Use of an inguinal approach adapted from equine surgery for cryptorchidectomy in dogs and cats: 26 cases (1999-2010)

OBJECTIVE-To determine whether a surgical technique used in cryptorchid horses can be used successfully to remove testicles retained in the inguinal region or abdominal cavity in dogs and cats. DESIGN-Retrospective case series. ANIMALS-22 dogs and 4 cats with cryptorchidism. PROCEDURES-In 1999 through 2010, 26 cryptorchid patients underwent surgery during which an incision was made over the inguinal ring and the undescended testicle was located for removal via identification of the vaginal process and the embryonic gubernaculum. Castration was performed once a testicle was located in the inguinal region or via removal of an intra-abdominally located testicle through the inguinal canal. RESULTS-4 dogs and 1 cat were bilaterally cryptorchid. Testicles were retained in the abdominal cavity in 18 dogs and in the inguinal region in 4 dogs; in all 4 cats, undescended testicles were located in the inguinal region. Twenty-one dogs and 4 cats were castrated without breaching the abdominal cavity; in one of those dogs, the inguinal ring was enlarged to permit extraction of a tumorous testicle. In 1 dog, the inguinal ring was enlarged into a paramedian laparotomy and viscera were manipulated to exteriorize an intra-abdominally located testicle because the gubernaculum had ruptured. Major intraoperative or long-term complications did not occur. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that as in horses, the surgical approach over the inguinal ring, wherein the vaginal process and the remnant of the gubernaculum are identified and used to locate an undescended testicle for removal, can be used successfully in dogs and cats.     

Laparoscopic Repair of Scrotal Hernia in Two Foals

Nonstrangulating indirect scrotal hernias were corrected in two 4-week-old Percheron foals by a laparoscopic technique. After laparoscopic reduction of herniated nonstrangulated small intestine each testes was retracted through the vaginal ring. The ligament of the tail of the epididymis was transected by electrocautery. The testicular vessels and nerves were isolated by cautery of the mesenteric portion of the mesorchium and then ligated. Staples were used to close the opening of the inguinal canal by apposing the peritoneal edges of the vaginal ring. Resection of umbilical stalk remnants via celiotomy performed in one foal after laparoscopic observation of enlargement of the right umbilical artery and urachus. No complications or recurrence of herniation had occurred 16 weeks after surgery.     

Pyometra with inguinal herniation of the left uterine horn and omentum in a Beagle dog

Objective: To describe a unique case of pyometra with inguinal herniation of the left uterine horn and omentum. Case summary: A 7‐year‐old, 19 kg, intact female Beagle dog presented for surgical treatment of presumptive pyometra and biopsy of a caudal abdominal mass in the left inguinal mammary gland region. Ventral midline celiotomy was performed, and a distended, fluid‐filled uterus with passage of the distal aspect of the left uterine horn through the left vaginal process into the inguinal canal was identified. The patient recovered uneventfully following ovariohysterectomy and left inguinal herniorrhaphy. New or unique information provided: This is the first documented report of inguinal herniation of a uterine horn associated with a pyometra.     

Ruptured inguinal hernia in new-born colt foals: a review of 14 cases

Over a six year period, 14 new-born colt foals were treated surgically because of ruptured inguinal hernia. In all cases, the prolapsed intestines, which were jejunal loops, were situated subcutaneously and protruded through a rent in the parietal vaginal tunic at the level of the inguinal canal. After herniorrhaphy and unilateral castration, the prolapsed loops were replaced into the abdomen, and the superficial inguinal ring closed. Seven foals survived.     

Laparoscopic‐assisted diagnosis of anomalous unilateral abdominal cryptorchidism

This report describes an unusual case of unilateral abdominal cryptorchidism in a Shetland pony. On the cryptorchid side, no testicular structures were present in the inguinal area but testicular/epididymal remnants at the distal end of a pedunculated structure could be discerned in the abdomen at laparoscopic examination. Furthermore, the deferent duct was disconnected from the epididymal remnants and the deferent duct was visible at the caudal aspect of the bladder, traversing over the lateral ligament of the bladder into the vaginal ring where it ended blindly in the vaginal process. After laparoscopic removal of the testicular/epididymal remnants and castration of the contralateral normally descended testicle, the hCG stimulation test was negative and the pony no longer exhibited masculine behaviour.     

Peritoneal fluid accumulation in the femoral canal as a result of a post-traumatic femoral hydrocele in a mature Warmblood stallion

The following case report documents the clinical presentation, ultrasonographic appearance, surgical management and outcome of a horse with a traumatic tear extending from the superficial and deep inguinal rings, across the aponeurosis of the external abdominal oblique muscle and inguinal ligament, disrupting the femoral ring, vascular lacuna and peritoneum. This subsequently resulted in fluid accumulation within the femoral canal. This unusual injury and presentation gives rise to discussion of the aetiology and nomenclature that should be used to properly describe this injury.     

Intracorporeal suture closure of the internal inguinal and vaginal rings in foals and horses

Objective— To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings.
Study Design— Case series.
Animals— Foals (n=6) and geldings (n=2).
Methods— After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close the internal inguinal and vaginal rings.
Results— There was no recurrence of inguinal hernia. Postoperative morbidity was minimal and cosmetic outcome was comparable to that achieved with conventional, open techniques.
Conclusion— Laparoscopic, primary closure of the internal inguinal ring by use of intracorporeal sutures provides a secure barrier to herniation and costs considerably less than using endoscopic staples.
Clinical Relevance— Laparoscopic suture closure of the internal inguinal and vaginal rings provides safe and effective repair of inguinal hernia in horses.     

Pyometra in cats: 183 cases (1979-1984)

Pyometra was diagnosed in 183 cats. The most common signs detected by owners included vaginal discharge, anorexia, and lethargy. Main clinical findings on physical examination were vaginal discharge, abdominal distention, dehydration, palpable uterus, and pyrexia. Abdominal radiography revealed a large uterus in 138/169 cats. Most cats had leukocytosis with a left shift. Diagnosis of pyometra was confirmed at surgery in all cats on the basis of finding a large uterus containing purulent material. Clinical signs resolved in 168 cats after surgery; 15 cats (8%) died or were euthanatized. Postoperative complications in 20% generally resolved within 2 weeks after the cats were sent home. Signs detected by owners and results of physical examination in cats with pyometra were similar, but not as conspicuous as those reported in the dog. Mortality (8%) was similar to that seen in dogs.     

Inguinal herniation with hydrometra/mucometra in a poodle bitch

A 5-year-old, sexually intact poodle bitch was presented with a 2-year history of inguinal mass. A tentative diagnosis of hydrometra/mucometra with inguinal herniation was made and ovariohysterectomy with hernia repair was performed. Both fluid-filled uterine horns, both broad ligaments, and the uterine body were observed to be herniated through the inguinal ring. On histopathology, marked edema and diffuse hemorrhage were diagnosed in the uterus.     

Laparoscopic inguinal herniorrhaphy with barbed suture in a ram

A 7-month-old Hampshire ram, with no history of trauma or breeding, was referred for treatment of acute, unilateral scrotal swelling. Physical examination revealed a moderately sized, soft, left-sided, non-reducible swelling of the proximal scrotum and mild swelling of the scrotal neck. Ultrasound evaluation of the scrotum revealed morphologically normal testicles and a mild accumulation of free fluid in the left vaginal tunic. Unilateral, laparoscopic inguinal herniorrhaphy under general anesthesia was performed. The herniated omentum was reduced and barbed suture was used to imbricate the internal inguinal ring and the vaginal ring. No recurrence of herniation was reported 5 months after surgery.Key clinical message:Laparoscopic inguinal herniorrhaphy with barbed suture can be a safe and effective means of scrotal hernia resolution in a ram. When performed by a competent surgeon experienced in laparoscopy, this treatment for inguinal and scrotal herniation may minimize post-operative pain, provide a rapid return to function, and preserve normal testicular and scrotal anatomy.     

Post-trauma inguinal seroma formation in the cat

Seven cats presented with large caudoventral abdominal or inguinal swellings following road traffic accidents. No case had evidence of disruption to the body wall or inguinal ring and the inguinal swellings may have been the result of either shear or compressive injury to soft tissues of the inguinum or disruption of the regional lymphatics. Six cases resolved completely following strict rest or simple Penrose drain placement with no recurrence reported. Recurrence of seroma was seen in one case but which then fully resolved following omentalisation of the inguinum.     

Abdominal cryptorchidectomy in the horse, using inguinal extension of the gubernaculum testis.

Removal of abdominal testes was accomplished in 32 horses ranging in age from 6 to 72 months. Twenty were unilateral and 12 were bilateral abdominal cryptorchids. An incision was made over the superficial inguinal ring, and the extension of the gubernaculum testis was identified and grasped with forceps. Traction was applied to this structure until the vaginal process was everted beyond the superficial inguinal ring. The vaginal process was incised and the protruding structure, usually the epididymis, was grasped. The testis was drawn out by gentle traction on the epididymis, and castration was performed in the routine manner.     

Pyometra in an Inguinal Hernia in a Bitch

Pyometra in an inguinal hernia was diagnosed in a 10‐year‐old intact cross‐bred bitch which had had dysorexia, depression and inguinal distension. The hernia contained caudal portions of the two uterine horns, uterine cervix and cranial part of the vagina. As the organs were enlarged and full of pus, manual attempt to push back the uterine horns and the vagina in the abdominal cavity through the inguinal canal was unsuccessful. Herniated uterine horns were ligated and cut in their median portion, so it became possible to remove the cervix and the caudal portion of the horns through the hernial orifice, and the ovaries and the cranial part of the horns through a peritoneal midline incision. This bitch was not intended for breeding purposes and, given the presence of a huge pyometra associated with an inguinal hernia, an ovario‐hysterectomy was recommended. Uterine herniation should be considered as a differential diagnosis of a caudal lateral inguinal mass. When pushing the uterus back in the abdominal cavity is impossible, a surgical procedure should be performed to detect ischemia–reperfusion injury and/or a septic risk.     

Characterization of the bacterial population of the genital tract of adult cats

OBJECTIVE: To characterize the bacteria of the genital tract in adult cats; assess the effect of estrus, mating, and administration of progestins on those microorganisms in females; and evaluate whether results of bacteriologic culture of vaginal swabs are affected by cleansing of the vulva prior to sampling or by repeated sampling. ANIMALS: 66 female and 29 male cats undergoing routine ovariohysterectomy or castration. PROCEDURE: Specimens were obtained from vaginal and uterine or preputial mucosae with swabs moistened with sterile saline (0.9% NaCl) solution. In 9 cats, vaginal specimens were obtained before and after cleansing of the vulva with ethanol; in 7 female cats, 2 vaginal speci mens were obtained in immediate succession. RESULTS: Aerobic bacteria were most commonly isolated from cats' vaginas and prepuces; anaerobic bacteria were isolated frequently from males (41%) but rarely from females (5%). Generally, culture results were not affected by cleansing of the vulva or repeated vaginal sampling. The bacterial population of the vaginas of cats was influenced by stage of the estrous cycle but not by mating or administration of progestins. Bacteria were not isolated from the uterus of any cat. CONCLUSIONS AND CLINICAL RELEVANCE: In cats, bacteria of the genital tract in females are predominantly aerobic; in males, aerobic and anaerobic bacteria are found. The bacterial population of the vagina is affected by stage of the estrous cycle. Pure growth of bacteria in culture of genital tract specimens is a normal finding; antimicrobials should only be administered if clinical signs of genital infection are present.     

A polyorchid dog

The case of a polyorchid Irish Setter is presented here. Castration and intra-abdominal testis removal were performed one year of age when one scrotal and one cryptorchid testis near the right inguinal canal were removed. Later it became apparent that there was still testosterone production. A third testis, abdominal cryptorchid, was found on the right side cranially and right to the bladder. The third testis had a strong cranial suspensory ligament and the tail of the epididymis was elongated. The ductus deferens did not enter the prostate but followed the gubernaculum to the inguinal canal near the stump of the previous operation on the caudal right testis. This suggests that two right cryptorchid testes had common ductus deferens.     

Surgical treatment of acquired inguinal hernia in the horse: a review of 51 cases

During a seven year period, 51 cases of acquired inguinal herniation in 50 stallions were treated surgically. In 25 cases the herniated loop was ileal, in the other 26 it was jejunal. In cases of strangulation, the vaginal ring was enlarged by incising the peritoneum and transverse fascia. Closure of the superficial inguinal ring was advisable to prevent the hernia recurring. In all cases unilateral castration was performed. Laparotomy was carried out in 33 cases; 22 required intestinal resection and in four cases a bypass was made. Follow-up at least six months postoperatively indicated that surgery had been successful in 76 per cent of the cases treated.     

Herniation of the urinary bladder through a congenitally enlarged inguinal canal in a cat

A two-year-old, castrated male Main Coon cat was referred because of chronic, recurrent pollakiuria, haematuria, and acute vomiting. On clinical examination, a smooth, soft-tissue mass, suspected to be the urinary bladder, was palpable outside of the abdominal wall in the inguinal area. On radiographs, the urinary bladder was found to be extra-abdominal, and herniated through an enlarged right inguinal canal at exploratory coeliotomy.The left inguinal canal was also enlarged. The urinary bladder was repositioned and fixed to the caudal abdominal wall by incisional cystopexy and both enlarged inguinal canals were partially closed with an interrupted suture pattern.     

Normal and cryptorchid castration

Surgical exploration of the horse that has presumably had a normal castration or a previously successful cryptorchid surgery remains a distinct challenge. No hard and fast rules dictate a proper course of action for each case. If a horse was anesthetized for routine castration, discovered to have only one scrotal testis, had a brief exploratory on the nondescended side and was recovered, trauma to the inguinal region would probably be sufficiently minimal that an inguinal approach could be used at subsequent exploratory surgery. If the inguinal canal was extensively manipulated and the tail of the epididymis was inadvertently removed, however, one of the alternate approaches would be advisable. Where previous history is unknown, external and rectal palpation, hormonal assays, and careful evaluation of the scrotal/inguinal scars under anesthesia are advisable prior to proceeding with a specific course of action. As previously cited, "one hopes for the best but prepares for the worst." Where inguinal canals are being explored in the supposedly previously castrated horse that still has aggressive male behavior, the surgeon is searching for vaginal process and contents or the stump of the spermatic cord. If the stump is identified to suggest complete previous castration, the stump should contain cremaster muscle, parietal vaginal tunic, testicular vessels, and ductus deferens. If a second nonvascular tubular structure is found but no testicular vessels are found, the tail of the epididymis was inadvertently removed and assumed to be hypoplastic testis. This determination can be difficult to make on gross observation of the stump. Again, a thorough case workup helps one plan in advance for what should be found at surgery.     

Use of an ecraseur for ovariohysterectomy in mares.

Ovariohysterectomy was performed in 20 mares at three stages of estrus. An ecraseur was used to severe the ovarian branch of the ovarian artery and vein and the ovarian suspensory ligament en masse. All other vessels supplying the ovaries and uterus were doubly ligated and transected. All mares survived. Complications were intraoperative hemorrhage in three mares, postoperative vaginal bleeding in two mares, and a hematoma in the remnant of the broad ligament in one mare. No adhesions between the uterine stump or remnants of the broad ligament and abdominal structures were detected by palpation per rectum.     

Infertility in the cycling queen: seven cases

In this study we examined seven queens with normal oestrous cycles and a history of infertility after normal matings. We performed clinical examination, vaginal cytology, evaluation of oestradiol, progesterone and total T4 levels, vaginal bacterial culture, ultrasonography, and serum analyses for detection of antibodies against chlamydia and feline leukaemia virus (FeLV) antigenemia. Ovariohysterectomy (OHE) was recommended for 1/7 queens because of pathological uterine changes detected at ultrasonography and clinical examination. Four out of seven queens were treated with antibiotics and two of these had more litters. One of the queens that were treated was not mated again and one was mated without conceiving and was at a later OHE found to have degenerative uterine changes. No treatment was given and no diagnosis could be established in 2/7 queens. Both of them were later ovariohysterectomised and one showed degenerative uterine changes while the uterus of the other queen could not be obtained for follow-up. In summary, 4/7 cats were diagnosed with uterine pathology and no definitive diagnosis could be established for 3/7 queens.