Department for Equine Surgery, Justus-Liebig Universität Gießen, Gießen, Germany.
Vet Med Sci. 2022 Mar;8(2):546-552. doi: 10.1002/vms3.718. Epub 2022 Jan 6.
Lacerations of the axillary region occur frequently in horses. Typical complications caused by entrapment of air in the wound during locomotion are subcutaneous emphysema, with consecutive pneumomediastinum and pneumothorax. In this case report, the clinical, radiographic and laboratory diagnosis and management of these complications after an axillary laceration that finally resulted in pneumoperitoneum are described. A 1-year-old Hannoveranian was presented with a pre-existing axillary laceration of unknown duration and subcutaneous emphysema in the surrounding tissue. Due to extensive tissue loss, attempts to adequately close the wound surgically and by packing with sterile dressing material were unsuccessful. Despite stall confinement and tying of the horse, subcutaneous emphysema was progressive and pneumomediastinum as well as pneumothorax was developed. These complications were monitored radiographically. On day 5 after admission, signs of air accumulation were detected on radiographs craniodorsally in the peritoneum and a pneumoperitoneum was diagnosed. Repeated thoracentesis with a teat cannula to gradually evacuate the thoracic cavity was used in combination with nasal oxygen insufflation to treat global respiratory insufficiency. Subcutaneous emphysema and all other complications resolved progressively and the horse was discharged from the hospital 21 days after admission when the axillary wound was adequately filled with granulation tissue. The wound healed fully 1 month later and the horse did not develop long-term complications within the following year. To the authors´ knowledge, the development of pneumoperitoneum including its radiographic monitoring following an axillary laceration has not been described in horses previously.
马的腋窝区域经常发生撕裂伤。在运动过程中，空气被困在伤口中会导致典型的并发症，包括皮下气肿，随后出现纵隔气肿和气胸。在本病例报告中，描述了一例腋窝撕裂伤后这些并发症的临床、放射学和实验室诊断和处理，最终导致气腹。一匹 1 岁的汉诺威马出现了一个先前存在的腋窝撕裂伤，其持续时间未知，并伴有周围组织的皮下气肿。由于广泛的组织缺失，试图通过手术和无菌敷料填塞来充分关闭伤口的尝试均未成功。尽管将马关在马厩中并系上缰绳，皮下气肿仍在进展，并且出现了纵隔气肿和气胸。这些并发症通过放射学进行监测。在入院后第 5 天，在腹部的颅背侧的放射片中检测到空气积聚的迹象，诊断为气腹。使用 teat 套管进行多次胸腔穿刺术，以逐渐排空胸腔，并结合鼻内给氧来治疗全身呼吸功能不全。皮下气肿和所有其他并发症逐渐消退，在腋窝伤口充分填满肉芽组织后，马在入院后第 21 天出院。一个月后，伤口完全愈合，在接下来的一年中，马没有出现长期并发症。据作者所知，马以前没有描述过腋窝撕裂伤后发生气腹及其放射学监测。
