Bethanechol-responsive bladder atony in a colt foal after cystorrhaphy for cystorrhexis.

This research focuses on a specific case of a three-day-old warmblood colt who suffered from bladder rupture. Presented with symptoms of abdominal pain and distension, the foal was diagnosed with uroperitoneum (the presence of urine in the abdomen) and was successfully treated with surgery and the administration of Bethanechol to recover bladder functionality.

Case Presentation and Initial Treatment

• The three-day-old warmblood colt was presented with symptoms of progressive abdominal distension and mild abdominal pain. The colt had not been observed to urinate since its birth.
• Initial tests revealed a moderate degree of abdominal distension and an umbilical hernia. Blood tests shed light on conditions like hyperkalaemia, hyponatraemia, and hypochloraemia. An immunoglobulin G (IgG) test also showed IgG levels above 800 g/l, indicative of a normal immune response in foals.
• Upon referral for further treatment, 1 litre of fluid was drained from the foal’s abdomen. It was diagnosed with uroperitoneum, a condition where urine leaks into the abdominal cavity and can cause severe electrolyte imbalances.
• Initial treatment involved slow drainage of the foal’s abdomen and administration of intravenous sodium chloride to counteract electrolyte imbalances. Approximately 5 liters of fluid were drained from the abdomen.

Surgical Intervention and Restoration of Bladder Function

• Four hours after presentation, the foal was taken into surgery where anesthesia was administered through diazepam and isoflurane. The foal was placed in a dorsal recumbency position for the procedure.
• The aim of the surgery was to address the bladder rupture by means of a cystorrhaphy, a surgical procedure used to close the bladder.
• Post-surgery, the foal developed a condition known as bladder atony – a decreased tonality of the bladder which affects its ability to contract and release urine. To resolve this, Bethanechol, a medication used to stimulate bladder muscle tone, was administered. This led to the restoration of normal bladder function witnessed through observed urination.
• The colt was eventually able to urinate without the need for catheter use, and was discharged three weeks after surgery, signifying the success of the treatment.