The usual organs in MWDs subjected to blunt trauma are the spleen, liver, and urinary bladder, in this order of frequency. Splenic and hepatic injuries are usually fractures of the organ; major vessel trauma is uncommon.1-7

 

Intra-abdominal hemorrhage.

Most hemoperitoneum cases in MWDs are due to splenic and hepatic fractures, which can vary markedly in size, with a significant difference in quantity of blood lost into the abdomen.

  • The majority of MWDs with BAT and intra-abdominal hemorrhage that survive to admission can be successfully managed conservatively, since most of the time the source of hemorrhage is small liver and splenic fractures. These usually will spontaneously cease bleeding given time and conservative fluid therapy. Monitor the MWD closely, as some will require exploratory laparotomy and surgical correction of hemorrhage, especially those that do not respond or deteriorate.
  • Given the difficulty in maintaining an abdominal counterpressure bandage, and the risk of respiratory compromise, do not apply an abdominal counterpressure bandage on a MWD.
  • Patients with massive intra-abdominal bleeding need surgery to find the site of bleeding and surgically correct the loss of blood. There may be instances in which emergent laparatomy is necessary by HCPs to afford a chance at patient survival. See Emergent Abdominal Laparotomy in this CPG for guidance.

 

Urinary tract trauma.

Urinary bladder rupture, with uroperitoneum, is fairly common, especially if the animal had not voided before the trauma.

  • MWDs with acute urologic trauma and uroperitoneum should be stabilized for other injuries, and aggressively managed for shock. Primary repair of a ruptured urinary bladder or other urologic injury must wait until the patient stabilizes to minimize the risk of complications associated with taking an unstable patient to surgery.
  • In many cases, urologic injury is not apparent for several days after trauma, so a high index of suspicion must be maintained. Special studies (ultrasound, excretory urography, contrast urethrocystography) may need to be performed to rule out urologic trauma.
  • In patients with known urologic tears and urine leakage, abdominal drains may be indicated if surgery is delayed for several days while the patient stabilizes. This will allow removal of urine, which will minimize chemical peritonitis and electrolyte and acid-base imbalances (metabolic acidosis, hyperkalemia). Intensive fluid therapy to correct or prevent electrolyte and acid-base imbalances is often necessary, especially if several days have passed since traumatic injury.
  • Surgical repair must only be performed after the patient is stabilized. Patients with severe uroabdomen need surgery to define the extent of injury and correct the problem. There may be instances in which emergent laparatomy is necessary by HCPs to afford a chance at patient survival. See Emergent Abdominal Laparotomy in this CPG.

 

Ruptured abdominal viscus.

Patients with a ruptured gastrointestinal viscus are candidates for emergent exploratory surgery to identify the part of the tract that is injured and allow primary repair. Delay in repairing bowel perforation can rapidly lead to septic peritonitis, septic shock, and rapid patient deterioration.13

  • Broad-spectrum antibiotic therapy is vital, especially against anaerobic and gram negative bacteria. Table 11 lists antibiotic options for initial use in MWDs with ruptured viscus or septic peritonitis.
  • Shock management is of special importance. Every attempt must be made to stabilize the patient as much as possible, with URGENT evacuation to a veterinary facility for definitive repair.
  • Patients with ruptured abdominal viscus need surgery to define the extent of injury and correct the problem. There may be instances in which emergent laparatomy is necessary by HCPs to afford a chance at patient survival. See Emergent Abdominal Laparotomy in this CPG for guidance.

 

Table 11.  Antibiotic Selection and Dosing for Military Working Dogs. 

Table 11.  Antibiotic Selection and Dosing for Military Working Dogs.