Monday, June 25, 2012

Case of the Missing Nut

    A seven-month old, medium sized dog presented to the clinic one Wednesday morning for a sudden case of ADR (a technical veterinary term that translates to “ain’t doing right”). He had slipped on the hardwood floor the day before, seemed normal afterward, but that day he was quiet and not himself. He also didn’t want to eat his breakfast. I noted his history, fairly normal puppy vaccine visits, and a note that said “unilateral cryptorchid”, meaning one of his testicles had failed to make it all the way to his scrotum during development. This happens fairly often and is corrected by neutering.

    This teenaged puppy was bright and alert in his exam, nothing out of the ordinary until I tried to touch his right hind leg and the right side of his abdomen, in which case he would show signs of extreme pain. I discussed a plan to take abdominal and hindlimb radiographs (x-rays) with his owners, and determined that he would need at least sedation, if not a general anesthesia, to get proper positioning, due to his extreme pain. I proposed that if everything was normal on x-rays, that I would neuter him that day, since he would already be under anesthetic.
    We took radiographs and found nothing out of the ordinary. My technicians shaved his belly and prepared him for an exploratory laparotomy, where we open his abdomen to look for his undescended testicle. Somewhere just north of his bladder, I found the errant testicle, but it wasn’t normal in appearance. Upon closer examination, the testicle was purple and the blood supply was twisted off. I called my boss over to have a look, saying “I think he’s got a testicular torsion”. Surely, with all her years of experience, she would have some insight. Dr. M. came into the surgery suite, had a peek at his abdomen and said “Wow, I’ve never seen that before”. This actually happens quite often in veterinary medicine, so as usual, we roll with it, using our knowledge and skills to come up with a treatment plan.

    In vet school, they had talked about horses with testicular torsions, who can present with colic (abdominal pain). It made sense that the same thing could happen in a dog, especially if the testicle wasn’t where it belonged. I carefully removed his retained testicle, closed his belly, and then removed his normal testicle, as I would during a routine neuter.

    After waking up from surgery, the puppy was back to normal, telling me that we had corrected the problem. I did some research on VIN and found photos of other dogs who had testicular torsions, discovered after they presented with similar symptoms. Removing the testicle ASAP is important, due to the risk of serious complications, including death. I’m glad this puppy’s owners and I listened to him when he told us something was very wrong!