Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Treatment of Spontaneous Serial Lung Lobe Torsion Using Self-Cutting Linear Endoscopic Stapler in a Pekingese Dog under Total Intravenous Anesthesia

페키니즈견에서 발생한 연속적 폐염전의 전정맥마취하 자가 절단식 선형 복강경 스테플러를 이용한 치료

  • Park, JiYoung (College of Veterinary Medicine.Research institute of Veterinary Medicine, Chungnam National University) ;
  • Lee, Young Won (College of Veterinary Medicine.Research institute of Veterinary Medicine, Chungnam National University) ;
  • Jeong, Seong Mok (College of Veterinary Medicine.Research institute of Veterinary Medicine, Chungnam National University)
  • 박지영 (충남대학교 수의과대학, 동물의과학 연구소) ;
  • 이영원 (충남대학교 수의과대학, 동물의과학 연구소) ;
  • 정성목 (충남대학교 수의과대학, 동물의과학 연구소)
  • Accepted : 2013.10.04
  • Published : 2013.12.31
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Abstract

A 9-year old, castrated male Pekingese dog weighing 6.9 kg was referred with one week history of dyspnea, depression, yellow vomiting and abdominal distension. Refractory right lung field opacity was diagnosed as spontaneous right cranial lung lobe torsion (LLT) with collapsed middle lobe on the computed tomography. Four days after diagnosis, right fourth intercostal thoracotomy was performed under propofol-remifentanil based total intravenous anesthesia (TIVA). Right cranial and middle lung lobes were twisted together in a clockwise direction. ENDOPATH-ETS-FLEX-45, an articulating endoscopic linear cutting stapler was applied at the hilus and there were no complications after resection. The patient recovered favorably and has been doing well up to one year follow up. Lung lobe torsion is an uncommon condition in small breed dogs, this case report suggests serial lung lobe torsion of cranial lobe followed by middle lobe in small breed dog, and immediately after diagnosis surgical intervention is beneficial to prevent progression of LLT. Furthermore, using self cutting stapling device and TIVA technique will be helpful for lung lobectomy in dogs.

9년령의 중성화 수컷, 6.9kg의 케피니즈견이1주일간 지속된 호흡곤란, 침울, 황색 구토와 복부 팽만을 주증으로 내원하였다. 치료에 반응을 보이지 않는 폐야의 밀도 항진은 CT 촬영에서 우폐중엽의 허탈을 동반한 우폐전엽의 염전으로 진단되었다. 진단으로부터 4일째, 프로포폴과 레미펜타닐을 이용한 전정맥 마취하에 우4늑간 개흉술을 실시하였을 때 우폐중엽과 우폐전엽은 함께 시계방향으로 꼬여있었다. 자가 절단식 선형 복강경 스테플러(ENDOPATHETS-FLEX-45)를 우폐전엽과 우폐중엽의 폐문부에 적용하였고, 폐엽절제 후 복합증은 나타나지 않았다. 본 증례는 우폐전엽의 염전을 따라 연속적으로 우중엽의 염전이 진행된 경우로, 소동물에서 흔하지 않은 폐염전은 진단 후 즉각적 수술 처치가 필요함을 지시하며, 덧붙여 개에서 폐엽 절제시 자가 절단식 스테플러의 적용과 전정맥 마취의 유용성을 나타낸다.

Keywords

References

  1. Al-Haddad M, Al-Haddad M, McKenna D, Ko J, Sherman S, Selzer DJ, Mattar SG, Imperiale TF, Rex DK, Nakeeb A, Jeong SM, Johnson CS, Freeman LJ. Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs. Surg Endosc 2012; 26: 3163-3173. https://doi.org/10.1007/s00464-012-2309-1
  2. Andreoni V, Lynne Hughes JM. Propofol and fentanyl infusions in dogs of various breeds undergoing surgery. Vet Anaesth Analg 2009; 36: 523-531. https://doi.org/10.1111/j.1467-2995.2009.00490.x
  3. d'Anjou MA, Tidwell AS, Hecht S. Radiographic diagnosis of lung lobe torsion. Vet Radiol Ultrasound 2005; 46: 478-484. https://doi.org/10.1111/j.1740-8261.2005.00087.x
  4. Breton L, Difruscia R, Olivieri M. Successive torsion of the right middle and left cranial lung lobes in a dog. Can Vet J. 1986; 27: 386-388.
  5. Gicking J, Aumann M. Lung lobe torsion. Compend Contin Educ Vet 2011; 33: E1-5. https://doi.org/10.1080/0158037X.2010.516745
  6. Gimenes AM, de Araujo Aguiar AJ, Perri SH, de Paula Nogueira G. Effect of intravenous propofol and remifentanil on heart rate, blood pressure and nociceptive response in acepromazine premedicated dogs. Vet Anaesth Analg 2011; 38: 54-62. https://doi.org/10.1111/j.1467-2995.2010.00579.x
  7. Hsia CC, Dane DM, Estrera AS, Wagner HE, Wagner PD, Johnson RL Jr. Shifting sources of functional limitation following extensive (70%) lung resection. J Appl Physiol 2008; 104: 1069-1079.
  8. Joubert KE, Keller N, Du Plessis CJ. A retrospective case series of computer-controlled total intravenous anaesthesia in dogs presented for neurosurgery. J S Afr Vet Assoc 2004; 75: 85-89.
  9. Laksito MA, Chambers BA, Yates GD. Thoracoscopicassisted lung lobectomy in the dog: report of two cases. Aust Vet J 2010; 88: 263-267. https://doi.org/10.1111/j.1751-0813.2010.00587.x
  10. Lansdowne JL, Monnet E, Twedt DC, Dernell WS. Thoracoscopic lung lobectomy for treatment of lung tumors in dogs. Vet Surg 2005; 34: 530-535. https://doi.org/10.1111/j.1532-950X.2005.00080.x
  11. LaRue SM, Withrow SJ, Wykes PM. Lung resection using surgical staples in dogs and cats. Vet Surg 1987; 16: 238-240. https://doi.org/10.1111/j.1532-950X.1987.tb00945.x
  12. Macphail CM. Surgery of lower respiratory system. In: Fossum TW, ed. Small Animal Surgery. 4th ed. St.Louis: Elsevier Mosby, 2013; 958-990.
  13. Monnet E. Lungs. In: Tobias KM, Johnston SA ed. Veterinary surgery: small animal. St.Louis: Elsevier Saunders, 2012; 1752-1768.
  14. Murrell JC, van Notten RW, Hellebrekers LJ. Clinical investigation of remifentanil and propofol for the total intravenous anaesthesia of dogs. Vet Rec 2005; 156: 804-808. https://doi.org/10.1136/vr.156.25.804
  15. Musk GC, Flaherty DA. Target-controlled infusion of propofol combined with variable rate infusion of remifentanil for anaesthesia of a dog with patent ductus arteriosus. Vet Anaesth Analg 2007; 34: 359-364. https://doi.org/10.1111/j.1467-2995.2006.00332.x
  16. Neath PJ, Brockman DJ, King LG. Lung lobe torsion in dogs: 22 cases (1981-1999). J Am Vet Med Assoc 2000; 217: 1041-1044. https://doi.org/10.2460/javma.2000.217.1041
  17. Pelaez MJ, Jolliffe C. Thoracoscopic foreign body removal and right middle lung lobectomy to treat pyothorax in a dog. J Small Anim Pract. 2012; 53: 240-244. https://doi.org/10.1111/j.1748-5827.2011.01175.x
  18. Purugganan RV. Intravenous anesthesia for thoracic procedures. Curr Opin Anaesthesiol 2008 Feb; 21: 1-7. https://doi.org/10.1097/ACO.0b013e3282f2bb8f
  19. Ryu CG, Min SW, Kim J, Han SH, Do SH, Kim CS. Effect of remifentanil on arterial oxygenation during one-lung ventilation. J Int Med Res 2010; 38: 1749-1758. https://doi.org/10.1177/147323001003800520
  20. Schultz RM, Peters J, Zwingenberger A. Radiography, computed tomography and virtual bronchoscopy in four dogs and two cats with lung lobe torsion. J Small Anim Pract 2009; 50: 360-363. https://doi.org/10.1111/j.1748-5827.2009.00728.x
  21. Scott LJ, Perry CM. Spotlight on remifentanil for general anaesthesia. CNS Drugs 2005; 19: 1069-1074. https://doi.org/10.2165/00023210-200519120-00010
  22. Spranklin DB, Gulikers KP, Lanz OI. Recurrence of spontaneous lung lobe torsion in a pug. J Am Anim Hosp Assoc 2003; 39: 446-451. https://doi.org/10.5326/0390446
  23. Tamburro R, Pietra M, Militerno G, Diana A, Spadari A, Valentini S. Left cranial lung torsion in a bernese mountain dog: a case report. Vet Med 2011; 56: 416-422.
  24. Terzo E, Pink J, Puggioni A, Shiel R, Andreoni V, McAllister H. Right cranial lung lobe torsion after a diaphragmatic rupture repair in a Jack Russell terrier. Ir Vet J 2008; 61: 170-4. https://doi.org/10.1186/2046-0481-61-3-170
  25. Tobias KM. Surgical stapling devices in veterinary medicine: a review. Vet Surg 2007; 36: 341-349. https://doi.org/10.1111/j.1532-950X.2007.00275.x
  26. White RN, Corzo-Menendez N. Concurrent torsion of the right cranial and right middle lung lobes in a whippet. J Small Anim Pract 2000; 41: 562-565. https://doi.org/10.1111/j.1748-5827.2000.tb03154.x
  27. Yoon HY, Jeong SW. Lung Lobe Torsion with Concurrent Intestinal Lymphangiectasia in a Maltese Dog. J Vet Clin 2011; 28: 262-266.