Case Presentation

A 4-year-old intact male domestic shorthair cat was referred to the Emergency and Critical Care Hospital after a vehicular trauma. The cat was brought in by a bystander, previous medical history was unknown. The cat was lethargic, had a prolonged capillary refill time, mandibular fracture, hypothermia and slight bradycardia suspected to be due to hypovolemia. Further diagnostics included point-of-care ultrasound of the thorax and abdomen. Results showed moderate volume of free abdominal fluid in three positions: spleno-renal (SR), cysto-colic (CC) and hepato-renal (HR) sites. Based on the initial blood gas and electrolyte results it was found that the patient had severe metabolic acidosis, azotemia, hyperkalemia, mild hypocalcemia and increased lactate. The patient was hospitalized for further care. Abdominocentesis was performed at the cysto-colic site and the ratios of creatinine and potassium in the abdominal effusion to peripheral blood were compared. The results were predictive for uroabdomen. A bubble study test with 8 ml of saline solution was administered via the urinary catheter. The solution was slowly infused over 10 s and, at the same time, the abdomen was assessed ultrasonographically. The bladder remained small, but microbubbles were seen to pass into the surroundings. With a lack of frequent electrolyte monitoring in this patient, it was difficult to decide whether the use of sodium bicarbonate contributed to the reduction in serum potassium levels, or if the combination of treatments led to the stabilization of this patient. After stabilization, a head radiography and a retrograde contrast cystography were performed showing evidence of urinary bladder rupture. Immediately after the contrast study the urinary rupture site and mandibular fracture were surgically corrected. Two days after surgery the patient developed SIRS.

New Information

There is limited information on using a bubble study test in case of a bladder rupture. This technique can be used when no X-ray machine is available in practice. It’s not necessary to perform both tests, but in case of other urinary tract components rupture—i.e., ureters or if a urethral catheter can’t be passed due to obstruction or damage, it is mandatory to perform a contrast study.

E-mail: zavoialinaandreea@gmail.com