Clinical rotation report on hematoma treatment and mummified fetus case in a cat

CLINICAL ROTATION REPORT at HARTAMAS VETERINARY
CENTRE
Hartamas, Kuala Lumpur, Malaysia
11TH OCTOBER - 30TH OCTOBER 2021
By:
KELOMPOK F
PPDH GELOMBANG II ANGKATAN 2020/2021
Mhaturi Sitti Rao B9404202816
PROGRAM PENDIDIKAN PROFESI DOKTER HEWAN

FAKULTAS KEDOKTERAN HEWAN
IPB UNIVERSITY 2021
Inguinal Internal Wound and Hematoma by Blunt Force Trauma in an
Eight-Month-Old Cat
Mhaturi Sitti Rao 1, Arief Purwo Mihardi 2 Sabrina Thevy Arumugam³
1
Mahasiswa Program Pendidikan Dokter Hewan, Fakultas Kedokteran Hewan, Institut Pertanian Bogor
2
Departemen Klinik Reproduksi dan Patologi, Fakultas Kedokteran Hewan,
Institut Pertanian Bogor
3
Hartamas Veterinary Centre, Kuala Lumpur.
Abstract: Hematoma is generally defined as a collection of blood outside of blood

vessels. Most commonly, hematomas are caused by an injury to the wall of a blood
vessel, prompting blood to seep out of the blood vessel into the surrounding tissues. A
hematoma can result from an injury to any type of blood vessel (artery, vein, or small
capillary). A hematoma usually describes bleeding which has more or less clotted,
whereas a hemorrhage signifies active, ongoing bleeding.
Keywords: hematoma, internal wound, cat
Introduction
Wound is an injury in which there is a break in continuity of soft tissues. It can

either be open or closed. Open wound occurs in the body covering (Skin or mucus
membrane), which can be seen and blood loss evaluated. Such a wound resulted of
sharp objects or due to a blow (Adeniran. 2014). In closed wound the injury causes no
break in the body covering, this occur when a body part or organ is struck by a blunt
object, twisted or deceleration force. It cannot be seen and blood loss is difficult to
evaluate (Julian. 2006). Wound can be caused intentionally as in surgery or
accidentally (unintentional) as in trauma. Wound can be classified as superficial when
it did not go beyond the epidermal layer of the skin or as deep (penetrating) when it
involves the skin as well as deeper tissues or organs. Wound may also perforate to the
deeper layers when a foreign object enters and exits an internal organ (Hassan et al.
2003).
A clean wound contains no pathogenic microbes and this includes all the
surgical wounds that did not enter the alimentary, respiratory and urogenital systems. A
clean-contaminated wound is aseptic but enters the gastrointestinal tract and urogenital
tract. Contaminated wounds are open traumatic wounds with presence of pathogenic
microbes, the tissues are not healthy and is associated with inflammation. The basic
fundamental principles in wound management is evaluating the wound as described
above and preparing the wound for closure either by primary or secondary intentions
depending on the outcome of the evaluations. In either primary or secondary intention
closure, the area around the edges is clipped of hair, lavaged with normal saline,
scrubbed with mild antiseptic and debrided of dead tissues if any to leave only viable
tissue (Jolle et al. 2013).
Signalment, Anamneses, and Clinical Symptoms
An 8-month-old male domestic cat (Felis catus) named Oreo was first brought
th
to 11 of October 2021 with the complaints of inguinal region swelling and reluctance
to eat. Pain was found upon palpation. He was also not defecating and was straining
when he tried to. An intravenous catheter was inserted and he was administered
intravenous fluid therapy; the fluid of choice was dextrose due to his reluctance to eat.
He was also hospitalized for a few days to be monitored further.
The next day on the 12th of October 2021, another thorough physical
examination was done. The fur around the inguinal region was clipped short and severe
bruising was found cranial to the penis. The suspected reason is due to blunt force
trauma. The swelling was also still prominent and suspected to be edema due to the
hematoma. The cat was still finding difficulties in urinating and defecating as there
were no signs of urination or stool found in the litter box. A urinary catheter was
inserted to aid urination and the cat was bleeding through the catheter. Lactulose was
given to aid the defecation process.
Figure 1. Hematoma found cranial to the penis and catheterization.
On the 5th day on 15th October 2021, the cat was still struggling to defecate, so
manual enema was done to remove the stool. Betamox, Serrapeptase for the
inflammation and dexamethasone was given. The cat was then discharged and sent
home. 4 days later, on the 19th of October 2021, the cat was brought back in due to
presence of pyogenic discharge at the wound site. The abscess site was cleaned, and
owner was taught to perform thorough wound cleaning every day. Silver sulfadiazine
cream was given to be applied topically after wound was cleaned. Silver sulfadiazine is
an antibiotic. It fights bacteria and yeast on the skin. Silver sulfadiazine topically is
used to treat or prevent serious infection on areas of skin. On the 25 th of October the cat
was hospitalized temporarily for a wound suture.
Figure 2. Ruptured abscess wound
Figure 3. Completed wound suture
Treatment
The cat was given medication intravenously to avoid further discomfort and
stress. He was given prednisolone to reduce the severe inflammation happening at the
site of the hematoma. Prednisone is a glucocorticoid used to treat many conditions in
many species. Broad uses include the following: replacement therapy for Addison’s
disease, an anti-inflammatory, an immune suppressant, and an antineoplastic (cancer
treatment). The most common side effects include increased drinking, increased
urination, and increased appetite. Vitamin K was also given to reduce the bruising.
Vitamin K helps to make various proteins that are needed for blood clotting and the
building of bones. Prothrombin is a vitamin K-dependent protein directly involved with
blood clotting. Osteocalcin is another protein that requires vitamin K to produce
healthy bone tissue. Vitamin K helps to make four of the 13 proteins needed for blood
clotting, which stops wounds from continuously bleeding so they can heal.
Furosemide was given intravenously to reduce the edema around the hematoma
and also to increase his urination. Furosemide belongs to a group of medicines called
loop diuretics. Furosemide is given to help treat fluid retention (edema) and swelling
that is caused by congestive heart failure, liver disease, kidney disease, or other
medical conditions. It works by acting on the kidneys to increase the flow of urine.
Lastly, enrofloxacin was given to cover any possible bacterial infections that may
occur. Enrofloxacin is a bactericidal fluoroquinolone antibiotic used to treat bacterial
infections.
Post-treatment Recovery
After being hospitalized and treated for 4 days, he was initially discharged to be
brought back home but he was brought back to the clinic due to his ruptured abscess
wound. After explanation and a wound cleaning demonstration, the cat was fit to e
monitored further at home. The cat was brought back in 6 days later for the abscess
wound to be cleaned and sutured close. The cat healed properly after the wound was
closed up and kept clean.
Conclusion
Successful treatment of blunt force trauma hematoma in a domestic cat is reported. The
internal wound was monitored and managed with administration of Vitamin K,
Furosemide, antibiotics and corticosteroids. The wound ruptured with pyogenic
discharge later but was cleaned and sutured close for better healing.
Mummified Fetus in a 3-year-old cat
Mhaturi Sitti Rao 1, Arief Purwo Mihardi 2 Sabrina Thevy Arumugam³
1
Mahasiswa Program Pendidikan Dokter Hewan, Fakultas Kedokteran Hewan, Institut Pertanian Bogor
2
Departemen Klinik Reproduksi dan Patologi, Fakultas Kedokteran Hewan,
Institut Pertanian Bogor
3
Hartamas Veterinary Centre, Kuala Lumpur.
Abstract: Fetal membranes becomes shrivelled & dried, fluids of allantois, amnion &
fetus are resorbed and uterus contracts on fetus and moulds it into a dry, contorted mass
leads to death of fetus at middle and last trimester of gestation
Keywords: mummification, fetal death, cat
Introduction
Fetal mummification is an uncommon condition in most domestic species.

While most often seen in multiparous and polytocous species like swine, it is also
observed in monotocous species when the fetus is retained for a long time. The low
prevalence of the condition may help explain the scarcity of information in the
literature. To further complicate the study of this phenomenon, the physiological
mechanisms that maintain pregnancy vary between species, implying different
pathways for the condition. The exact outcome of early fetal mortality is unpredictable,
and is influenced by several factors, including the cause of fetal mortality, differences
in pregnancy between species, stage of gestation at fetal death, and number of fetuses
(Meyers PJ et al. 1991).
Based on our current knowledge of natural fetal mummification events, there

are a number of prerequisites for the process of fetal mummification to occur.
Examining the circumstances associated with fetal mummification can help scientists
better understand the etiology and clinical situation in different species. Failure of
pregnancy is usually divided into stages based on the fetus’s development and potential
viability: embryonic mortality and fetal mortality. The exact outcome of early fetal
mortality is unpredictable and influenced by several factors, such as the cause of the
fetal mortality, species differences, stage of gestation at fetal death, and number of
fetuses. One possible outcome of fetal death is mummification (Christianson WT.
1992).
Signalment, Anamneses, and Clinical Symptoms

A 3-year-old female domestic cat (Felis catus) named Marble was first brought
st
to 21 of October 2021 for an ovariohysterectomy procedure for neutering purpose.
Her temperature was 38.6°C which is in the normal range for a healthy feline. She also
did not have any inappetence or vomiting prior to being brought to the clinic. She had
been fasted for up to 10 hours starting from 12am on 21st of October 2021. She had een
monitored throughout the fasting period by the owner for any abnormal behaviours and
none were reported by the owner.
Pre-Surgery
The cat was given TKX sedation intravenously to avoid discomfort and stress.
The anesthetic combination consists of tiletamine hydrochloride, zolazepam
hydrochloride, ketamine, and xylazine. Tiletamine is a dissociative anesthetic that is
chemically related to ketamine; it provides analgesia, immobilization, and dissociative
anesthesia with increasing doses. Zolazepam is a benzodiazepine that induces muscle
relaxation. The analgesic effects of tiletamine and zolazepam usually persist after the
anesthetic effects have diminished, and the result is a state of sedation, immobility, and
visceral analgesia. Ketamine is also a rapid-acting, nonnarcotic, nonbarbiturate drug.
Similar to tiletamine, ketamine also creates a dissociative anesthetic state. Ketamine is
a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist.
Surgery
The patient was positioned in dorsal recumbancy during surgery. Proper sterile draping
was confirmed in surgical site. Under general anaesthesia explorative laparotomy was
performed. Using scalpel blade (no. 10) ventral midline 2 to 3cm straight incision was
given between umbilicus to pelvis in linea alba. Blunt dissection was performed by
metzenbaum scissors to separate adipose tissue and the abdominal muscle was incised
to get access into the abdominal cavity. The engorged uterus was expelled out from
abdominal cavity. The uterus had 2 mummified fetus and blood and some pus when
opened up. Two separate ligature was ensured below each individual ovary to ligate the
ovarian blood vessels using 2/0 chromic cat gut. By using same suture material uterine
body was also ligated and Ovariohysterectomy was performed on standard procedure.
The abdominal muscle was closed by using simple continuous suture pattern.
Subcutaneous fascia was closed and skin was closed by intradermal suture.
Figure 1. Enorged uterus filled with fetus
Figure 2. Mummified fetuses
Post-surgery Recovery
After being hospitalized for 1 day after surgery, she was discharged to be brought back
home. The owner was called to be asked for an update a few days later. The cat was
updated to be doing well and not having any abnormalities. Her surgical site also did
not have any complications or infections.
Conclusion
Successful treatment of blunt force trauma hematoma in a domestic cat is reported. The
internal wound was monitored and managed with administration of Vitamin K,
Furosemide, antibiotics and corticosteroids. The wound ruptured with pyogenic
discharge later but was cleaned and sutured close for better healing.
References
Adeniran, A., 2014. Essential Veterinary Surgery. Ibadan University Publishing

House, University of Ibadan, Ibadan, Nigeria, 251-262: 269-276.
Christianson WT. 1992. Stillbirths, mummies, abortions, and early embryonic

death. Vet Clin North Am Food Anim Pract. ; 8:623–639.
Hassan, A.Z. and F.B. Hassan, 2003. An introduction to Veterinary Practice.

Ahmadu Bello University Press Ltd.Zaria, Nigeria, pp: 299-300.
Julian, H., 2006. Minor Veterinary Surgery. The book for Veterinary Nurses.
ButterWorth, Heinemann, Elsevier Limited, pp: 71-79.
Jolle, K. and H. Gertter, 2013. Reconstructive Surgery and Wound Management

of the Dog and Cat. Manson Publishing/The Veterinary Press ltd, 73 Corringham
Road, London NW 117Dl, UK., pp: 22-44
Meyers PJ, Varner DD. 1991. Abortion of a mummified fetus associated with
short uterine body in a mare. J Am Vet Med Assoc.; 198:1768–1770.
Date Time Activity
11/10/2021  9.50 am-10.00 am  Help the vet techs to
 10.00 am-1.00 pm feed warded patients
 1.00 pm-2.00 pm  Help out doctor with
 2.00 pm- 7.00 pm daily cases
 Lunch hour
 Help out doctor with
daily cases
 2.00 pm- 7.00 pm daily cases and
pyometra surgery
 Lunch hour
daily cases
castration
 Lunch hour
daily cases
 Lunch hour
daily cases
 Lunch hour
daily cases and
catheterization
 Lunch hour
daily cases
ovariohysterectomy
 Lunch hour
daily cases
 Lunch hour
daily cases and
castration
 2.00 pm- 7.00 pm daily cases and dental
scaling
 Lunch hour
daily cases
 Lunch hour
daily cases
castration
 Lunch hour
daily cases
castration
 Lunch hour
daily cases and
ovariohysterectomy
scaling
 Lunch hour
daily cases
 Lunch hour
daily cases and
castration
scaling
 Lunch hour
daily cases
 Lunch hour
daily cases
ovariohysterectomy
 Lunch hour
daily cases
 2.00 pm- 7.00 pm daily cases and manual
enema
 Lunch hour
daily cases

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CLINICAL ROTATION REPORT at HARTAMAS VETERINARY

11TH OCTOBER - 30TH OCTOBER 2021

Mhaturi Sitti Rao B9404202816

PROGRAM PENDIDIKAN PROFESI DOKTER HEWAN

Abstract: Hematoma is generally defined as a collection of blood outside of blood

Keywords: hematoma, internal wound, cat

Wound is an injury in which there is a break in continuity of soft tissues. It can

Signalment, Anamneses, and Clinical Symptoms

Figure 1. Hematoma found cranial to the penis and catheterization.

Figure 2. Ruptured abscess wound

Figure 3. Completed wound suture

Keywords: mummification, fetal death, cat

Fetal mummification is an uncommon condition in most domestic species.

Based on our current knowledge of natural fetal mummification events, there

Signalment, Anamneses, and Clinical Symptoms

Figure 2. Mummified fetuses

Adeniran, A., 2014. Essential Veterinary Surgery. Ibadan University Publishing

Christianson WT. 1992. Stillbirths, mummies, abortions, and early embryonic

Hassan, A.Z. and F.B. Hassan, 2003. An introduction to Veterinary Practice.

Jolle, K. and H. Gertter, 2013. Reconstructive Surgery and Wound Management

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