Anglesey Lodge Equine Hospital, The Curragh, Co, Kildare, Ireland.
Ir Vet J. 2009 Nov 1;62(11):734-6. doi: 10.1186/2046-0481-62-11-734.
An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.
一匹 11 岁的母马在分娩后 36 小时出现膀胱破裂。通过超声和腹腔液的肌酐浓度诊断为尿性腹膜炎。膀胱内窥镜检查显示组织坏死和膀胱背侧有裂缝。在稳定病情，包括腹部引流和灌洗后，这匹马被带到站立手术台上。在持续镇静和硬膜外麻醉下，以及在手术准备好后，将 Balfour 牵开器放入阴道。使用无菌润滑剂和适度的力量，就可以将一只手插入膀胱。在膀胱的背侧很容易摸到裂口。将两根手指插入裂口，用于牵引，将膀胱完全翻入阴道，然后用外科医生的另一只手抓住，以防止进一步的创伤。然后，第二位外科医生可以看到整个裂口，并使用单根 0 号 PDS 缝线进行单层连续缝合来修复。一旦修复了膀胱，就通过尿道将其放回。这匹马在手术后恢复良好，48 小时后出院，显然正常。这是首例描述不进行腹部切口或尿道括约肌切开术来修复膀胱的报告。与之前描述的站立技术相比，这种方法大大降低了术后尿液积聚的可能性，也降低了因腹部手术牵引导致膀胱创伤的可能性。
