Laparoskopischer Verschluss einer Harnblasenruptur postpartum bei einer Vollblutstute
Laparoscopic closure of an urinary bladder rupture in a Thoroughbred mare
Laves J, Bartmann C P, Trübenbach L, Antpöhler J, Pudert T, Röcken M
DOI: 10.21836/PEM20210504
Jahr: 2021
Volume: 37
Ausgabe: 5
Seiten: 481–487
During parturition of her second foal, a seven-year-old Thoroughbred mare suffered a rupture of the urinary bladder. A few hours after birth the mare showed colic symptoms, which initially did not allow any conclusion about the cause. In an equine hospital, an uroperitoneum was diagnosed by abdominal puncture. The measured creatinine concentration in the peritoneal fluid was 1135.2 μmol/l. This value was about four times higher than the measured concentration of creatinine in the peripheral blood, which was 220 μmol/l. The urinary bladder endoscopy revealed a tear at the apex of the urinary bladder. After stabilization of the mare – by infusion therapy, intensive care and abdominocentesis-laparoscopic surgical therapy was performed under general anesthesia and in Trendelenburg position. The contusion of the bladder with hematoma formation and hemorrhage into the lateral bladder ligaments were clearly visible in the laparoscopic procedure. The empty bladder was located far caudally in the pelvic cavity and was covered by the still large, postpartum uterus. Therefore, an additional surgeon performed a transvaginal manipulation of the uterus with its dorsolateral displacement until the urinary bladder as well as the bladder ligaments could be viewed laparoscopically. The urinary bladder rupture was successfully closed with barbed sutures. This new generation absorbable polyglyconate suture material enables secure closure of the rupture without knotting. About four hours after recovery from general anesthesia, an abdominal lavage was performed on the standing, lightly sedated horse and a urinary catheter was placed by transvaginal approach. The postoperative period was without complications. The mare received analgesic and anti-inflammatory treatment for 5 days as well as antibiotic treatment for seven days. Six days after surgery a cystoscopy showed no signs of infection and the tear was almost completely epithelized. The mare was discharged from the hospital seven days after surgery. Eight weeks later she was in good general condition and pregnant again after covering. In the described case, the rapid diagnosis led to a good stabilization of the mare so that laparoscopic closure of the urinary bladder rupture could be performed after a short amount of time under general anesthesia. Early recognition of a urinary bladder rupture is challenging, but critical for a good prognosis and successful treatment. Diseases of the gastrointestinal tract, the genital and the urinary tract can cause colic symptoms in postpartum mares. A thorough obstetric follow-up examination including clinical general examination, adspection and transvaginal exploration may need to be extended according to the mare’s symptoms by transrectal palpation, ultrasonography examination, abdominocentesis and evaluation of laboratory diagnostic parameters. Various surgical treatment options for the closure of urinary bladder ruptures have been described in the literature. Minimally invasive laparoscopy provides good and complete examination of the abdominal and pelvic cavity and visualization of the tear in the urinary bladder. The main challenge of laparoscopic closure of bladder ruptures is the intracorporeal suture technique and knotting. To simplify this procedure, we used barbed suture to close the tear. Barbed suture is a new generation of absorbable suture material, which allows the suture to be anchored in a tissue-friendly way and eliminates the need for knotting. This case report highlights the importance of early diagnosis of bladder rupture. Early detection of this condition was challenging, but critical for good prognosis and successful treatment. Laparoscopy as a minimally invasive procedure and the use of the „barbed suture” provided a safe closure of the rupture and a smooth recovery of the horse.