Search

Objective: To describe the approach for placement of a transcerebellar fourth ventriculoperitoneal shunt for management of presumed fourth ventricle arachnoid diverticulum and secondary obstructive hydrocephalus of a dog. To describe the outcome of this procedure., Study Design: Case report., Animals: Male entire English springer spaniel, 3 years 9 months of age., Methods: The dog was initially presented for management of acute, progressive, and multifocal brainstem and forebrain dysfunction. Magnetic resonance imaging revealed internal obstructive hypertensive hydrocephalus. The dog was managed via ventriculoperitoneal shunting from the left lateral ventricle and made an excellent recovery. The dog acutely deteriorated 18 months after initial discharge and follow-up magnetic resonance imaging confirmed the ventricular shunt remained in situ with normal-sized lateral ventricles but revealed a cystlike lesion within the fourth ventricle, presumed to be a fourth ventricle arachnoid diverticulum. The diverticulum was causing mass effect and resultant compression of adjacent neuroparenchyma. A second ventriculoperitoneal shunt was subsequently placed into the fourth ventricle via the caudal cranial fossa and cerebellum. This was attached to a three-way connector, to which the existing shunt (within the left lateral ventricle) was also attached, and then secured to the existing medium-pressure valve., Results: Postoperatively, the dog immediately developed mild vestibular-cerebellar ataxia, with a marked improvement after 3 months. There were no shunt-associated complications. Long-term follow up at 40 months after the second surgical procedure revealed a normal neurological examination., Conclusion: Transcerebellar ventriculoperitoneal shunt placement for treatment of a presumed fourth ventricle arachnoid diverticulum was performed and was associated with a favorable long-term outcome., (© 2024 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

The conformation of spinal arachnoid diverticula (SAD) and their clinical implications are poorly characterized in dogs. This retrospective cross-sectional study describes different SAD conformations in dogs and aims to identify if there is an association between SAD conformation and clinical features, localization, syringomyelia (SM) presence, concurrent vertebral condition, treatment option, and short as well as long-term outcome. Sixty-two dogs were included (12 cervical and 50 thoracolumbar SAD). All dogs with a cervical SAD had a cranial tethered conformation and were not included in the statistical analysis. Half of the dogs with a thoracolumbar SAD were cranial tethered, and the other half were caudal tethered. SM associated with SAD had a moderate prevalence in the cervical region (58.3%) and a high prevalence in the thoracolumbar region (82%). All dogs with the presence of SM and caudal tethered SAD had a cranial positioned SM, and all dogs with SM and a cranial tethered SAD had a caudal positioned SM. The SM absolute length and SM length/L2 ratio were significantly higher (P = .018, respectively) in the caudal tethered SAD compared with the cranial tethered SAD. The short-term outcome was statistically different (P = .045) between caudal and cranial tethered thoracolumbar SAD, but not the long-term outcome (P = .062). Multivariable logistic regression identified thoracolumbar caudal tethered SAD conformation had a better short-term outcome (P = 0.017, OR: 0.043, CI: 0.003-0.563), independently of SM length measurements. SAD conformation in dogs can influence SM formation. A possible link between short-term outcome and SAD conformation was found, but further research is warranted., (© 2024 The Authors. Veterinary Radiology & Ultrasound published by Wiley Periodicals LLC on behalf of American College of Veterinary Radiology.)

Background: Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs., Hypothesis/objectives: Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS)., Animals: Eight client-owned dogs with UD treated with an AUS., Methods: Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed., Inclusion Criteria:  diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively., Results: Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs)., Conclusion: Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs., (© 2024 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

A four-month-old domestic shorthair cat with no clinical signs was referred for further examination of a heart murmur. An echocardiogram revealed marked right atrial dilation, extending into the left hemithorax. Computed tomography angiography was conducted to investigate further, which revealed a balloon-shaped, contrast-filled cavity on the cranial and left side of the chest that connected to the right atrium through a narrow passage. This was diagnosed as a congenital right atrial diverticulum. Treatment included clopidogrel to reduce the risk of thrombus formation. Two months after the initial diagnosis, castration surgery was successfully performed without complications. The cat died suddenly at home 10 months after diagnosis. To the authors' knowledge, this is the first right atrial diverticulum reported in a cat., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Case Description: A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier., Clinical Findings: Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed., Treatment and Outcome: A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery., Clinical Relevance: An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.

Spinal subarachnoid diverticula are fluid dilations of the subarachnoid space that can cause a compressive myelopathy in dogs. These diverticula are usually associated with high motion areas in the cervical and caudal thoracic spine. The definitive etiopathogenesis has not been determined but likely involves congenital or acquired causes. Pugs, French bulldogs, and Rottweilers are overrepresented breeds. Clinical signs typically include ataxia, paresis, and upper motor neuron urinary and/or fecal incontinence; pain is a less common feature. Diagnosis is based on advanced imaging, with magnetic resonance imaging now being favored given the additional detail of the spinal cord parenchyma that can be obtained. Outcomes are better with surgical intervention than with medical therapies, though there is a lack of long-term data. No superior surgical technique has been identified, and questions remain on the significance of addressing leptomeningeal adhesions at the time of surgery. Clinical signs can recur, though not always due to recurrence of diverticulum formation, and pugs may be less likely to have a successful long-term outcome., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

A 3 yr old spayed female French bulldog was evaluated for a progressive regenerative anemia of unknown origin that was unresponsive to empiric immunosuppressive and gastroprotective therapy. The patient had a history of previous resection and anastomosis of a small intestinal diverticulum ∼2 yr prior to evaluation for her anemia. Capsule endoscopy revealed a focal abnormality in the distal jejunum at the site of a previous bowel resection and anastomosis. This lesion was suspected to be the cause of ongoing gastrointestinal bleeding and anemia. Exploratory laparotomy combined with endoscopy was performed to further investigate and localize the jejunal lesion. The lesion was resected, and a primary end-to-end jejunal anastomosis was performed. Histopathology of the specimen revealed jejunal suture granulomas with focal ulceration. The patient recovered well from surgery with significant improvement of the anemia and resolution of clinical signs at recheck examinations 1 and 2 wk postoperatively. Complete resolution of the anemia was noted at a 6 wk follow-up. The case report demonstrates how, in cases of unknown causes of anemia, capsule endoscopy is a noninvasive method of identifying the presence of gastrointestinal bleeding as a result of lesions that might otherwise not be detectable with abdominal ultrasound or conventional endoscopy. The report also documents a long-term complication to a resection and anastomosis surgery.

A one-year-old intact male German shepherd dog was referred with a 3-month history of dysuria and pollakiuria. Physical examination revealed a large firm mass in the caudal abdomen. Findings from survey radiography, negative contrast cystography, computed tomographic (CT) retrograde positive contrast cystography, and CT excretory urography were consistent with a large urinary bladder diverticulum. An exploratory laparotomy revealed a normal wall appearance in the ventral compartment (true bladder) and marked thinning of the wall in the dorsal compartment (diverticulum). Both ureters inserted into the ventral compartment. The dorsal compartment was excised and histopathology confirmed the diagnosis of urinary bladder diverticulum., (© 2018 American College of Veterinary Radiology.)

This study describes the clinical presentation of superficial swellings and evaluates the utility of ultrasonography in the diagnosis of such swellings in sheep and goats. Ninety-three sheep and 73 goats were included in this study on the basis of presence of superficial swellings on the head (n=56), neck (n=16), chest wall (n=3), abdominal wall (n=40), umbilicus (n=14), scrotum (n=16), testes (n=1), udder (n=7), limbs (n=2), gluteal region (n=5), tail (n=1), and penile urethra (n=5). Ultrasonographic evaluation of these superficial swellings allowed the diagnosis of abscesses (n=54; 32.52%), cysts (n=12; 7.23%), hernias (n=57; 34.33%), hematomas (n=14; 8.44%), tumors (n=24; 14.45%), and urethral diverticula (n=5; 3.03%). Each lesion type could be precisely discriminated (sensitivity, 88-100%; specificity, 80-100%; and P=0.001). Ultrasonography was found to have a specificity of 100% for the diagnosis of hernias, urethral diverticula, and tumors, and a lower specificity of 80% for hematomas and 93% for abscesses when used for evaluation of superficial swellings in sheep and goats. In conclusion, ultrasonography is a unique, non-invasive diagnostic imaging tool that allows the diagnosis, differential diagnosis, and subsequent surgical treatment of different types of superficial swellings in sheep and goats.

Acquired outpouches of the intestinal tract are referred to as pseudodiverticula or false pulsion diverticula. In contrast to true diverticula, in which the wall contains all layers of the intestinal tract, the wall of pseudodiverticula lacks the tunica muscularis. Smooth muscle hypertrophy of the small intestine is commonly considered a cause of pseudodiverticulosis in animals due to increased intraluminal pressure. This study reports pseudodiverticula associated with idiopathic smooth muscle hypertrophy of the small intestine in lagomorphs. Four domestic rabbits had single or multiple (up to 200) pseudodiverticula of various size in the small intestine. In all cases the tunica muscularis was diffusely thickened, significantly exceeding reference thickness of 14 rabbits (mean, 112.3 µm; range, 26.3-389.0 µm). Clinical signs were considered to be caused by severe necrosis and inflammation of the wall of large pseudodiverticula, leading to perforation with subsequent peritonitis and mesenteric and omental abscess formation in 2 cases.

A 2-year-old neutered male dog with a history of urinary incontinence, recurrent urinary tract infections, and unilateral cryptorchidism was presented with an acute onset of perineal swelling. Urinary contrast studies revealed a urothelial lined structure in the perineum. Surgical resection of 80% to 90% of this structure, suspected to be a congenital urethral diverticulum, was successful.

Preputial dilation is an infrequently reported condition in pigs. The pathophysiology and etiology is unclear. Causes for diverticulum dilation are proposed to be chronic preputial diverticulitis with subsequent fibrosis of the preputial cavity, phimosis of the preputial orifice or the preputial diverticulum, but the large majority of cases are reportedly idiopathic in nature. Surgical interventions include ablative procedures, but many cases are not treated because of an assumed lack of clinical relevance in pigs not used for breeding. We report a case of progressive preputial dilation that recurred after surgical intervention. Histopathological examination revealed no primary inflammatory condition, contrary to literature suggesting a role for inflammatory mediators in pathogenesis. Phimosis of the preputial orifice was noted post mortem and might be a contributing factor. These findings partially contradict the current assumptions in regards to pathophysiology and treatment choices in the literature and warrant further investigation into alternative therapeutic interventions for this condition.

CASE DESCRIPTION A 5-year-old sexually intact female guinea pig was evaluated because of mild dysuria and a subcutaneous mass located cranioventral to the urogenital openings. CLINICAL FINDINGS Non-contrast-enhanced CT and surgical exploration of the distal aspect of the urethra revealed a urethral diverticulum with an intraluminal urolith. Analysis revealed that the urolith was composed of calcium carbonate and struvite. TREATMENT AND OUTCOME The urolith was surgically removed and ablation of the urethral diverticulum was attempted. Approximately 3 months later, the guinea pig was reevaluated for masses in the perineal region, and positive-contrast urethrocystography revealed 2 uroliths present in the same diverticulum. Uroliths were manually expressed with the patient under general anesthesia. Approximately 2 weeks later, urethroplasty was performed to create an enlarged stoma with the diverticulum, thereby preventing urine from pooling in the diverticulum and potentially reducing the risk of future urolith formation. The urethroplasty site healed well with no reported complications or evidence of urolith recurrence 6 months after surgery. CLINICAL RELEVANCE Urolithiasis is common in guinea pigs, and urethral diverticulum and intraluminal urolith formation should be considered as a potential differential diagnosis for a subcutaneous mass along the distal aspect of the urethra. Creation of a urethral stoma from a urethral diverticulum via urethroplasty achieved a successful outcome in this patient.

A 57-yr-old female Sumatran orangutan ( Pongo abelii) presented with signs of intermittent lethargy and inappetence, then subsequently developed profuse hemorrhagic diarrhea. Colonoscopy under anesthesia revealed diverticulosis of the descending colon, with multiple large diverticula containing fecoliths. There was no evidence of diverticulitis, but a regenerative anemia had developed following an acute diverticular bleed. The orangutan recovered with conservative therapy. Colonic diverticulosis has been reported in nonhuman primates and appears to have a similar clinical presentation to the condition as it occurs in humans. This is the first published report of colonic diverticulosis in a great ape.

Objective: This report describes the clinical findings and diagnostic images of a traumatic intrathoracic tracheal avulsion with a tracheal diverticulum in a cat. Furthermore, a complete description of the tracheal resection and anastomosis using one-lung ventilation (OLV) with total and partial intravenous anesthesia is made., Case Summary: A 3-year-old neutered male domestic shorthair cat weighing 6.8 kg was presented to the University Teaching Hospital for evaluation of increased respiratory noise 3 months following unknown trauma. Approximately 12 weeks prior to presentation, the cat had been seen by the primary care veterinarian for respiratory distress. At that time, the cat had undergone a tracheal ballooning procedure for a distal tracheal stricture diagnosed by tracheoscopy. The tracheal ballooning had provided only temporary relief. At presentation to our institution, the cat had increased respiratory effort with harsh upper airway noise auscultated during thoracic examination. The remainder of the physical examination was normal. Diagnostics included a tracheoscopy and a thoracic computed tomographic examination. The cat was diagnosed with tracheal avulsion, pseudotrachea with a tracheal diverticulum, and stenosis of the avulsed tracheal ends. Surgical correction of the tracheal stricture via a thoracotomy was performed using OLV with total and partial intravenous anesthesia. The cat recovered uneventfully and at last follow-up was active and doing well., Unique Information Provided: This case report describes OLV using standard anesthesia equipment that is available at most private practices. Furthermore, this case describes the computed tomographic images of the intrathoracic tracheal avulsion and offers a positive outcome for tracheal resection and anastomosis., (© Veterinary Emergency and Critical Care Society 2015.)

We studied 72 buffalo with superficial swellings in the head (n=4), neck (n=5), chest wall (n=4), abdominal wall (n=28), limbs (n=16), gluteal region (n=8), perineal region (n=6) and udder (n=1). Ultrasonographically, the swellings varied according to type, duration, content and location. The clinical use of ultrasound to assess these superficial swellings allowed diagnosis of abscesses (n=21), hematomas (n=11), hernias (n=17), bursitis (n=13), urethral diverticula (n=6) and tumors (n=4). Ultrasonography could precisely discriminate each lesion type (sensitivity, 71-100%; specificity, 75-100%; odds ratio, 1.0-8.4; Confidence Interval, 74.2-20; and P value 0.001). The specificity for ultrasonographic evaluation of superficial swellings was 100% for hernias, urethral diverticula and tumors, whilst the lowest specificity was recorded for hematomas (75%) and abscesses (92%). In conclusion, ultrasonography provides a precise, non-invasive and fast technique for the evaluation, classification and subsequent treatment of a variety of superficial swellings in buffalo.

Leatherback sea turtles are globally distributed and endangered throughout their range. There are limited data available on disease in this species. Initial observations of solitary large intestinal diverticulitis in multiple leatherbacks led to a multi-institutional review of cases. Of 31 subadult and adult turtles for which complete records were available, all had a single exudate-filled diverticulum, as large as 9.0 cm in diameter, arising from the large intestine immediately distal to the ileocecal junction. All lesions were chronic and characterized by ongoing inflammation, numerous intralesional bacteria, marked attenuation of the muscularis, ulceration, and secondary mucosal changes. In three cases, Morganella morganii was isolated from lesions. Diverticulitis was unrelated to the cause of death in all cases, although risk of perforation and other complications are possible., (© The Author(s) 2014.)

A 14-year-old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall., (© 2014 American College of Veterinary Radiology.)

Objective: To report 2 dogs that developed temporary pelvic limb paralysis with loss of deep pain sensation after topical intrathecal morphine administration during spinal surgery., Study Design: Clinical report., Animals: Dogs (n = 2)., Methods: A 5-year-old castrated male French Bulldog with a subarachnoid diverticulum at T9-T10 and a 9.5-year-old castrated male Belgian Shepherd dog with a herniated disc at T12-T13 and intradural component, had Gelfoam soaked with morphine placed over the dura mater defect., Results: Pelvic limb paralysis and loss of deep pain sensation was noticed immediately after recovery from anesthesia. After intravenous naloxone administration, both dogs immediately regained ambulation and normal pain sensation; however the effect was temporary lasting only a few hours. Permanent resolution of clinical signs occurred 24 hours after surgery., Conclusions: Topical intrathecal morphine administration resulted in temporary pelvic limb paralysis and loss of deep pain sensation. This route of administration should be used cautiously until further determination of the efficacy and adverse effects associated with topical intrathecal morphine administration., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Necropsy examination of an 8-year-old female swamp wallaby (Wallabia bicolor) from a zoological garden revealed four intestinal diverticular outpouchings at the mesenteric border of the jejunum, which were partly ruptured causing a fatal peritonitis. Microscopically, affected small intestinal segments were characterized by an abrupt gap in the muscular layer with subsequent herniation of respective mucosal and submucosal layers, interpreted as acquired pseudodiverticula. Multifocal perforations of these diverticula were associated with prominent fibrinosuppurative serositis with leakage of ingesta. In addition, there was intestinal nematodal endoparasitism with accompanying neutrophilic to eosinophilic enteritis. Small intestinal pseudodiverticula resembling human colonic diverticulosis are rare in animals and can lead to fatal peritonitis by faecal impaction, subsequent transmural inflammation and eventual perforation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

A 10-month-old male Pomeranian dog was examined for neurological abnormalities consistent with diffuse forebrain and cerebellar disease. Based on ultrasound and magnetic resonance imaging (MRI) a diagnosis of diverticulum of the third ventricle, partial agenesis of the corpus callosum, and absence of the interthalamic adhesion was made. As conservative treatment was unsuccessful, a ventriculoperitoneal shunt was placed.

Three mature horses presented with progressive weight loss, inappetence, ventral abdominal oedema and lethargy. Two of the animals had intermittent signs of low grade abdominal pain. At presentation, all 3 had hypoalbuminaemia; 2 had hyperfibrinogenaemia and the other had neutrophilia. An oral glucose tolerance test was performed in 2 cases, both of which demonstrated impaired glucose absorption. One pony treated with corticosteroids failed to improve and developed peritonitis and was subjected to euthanasia after 2 weeks. One pony had small intestinal biopsies obtained via a standing flank laparotomy, which revealed a mainly mononuclear cell infiltrate of the mucosa. It failed to respond to treatment with antibiotics and corticosteroids and, after 2 months, developed sternal oedema in addition to the ventral abdominal oedema and peritonitis and was subjected to euthanasia. The remaining pony deteriorated despite symptomatic therapy and was subjected to euthanasia after one week. At post mortem examination, all 3 animals had multifocal lesions of small intestinal wall thickening, mucosal ulceration, pseudodiverticula and enlarged mesenteric lymph nodes. One pony also had a multinodular mass at the root of the mesentery, a mediastinal mass and a lung mass. Histological examination confirmed the presence of lymphoma of the intestinal wall at post mortem examination in each case and immunohistochemistry (including retrospective evaluation of the intestinal biopsies obtained from the pony that underwent a flank laparotomy) indicated that the lymphomas were of T cell origin., (© 2011 EVJ Ltd.)

Multiple diverticula of the right and left cardiac ventricular walls were incidental findings at necropsy in a juvenile, male, mixed-breed dog with no clinical history of heart disease. Each saccular diverticulum had a narrow communication into the corresponding ventricular chamber. Histologically, the diverticular walls consisted mainly of collagen without elastin fibers and atrophic cardiomyocytes. No inflammation or other lesions were associated with the diverticula or the rest of the myocardium. Based on the history and pathologic findings, a diagnosis of congenital biventricular fibrous diverticula was made.

A 3-month-old, female Holstein calf was examined because of marked perineal swelling and tenesmus of 4-days duration. A congenitally enlarged urethral diverticulum was diagnosed using fluoroscopic and ultrasonographic imaging techniques. The urethral diverticulum was surgically resected and the perineal area was reconstructed.

Objective: To report a case of multiple acquired jejunal pseudodiverticula managed successfully by resection and jejunojejunostomy., Study Design: Clinical report., Animals: Arabian filly., Methods: The filly was referred for signs of acute colic of several hours duration and had a 2-week history of inappetence and weight loss. Three meters of thickened, edematous, and dilated jejunum removed during exploratory celiotomy had an intussusception and numerous diverticula; jejunojejunostomy performed. The pathoanatomic diagnosis was proliferative enteropathy with pseudodiverticula formation and jejunal muscular hypertrophy and diverticulosis. The diverticula appeared to be acquired; however, the exact cause was not determined., Results: There were no postoperative gastrointestinal complications and 1 year later, the filly was doing well., Conclusion: Multiple acquired jejunal pseudodiverticula not associated with classic muscular hypertrophy can occur in young horses. Long-term prognosis seemingly can be excellent after resection and jejunojejunostomy., Clinical Relevance: Compared with other reports of small intestinal diverticula in horses, this case is unique because it was not congenital or associated with classic muscular hypertrophy.

A young female Boxer had a history of chronic soft stool. Survey abdominal radiographs were unremarkable. A duodenal diverticulum was identified in abdominal ultrasound and barium upper-gastrointestinal contrast examinations. Before surgery a 99mTc-pertechnetate study was performed to evaluate for ectopic gastric mucosa in the duodenal diverticulum. Focal abnormal increased radioactivity was identified in the right caudal abdominal quadrant. The diverticulum was excised. Upon histopathologic examination of the duodenal diverticulum, ectopic gastric mucosa was not identified but ectopic pancreatic tissue was found. Mild eosinophilic inflammation within the diverticulum was suspected to be the cause of the mild 99mTc uptake seen in this dog.

This report provides a detailed description of the surgical repair of perineal hypospadias in a Boston terrier. A 2-year patient follow-up, including diagnostic data demonstrating urethral patency and resolution of recurrent urocystitis and urine skin scald are reported.

Guttural pouch diseases pose serious challenges in diagnosis and treatment. Complications from treatment are common and often life-threatening, largely because the unique anatomy of the guttural pouches brings them into intimate contact with the nervous, respiratory, and cardiovascular systems. There is little forgiveness for surgical errors, and so the surgeon should focus on ways to anticipate and prevent them. As with any disease, errors in diagnosis can set the stage for many surgical errors and must be recognized. This article deals with errors that can be expected after the most common surgical treatments for guttural pouch diseases.

A 6-year-old male elk presented in August with a 4-month history of weight loss and a 1-day history of being recumbent and unable to rise. The elk's body condition score was 1.5/5. Hematology and blood chemistry showed an inflammatory leukogram, mild electrolyte abnormalities, and elevated liver enzyme activities. Because of poor prognosis, the owner elected euthanasia. On necropsy, 8 diverticula were in the duodenum distal to the common bile duct, which was dilated and filled with feed material. Many intrahepatic bile ducts were dilated up to 5 cm, were filled with ingesta and gritty material, and had walls thickened up to 1.5 mm. On histologic examination, mural thickening of dilated bile ducts was because of increased fibrous connective tissue with inflammatory cell infiltration and hyperplastic and hypertrophic epithelial lining. Portal tracts diffusely contained hyperplastic bile ducts and had increased amounts of fibrous connective tissue. Abscesses that contained bacteria were scattered throughout the liver. Duodenal diverticula lacked the tunica muscularis, and the muscularis mucosa was hypertrophied. Caudal to some diverticula, the duodenal lumen was narrowed. An additional finding was embolic pneumonia with fungi morphologically and immunohistochemically consistent with Aspergillus spp.

An 11-year-old, entire male coton de tulear was presented on emergency with acute and severe depression, acute abdominal pain and vomiting of 24 hours duration. Historical complaints included right perineal swelling, dyschezia and tenesmus of 18 months duration. Abdominal ultrasonography and radiography suggested a pneumoperitoneum and positive-contrast colonography showed leakage of contrast medium into the caudal abdomen and the presence of a large retroperitoneal pouch. Exploratory laparotomy allowed the visualisation of faecal leakage from the retroperitoneal space into the peritoneal cavity. Using a perineal approach, a large necrotised rectal diverticulum filled with faeces was found over the retroperitoneal structures. A standard herniorrhaphy was then performed. The dog recovered uneventfully and dyschezia did not recur at the nine month follow-up. Rectal diverticulum rupture associated with peritonitis has not been described in the veterinary literature, to the authors' knowledge, and should be considered as a rare differential diagnosis in dogs being presented with gaseous peritonitis.

Two littermates, a young male and female boxer, were admitted to the Utrecht University's Department of Clinical Sciences of Companion Animals within a three month period. Both dogs suffered from anaemia caused by chronic intestinal blood loss, vomiting and weight loss. In both cases, there was no response to conservative medical management. Eventually, the dogs suffered significant gastrointestinal haemorrhage that resulted in collapse. Gastroduodenoscopy and exploratory surgery showed a duodenal diverticulum in both dogs. This is the first report that describes this congenital anomaly in two siblings.

A 12-year-old, grey, crossbred pony mare was presented with a swelling in the neck over the area of the 2nd cervical vertebra (C2), which was found to be painful on palpation. The neck was held stiffly. Radiography of the cervical region showed a focal area of increased radio-opacity over the dorsal, caudal and lateral aspect of the dorsal spinous process of C2. Ultrasound confirmed the presence of a hypoechoic area approximately 15 cm in diameter superimposed over the dorsal spinous process of C2. An aspirate was taken of the mass, which revealed purulent exudate confirming the diagnosis of an abscess. The abscess was lanced with a scalpel blade and samples of the purulent material revealed a pure culture of Streptococcus equi subsp. equi. The guttural pouches (Eustachian tube diverticulae (ETD)) were then evaluated endoscopically and multiple chondroids were seen filling most of the right ETD. Surgery was subsequently performed and 189 chondroids were removed via a right-sided hyovertebrotomy. The ETDs were flushed and penicillin installed into both ETDs on 3 different occasions via a catheter introduced using a fibre optic scope. This procedure was repeated until a negative culture status was achieved in order to eliminate the carrier status.

Objective: To report use of a modified Whitehouse approach in standing horses for management of inspissated guttural pouch empyema., Study Design: Retrospective study., Animals: Adult horses (n=10) with guttural pouch empyema., Methods: Inspissated exudate in 1 or both guttural pouches was removed surgically through a modified Whitehouse approach, with the horses standing and sedated. Medical records of affected horses were reviewed to determine history; physical, endoscopic, and radiological examination findings; surgical technique; complications, and outcome., Results: All horses had purulent nasal discharge; 3 horses had dysphagia, 2 had recurrent laryngeal neuropathy on the side affected by guttural pouch empyema, and 1 had persistent soft palate displacement. Inspissated exudate was removed safely without causing apparent discomfort. Eight horses returned to their previous level of athletic activity after surgery; 1 horse dysphagic before surgery, was euthanatized because of persistent dysphagia after surgery, and 1 horse died 1 week after surgery for unknown reasons. Streptococcus equi subsp equi was isolated from the affected guttural pouch of 3 horses., Conclusions: Inspissated exudate can be removed surgically from the guttural pouch in standing horses through a modified Whitehouse approach., Clinical Relevance: To eliminate risks associated with general anesthesia and avoid surgical suite contamination, removal of chondroids can be performed in standing sedated horses through a modified Whitehouse approach.

Selective brain cooling (SBC) is defined as the lowering of brain temperature below arterial blood temperature. Artiodactyls employ a carotid rete, an anatomical heat exchanger, to cool arterial blood shortly before it enters the brain. The survival advantage of this anatomy traditionally is believed to be a protection of brain tissue from heat injury, especially during exercise. Perissodactyls such as horses do not possess a carotid rete, and it has been proposed that their guttural pouches serve the heat-exchange function of the carotid rete by cooling the blood that traverses them, thus protecting the brain from heat injury. We have tested this proposal by measuring brain and carotid artery temperature simultaneously in free-living horses. We found that despite evidence of cranial cooling, brain temperature increased by about 2.5 degrees C during exercise, and consistently exceeded carotid temperature by 0.2-0.5 degrees C. We conclude that cerebral blood flow removes heat from the brain by convection, but since SBC does not occur in horses, the guttural pouches are not surrogate carotid retes.

A Warmblood horse presented with a purulent nasal discharge that had failed to respond to antibiotic therapy. Radiography and endoscopy confirmed a large number of chondroid masses (over 200) in the left guttural pouch. Despite the large number of chondroids present, there was no external swelling evident. The masses were surgically removed via a hyovertebrotomy approach that provided excellent exposure, and no postoperative complications were encountered. Long term follow-up (3 years) confirmed a successful outcome.

A neutered female chow chow aged six years and five months was evaluated for dysuria. An initial diagnosis of bladder distension and atony was made following physical, ultrasonographic and radiographic examinations. The problems did not resolve with medical management and exploratory surgery revealed a large bladder diverticulum. This report describes the radiographic findings and surgical repair of the acquired bladder diverticulum. The literature available on this condition is also reviewed.

Objective: To describe removal of guttural pouch chondroids through a laser fenestrated mesial septum in a pony with an obstructed pharyngeal ostium of the left guttural pouch., Study Design: Case report., Animals: Pony., Methods: Transendoscopic laser neodymium:yttrium aluminum garnet (Nd:YAG) fenestration of the mesial guttural pouch septum was made by contact method (bare fiber, 15-25 W, exposure time 4 seconds). Dissected tissue was removed by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and multiple chondroids of varying size were removed from the left guttural pouch through the fenestration., Results: After removing all chondroids and repeated flushing of the left guttural pouch via the right side, inflammation of the guttural pouch membranes decreased remarkably. The pony was discharged with instructions for transendoscopic lavage once weekly and was reevaluated at 2 months. A permanent septal fenestration was observed and the pony was free of abnormal clinical signs and being used for carriage driving competitions., Conclusion: Nd:YAG laser fenestration of the mesial septum is an approach for access to guttural pouch chondroids., Clinical Relevance: When guttural pouch empyema and/or chondroids is associated with adhesion of the pharyngeal ostium, laser fenestration of the mesial septum from the opposite guttural pouch should be considered as an alternative approach for access, rather than classic external surgical approaches.

A 3-month-old female tortoise-shell cat showing azotemia died with a marked swollen abdomen. Necropsy revealed a huge perirenal cyst (8.5 x 6.0 x 4.5 cm) on the ventral aspect of the right kidney. The cyst was filled with the pellucid yellow fluid with a smell of urine. The lumen was connected with irregularly dilated renal pelvis by a narrow channel passing through the renal parenchyma. The cyst was lined by epithelial cells and its wall was consisted of collagen fibers and smooth muscle cells as that of the renal pelvis and ureter. Renal parenchyma adjacent to the channel showed interstitial infiltration of the lymphoid cells. The cyst was a diverticulum of the renal pelvis due to an impaired development.

Objective: To determine prevalence and radiologic and histologic appearance of vesicourachal diverticula in dogs without clinical signs of urinary tract disease., Design: Original study., Animals: 50 dogs between 4 months and 17 years old representing 22 breeds that had been euthanatized for unrelated reasons; none of the dogs had a history or clinical signs of urinary tract disease., Procedure: Retrograde positive-contrast radiography was performed, and radiographs were examined for macroscopic diverticula. Necropsy specimens from the urinary bladder vertex were examined by means of light microscopy for diverticula and signs of inflammation., Results: 17 of the 50 (34%) dogs had vesicourachal diverticula, and 1 additional dog had a urachal cyst. Fifteen of the 17 diverticula were macroscopic; surface area of the diverticulum could be measured radiographically in 13 of these dogs and ranged from 1 to 90 mm2. The remaining 2 diverticula were microscopic. Sixteen diverticula were intramural and 1 was extramural. Light microscopic signs of bladder wall inflammation could be detected in 5 dogs, 4 of which had macroscopic diverticula., Conclusions and Clinical Relevance: Results suggest that a high percentage of dogs without clinical signs of urinary tract disease may have vesicourachal [corrected] diverticula. Further studies are needed to determine the clinical relevance of vesicourethral diverticula in dogs.

Five horses with unilateral epidermal inclusion cysts located in the nasal diverticula were sedated and treated with intralesional injection of neutral-buffered 10% formalin (volume range, 2 to 4.5 mL). After aspiration of the cyst, formalin was injected intralesionally until leakage of fluid around the needle was observed. After several weeks, desiccation of the cyst was evident; it was excised 2 weeks after treatment in 3 horses, digitally removed by the owner of 1 horse, and never removed in 1 horse, because the owner declined further treatment after resolution of the original swelling of the nasal diverticulum. Swelling of the cyst after treatment was observed in all horses; nasal discharge (2 horses) and a mild episode of epistaxis (1 horse) were the only other complications of the treatment. Intralesional administration of formalin appears to be a simple and effective treatment for epidermal inclusion cysts in the nasal diverticula of horses.

A 5-month-old male Thoroughbred foal with a history of chronic septic arthritis of the tibiotarsal joint and recent respiratory distress was euthanized and a postmortem examination performed. A giant diverticulum communicating with the lateral aspect of the right atrial cavity of the heart was observed. Histologically, the wall was comprised of myocardial tissue containing cavernous vascular spaces. There was gross and histologic evidence of right-sided heart failure. Congenital right atrial diverticula are rare anomalies in humans and have not previously been reported in foals.