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Wednesday, January 9, 2013

Traveler's Travails


This case is actually from last summer, but I'm just now getting around to posting it.  The dog was Traveler, named after Confederate general Robert E. Lee's horse.  He was a very sweet white German shepherd that came to me for a large, painful wound near his rectum.  

The owners had no idea how it happened, just that it suddenly appeared.  When I tried to examine him he was very nice, except when I went to look under his tail.  He turned around and tried to bite, then returned to being sweet.  It was obviously extremely painful and he was trying to protect it.  With a muzzle, good restraint, and a light touch I was able to get a good enough look to tell that it was large and deep and something we would need to sedate him to examine further. I didn't know what I was going to find, but I knew we couldn't just put him on medications and hope for the best.  Thankfully the owners agreed to our treatment plan.

Ready for the grossness?  I hope your stomach is strong.

Here is what we found once he was heavily sedated and we could get a good look at things.

This looks bad on the surface, but it was worse as I explored it and got some light into it.  This was not a simple wound, ruptured anal sac, or anything similar.  As I put my finger in I was amazed at how deep the wound went.  I could feel the outside of the rectal wall!

I was concerned that there was a puncture through the rectum or lower colon which would require major surgery to correct.  I had no idea what caused damage but knew we needed to fix it.  With some exploration I began to feel that this wasn't the case and took the chance that we might be able to manage it more conservatively, especially since he was so stable otherwise.

I flushed the wound with chlorhexidine (a disinfectant), placed a drain tube, and closed the hole.

We sent him home with antibiotics and pain medication.  I hoped that would be the end of the major problem, though I warned the owner that this could still fall apart and go bad, potentially even requiring surgery by a specialist.  And it did indeed start to fail.  

A few days later I had him scheduled to come back and remove the drain.  The skin had pulled through most of the stitches and the wound had opened up again, though not quite as much as on the original visit.

However, Traveler was feeling much, much better and was no longer painful.  He was defecating normally and in good spirits, all of which was very encouraging.  We decided to manage it more as an open wound rather than going back in for further surgery.  We kept him on antibiotics and started using Granulex spray, designed to help wounds heal.  

Believe it or not, this worked!  A couple of days later we had a slight improvement in the size of the wound, and more importantly I could see that the deeper tissues were closing up.

We checked him after a few days, continued to see improvement, and then went to weekly rechecks.  Here's a picture of Traveler's rectal area about two weeks later.

Incredible healing!  Go back and compare it to the top photo and you'll see how dramatic this was.  

Traveler made a complete recovery and had no long-term damage to his rectum or muscles.  I still have no idea what caused the wound, but in the end (pun intended) it all turned out well.  I love stories like this!