Repair of urinary bladder rupture through a urethrotomy and urethral sphincterotomy in four postpartum mares

OBJECTIVE: To report the clinical findings, surgical technique, and outcome after repair of urinary bladder rupture through a urethral incision in postpartum mares. STUDY DESIGN: Retrospective study. ANIMALS: Four Thoroughbred broodmares. METHODS: Medical records were reviewed for clinical signs, surgical technique, medical therapy, and outcome. The bladder was everted into the vagina through a urethral incision that included a sphincterotomy. The bladder defect was repaired with absorbable suture material in a single-layer, full thickness, simple, continuous pattern. The urethral incision was closed similarly. RESULTS: Depression, inappetence, signs of shock, dehydration, azotemia, and serum electrolyte abnormalities were consistent findings that increased temporally after bladder rupture. Each bladder defect was repaired successfully, and metabolic derangements were corrected with supportive medical therapy. All mares survived, conceived, and had more foals without further complications CONCLUSION AND CLINICAL RELEVANCE: Bladder rupture associated with parturition in mares can be repaired in a standing position by eversion of the bladder through a urethrotomy and urethral sphincterotomy.     

Uterine rupture as a postpartum complication in two mares

Uterine rupture was diagnosed in 2 postpartum mares with hemorrhagic vaginal discharge. Both mares had abdominal pain, as evidenced by pawing, kicking at the abdomen, or attempting to roll. Peritoneal fluid analysis was useful in establishing a diagnosis. One mare had many RBC in the peritoneal fluid and was anemic; this mare was managed medically with oxytocin, antibiotics, and blood transfusion. The mare was able to raise her foal to weaning age. The second mare had many RBC, degenerate neutrophils, and intracellular and extracellular bacteria in peritoneal fluid. Surgical repair of the uterus was performed, and the mare was treated for peritonitis. The mare later became pregnant.     

Vaginal evisceration of the small intestine in three mares

Three mares were treated for vaginal evisceration of a portion of the small intestine. Evisceration occurred in 2 mares shortly after breeding accidents in which the stallion's penis penetrated the vaginal fornix dorsal to the cervix. The affected bowel was replaced through the laceration, and the vaginal defects were sutured with the mares standing, utilizing epidural anesthesia. One mare recovered without complications, was subsequently bred, and delivered a foal with no difficulty. The other mare developed signs of a strangulating small intestinal obstruction 24 hours after the injury, necessitating exploratory celiotomy. Two meters of small intestine had become devitalized secondary to avulsion of the mesentery and adjacent vascular supply during the evisceration. The affected portion was resected and a jejunocecostomy was performed. Recovery was uncomplicated and 21 months later the mare was 9 months in foal. A third mare was treated unsuccessfully for evisceration of several meters of small intestine through the external urethral orifice after rupture of the urinary bladder.     

A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report

An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.     

Torsion of the uterus--a cause of colic in the mare.

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Torsion of the Uterus — A Cause of Colic in the Mare

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Standing surgical repair of cystorrhexis in two mares

Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares.     

Surgical Correction of Uterine Torsion and Mare–Foal Survival in Advance Pregnant Equine Patients

This article describes the surgical management of uterine torsion by midline celiotomy and cesarean section on 12 mares presented with signs of colic to a teaching veterinary hospital. The mares were either in full term of gestation (n = 7) or in advanced stage of pregnancy (n = 5). Six mares were in first parity. Uterine torsion was diagnosed by per rectal and per vaginal examinations. For surgical intervention, mares were anesthetized using a combination of xylazine (1.1 mg/kg) and ketamine (2.2 mg/kg), intravenously. After intubation, the animals were maintained on halothane (n = 4) or isoflurane (n = 8) inhalation anesthesia. Midline celiotomy was performed, and foals were delivered by cesarean section. In 11 mares, before closing the abdominal wound, the uterus was detorted manually and confirmed for its normal position. Both anesthetic protocols using halothane and isoflurane were found satisfactory for surgical correction of uterine torsion. After long-term follow-up, the study reported 75.0% (9/12) survival rate for mares. One mare was euthanized because of devitalized, necrosed, and adhered uterus to the abdominal wall. Of the nine surviving mares, seven were successfully bred. Three foals were born alive, and only one could survive on long-term basis. Of the nine dead foals, two had umbilical cord torsion.     

Nonsurgical treatment of uterine torsion in seven mares

Nonsurgical correction of uterine torsion was performed in 7 mares, and 6 foals were subsequently born alive. Uterine rupture necessitated euthanasia in 1 mare. Correction was achieved by rolling of the mares after general anesthesia had been induced. Previously, this technique was believed to be associated with a high prevalence of fetal and maternal mortality. Nonsurgical correction may be a satisfactory alternative to abdominal surgery in treating uterine torsion in mares.     

Infertility in a mare with a chronic uterine tear,diagnosis and successful standing hand‐assisted laparoscopic repair

Uterine rupture is a well recognised and potentially fatal complication in the peripartum broodmare. This case report describes a 16 month history of infertility as the sole clinical sign in a Thoroughbred mare, subsequently diagnosed with a full thickness uterine tear. The clinical course, standing laparoscopically assisted repair and outcome are discussed.     

Surgical technique to repair grade IV rectal tears in post-parturient mares

Objective— To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome.
Study Design— Clinical report.
Animals— Horses (n=6) with grade IV rectal tears.
Methods— Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving ∼5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares).
Results— Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact.
Conclusion— In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern.
Clinical Relevance— Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.     

Equine placenta – A clinician's perspective. Part 2: Abnormalities

Any insufficiency of the equine placenta has dramatic effects on the developing equine fetus. Placental abnormalities, such as the separation of the chorioallantois from the maternal endometrium or torsion of the umbilical cord, lead to fetal demise, premature labour or abortion. These conditions are each associated with characteristic lesions on the equine placenta, which can be found during a detailed examination. These findings can be very helpful for diagnosing problems and implementing appropriate treatments for mares and affected newborn foals. Furthermore, the retention of the entire placenta or any small fragment thereof can cause metritis, laminitis and sepsis. The prompt diagnosis and aggressive treatment of this condition is necessary to save the mare from becoming seriously ill. Therefore, a thorough evaluation of the equine placenta is a crucial element of the post partum evaluation of every brood mare.     

Ovariohysterectomy in Six Mares

Six mares had ovariohysterectomy performed for chronic pyometra associated with cervical abnormalities, uterine neoplasia, or removal of a macerated fetus. Ovariohysterectomy was performed through a ventral midline incision with access to the ovarian and uterine vessels aided by traction on the uterus and retraction of abdominal viscera. Abdominal pain, the most common complication after surgery, occurred in four mares but resolved within 36 hours. Peritonitis occurred in two mares; one mare was subsequently euthanatized. Other complications that resolved with treatment included infection of the uterine stump (two mares), abdominal hemorrhage (one mare), diarrhea (one mare), and incisional infection (one mare). Complications after surgery can be reduced by removing as much of the uterus as possible, minimizing peritoneal contamination with uterine contents, and providing a secure closure of the caudal reproductive tract.     

Post-partum uterine rupture: Standing repair in three mares using a laparoscopic technique

Three mares underwent diagnostic laparoscopy because of suspicion of post-partum uterine ruptures. All three horses showed clinical signs of a uterine rupture between 1 and 3 days after parturition and underwent diagnostic laparoscopy. In all cases a full thickness uterine rupture could be detected and was sutured laparoscopically. Availability of suture material and surgeon experience were responsible for the surgical methods chosen for repair. In the first case, a hand-assisted laparoscopic approach was chosen for suturing the ruptured uterus, whereas in the other cases the approach was entirely laparoscopic. In the second case, extracorporeal knots were used for the repair and in the last case described a barbed loop suture was available for closure of the uterus. Two of three mares were alive for at least 12 months after surgery without any abdominal problems. One of these mares delivered a healthy foal 2 years after surgery. The remaining mare died 3 months after surgery but no necropsy was done. Laparoscopy should be considered for post-partum mares with signs of peritonitis to access the uterus and repair a rupture if it is accessible. A laparoscopic approach using intracorporeal knots or barbed sutures for the repair of the uterine rupture as well as a hand-assisted laparoscopic approach are feasible. The use of the barbed suture for intracorporeal closure makes the minimal invasive laparoscopic technique easier to perform.     

The effect of uterine torsion on mare and foal survival: a retrospective study, 1985--2005

REASONS FOR PERFORMING STUDY: Anecdotal speculation suggests that prognosis for survival of mares and foals following correction of uterine torsion has improved over the past 30 years. OBJECTIVES: To determine statistically the outcome of uterine torsion according to duration of clinical signs, stage of gestation, parity, physical examination findings, method of correction, prognosis for survival and reproductive health of the mare, and prospects for the foal within the neonatal period. METHODS: This retrospective study combined cases from 4 equine referral hospitals. RESULTS: The stage of gestation at which uterine torsion occurred was a risk factor for survival of mare and foal. Overall mare survival was 53/63 (84%); when uterine torsion occurred at < 320 days gestation, 36/37 (97%) of mares survived compared to 17/26 (65%) survival rate when uterine torsion occurred at > or = 320 days gestation. Overall foal survival was 54% (29/54). When uterine torsion occurred at < 320 days gestation, 21/29 (72%) foals survived compared to 8/25 (32%) when uterine torsion occurred at > or = 320 days gestation. Thirty mares were discharged from the hospital carrying a viable fetus following uterine torsion correction and 25/30 (83%) of these mares delivered live foals that survived beyond the neonatal period. CONCLUSIONS: Prognosis for survival for mares and foals following uterine torsion is good and improves if torsion occurs < 320 days compared to > or = 320 days gestation. CLINICAL RELEVANCE: Gestational timing of uterine torsion should be considered when advising clients about the prognosis for survival of the mare and foal. The prognosis for a mare delivering a live foal is good if the mare is discharged from the hospital following uterine torsion correction with a viable fetus.     

Repair of an incompetent urethral sphincter in a mare

Objective: To describe successful surgical treatment of urinary incontinence caused by a ruptured and/or transected urethral sphincter in a mare. Study Design: Clinical report. Animal: A 7‐year‐old, Swedish Warmblood mare with urinary incontinence. Methods: The urethral sphincter, which had been damaged during removal of a cystic urolith, was repaired by apposing the ends of the disrupted urethralis muscle and tunica muscularis. Results: The mare was no longer incontinent after repair of the defect by apposition of the ends of the urethralis muscle and tunica muscularis. Conclusions: Transection and/or rupture of the urethral sphincter of a mare may result in urinary incontinence. Clinical Relevance: Apposition of the ends of the ruptured or transected urethralis muscle and tunica muscularis can correct urinary incontinence caused by this defect.     

Laparoscopic Anatomy of the Abdomen and Laparoscopic Ligating Loops,Electrocoagulation, and a Novel Modified Electroligation Ovariectomy in Standing Mare

The purpose of this study was to provide a detailed laparoscopic anatomy of the caudal abdominal region of mare in a standing position and to evaluate and modify a technique for standing laparoscopic ovariectomy using combination between hand-tied ligating loop and electrocoagulation techniques, as the ligating loops, electrocoagulation, and modified electroligation laparoscopic ovariectomy were applied using nine adult mares. Laparoscopy was practical and effective for direct visual examination of internal abdominal organs in the mare. Ventral dislocation of abdominal viscera after pneumoperitoneum was established with the mare in standing position, which provided an excellent inspection of the dorsal and ventral structures in the peritoneal cavity on the right and left sides. Standing laparoscopic ovariectomy using an electroligation modified method was considered a safe and effective method for hemostasis of the mesovarium, technically easy, time saving, and economical. The mean surgical time for bilateral ovariectomy was 40 ± 7.63, 60 ± 5.25, and 85 ± 6.43 minutes for electroligation-modified technique, ligating loops technique, and electrocoagulation technique, respectively.     

Surgical treatment of uterine torsion using a ventral midline laparotomy in 19 mares

OBJECTIVE: To report on the outcome of surgical treatment of uterine torsion in preterm mares. DESIGN: Retrospective case series of pregnant mares with uterine torsion presented to the Clinic for Obstetrics, Gynaecology and Andrology of Large and Small Animals. METHODS: Hospital records of all pregnant mares that underwent ventral midline laparotomy for uterine torsion between 1998 and 2004 were reviewed. The signalment, history, clinical signs, results of diagnostic procedures, direction and degree of the uterine twist, treatment and outcome were retrieved from each case record. RESULTS: This study comprised 19 mares between months 5 and 11 of pregnancy (8.7 +/- 1.9) and suffering from uterine torsion. In all cases ventromedian laparotomy was carried out under general anaesthesia. Gastrointestinal disorders were also present in 52.6% of horses. Postoperative complications included subcutaneous seromas (five mares), peritonitis (one mare) and abortion (two mares). In four mares (21%) the operation was unsuccessful (i.e. these mares had to be euthanased intra- or postoperatively). Of the surviving 15 mares, 13 (86.6%) gave birth to viable foals at full term. The foals developed normally. Only two mares aborted. CONCLUSIONS: Because of its versatility the ventral midline approach should be considered for correction of uterine torsion. The approach has many advantages, including rapid and clear access to the abdominal cavity, safety, visual assessment of uterine wall viability, correction of concomitant gastrointestinal tract problems, and performance of hysterotomy or hysterectomy, if indicated. In this study, managing uterine torsion in this way resulted in a high percentage of cases (86.6%) in which pregnancy was maintained, with the birth of a viable, mature foal.     

Uterine torsion diagnosed in a mare at 515 days' gestation

A pregnant mare with a history of prolonged gestation (～515 days) and suspected diagnosis of fetal mummification was examined. Rectal palpation revealed that the left broad ligament of the uterus was dorsal and medial to the right uterine ligament and it was not possible to observe the cervix during vaginal examination. Transabdominal ultrasound revealed fluid in the uterus, fetal membranes and the uterine walls defined and thickened. Free fluid was not seen in the peritoneal cavity. Laboratory tests (blood cell count and clinical chemistry) were normal. Based on clinical history, physical examination and ultrasound findings, a chronic uterine torsion with fetal death was diagnosed and the mare was subjected to exploratory celiotomy. The uterus was strongly adhered to the peritoneum of the ventral abdominal wall and there were multiple adhesions to the colon. Hysterotomy was performed to remove the fetus and to permit repositioning of the uterus. When the fetus was removed, a large devitalised grey tissue area of the right ventral uterine horn was observed. Multiple adhesions prevented a rescue hysterectomy and euthanasia of the patient was performed. During the necropsy, a 180° cranial cervix clockwise uterine torsion was observed. This rare case of uterine torsion appears to be the most chronic case reported in the equine literature.