Gestione medica, anestesiologica e chirurgica dell'uroperitoneo nel puledro

Abstract

Uroperitoneum is a long recognized and well documented disease that occurs in the newborn foal. Disruption of the ureters, bladder, urethra or urachus can lead to leakage of urine into the peritoneal cavity. The main cause of uroperitoneum is the rupture of the urinary bladder at birth, secondary to pressure applied during transit through the birth canal. Also septicemia and local infections can lead to necrosis and disruption of the urinary tract. There may be a sex difference in prevalence for bladder rupture because males are more frequently affected shortly afterwards birth than females. Conversely, when uroperitoneum develops later, secondary to infections, there is not sex difference in prevalence. Clinical signs combined with uroperitoneum may vary based on the site of lesion. Nevertheless, affected foals often present weakness, dehydration, dysuria, discomfort, abdominal distention and pain, tachycardia and tachypnoea. Diagnosis is based on physical examination, clinical pathology and abdominal ultrasonography. The traditional pathological findings are hyperkalemia, hyponatremia, hypochloremia, azotemia and metabolic acidosis. Uroperitoneum is a medical emergency, prior than surgical, and the immediate goals of treatment are to improve cardiovascular and respiratory status by drainage of the peritoneal cavity and to correct electrolyte imbalances and dehydration by fluid therapy. Preanesthetic stabilization of the foal is needed to reduce the anesthetic risk and perioperative mortality. Foal anesthesia, especially for critical patient, is challenging and requires that practitioners consider the physiology of the equine neonate. Urinary tract defects require surgical repair as final treatment. Providing analgesia for foals undergoing surgical treatment improves the outcome of the procedures.