublumbar abscess and abdominal drain was removed five days be challenging due to the adhesions, which
abdomen were copiously lavaged, an active after admission as fluid production had would be expected to progress further
suction abdominal drain was placed and the subsided. He was discharged the following following the most recent surgery.
abdomen was closed routinely. day, with a two-week course of amoxiclav, to
Norman spent five days recovering in the be followed by four more weeks. Recovery
Queen Mother Hospital for Animals (QMHA) As no inciting cause was found, the risk Norman made excellent progress
and made good progress. As fluid production of recurrence was reiterated to owners, and postoperatively and his abdominal drain
had subsided, the abdominal drain was they were advised to have him re-examined was removed two says after surgery. He
removed the day before discharge. A if signs of recurrence were observed. was discharged the following day with the
nasogastric tube that had been placed to same antibiotic course as before as well as
support nutrition in the postoperative period Third admission – underlying cause a NSAID and an analgesic.
had been removed the day before as he identified The day after discharge Norman
was eating well.. Norman was returned to the RVC two presented to the out-of-hours service after
He was discharged from the QMHA months later, following a recurrence interfering with his surgical wound – he had
with a four-week prescription of amoxiclav. of previous symptoms. Abdominal CT managed to remove his buster collar and
Norman’s owners were cautioned about the confirmed a recurrence of a sublumbar lick his wound.
possibility of recurrence of the sublumbar abscess and a suspect foreign body visible The surgical wound was dry but there
abscess, as an underlying inciting cause in the caudal aspect of the abscess, ventral were two areas where the skin was slightly
had not been identified. They were advised to the transverse process of the L7 vertebra. open. Following recommendation from
to have Noman re-examined if he developed After deliberation, Norman's owners the Emergency and Critical Care team,
any signs of recurrence, including lethargy, opted to proceed with further surgery. An Norman's wound was cleaned and three
inappetence, pyrexia, lameness, and exploratory laparotomy identified a large, staples placed on the areas where the skin
lumbar or abdominal pain. sublumbar abscess – and a grass seed was was open. A body suit was placed before he
retrieved using intraoperative ultrasound returned home.
guidance. His owner Jack informed us that he is
The abscess had begun to leak into the doing “brilliantly” and is back to his normal
abdomen, causing generalised peritonitis. self: “swimming, racing around and living
The sublumbar abscess was opened and and loving life to the full.”
debrided extensively, and the abdomen
was copiously lavaged. An active suction
abdominal drain was placed and the
abdomen closed.
Norman also had fairly extensive
abdominal adhesions. Some of them were
removed for surgical access to the abscess, For small animal referrals, please call:
but many around the GI tract were left. 01707 666399
Norman
Email:
qmhreception@rvc.ac.uk

4 Summer 2025