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.     

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.     

Uterine torsion and uterine tear in a mare.

A 15-year-old Standard-bred mare was examined because of signs of abdominal discomfort in late gestation. Palpation per rectum revealed tight broad ligaments above and below the uterus, with the right broad ligament running across the top of the uterine body down toward the left, ventral side of the abdomen. A diagnosis of counterclockwise uterine torsion was made and surgical correction was approached via a left, flank laparotomy with the horse standing. The uterus was repositioned and a uterine tear encompassing 180 degrees of the uterine surface was found in the lateral, uterine body just cranial to the cervix. A live colt was delivered vaginally after uterine repositioning and the laparotomy incision was closed. The uterine tear was then repaired via a blind, vaginal approach. The mare was discharged 10 days after surgery. Repair per vaginum of a uterine tear is presented as an alternative treatment in cases for which the tear is recent, abdominal contamination is minimal, and the tear is easily accessible from the vaginal approach.     

Standing laparoscopic-assisted vaginal ovariohysterectomy in a mare

A 20-year-old Arabian mare presented to Washington State University Veterinary Teaching Hospital for evaluation of haemorrhagic vaginal discharge of 3 months' duration. The referring veterinarian had identified a mass within the uterine wall via transrectal ultrasonographic examination. On presentation, the mare had an unremarkable physical examination with the exception of a mild haemorrhagic vaginal discharge. Rectal palpation was performed and an approximately 9 cm diameter mass with a granular texture was identified associated within the uterine body and left uterine horn. Endoscopic examination of the reproductive tract revealed a linear defect in the ventral uterine wall near the cervix with direct communication into the abdomen. Standing laparoscopic-assisted vaginal ovariohysterectomy (OHE) was performed, which involved laparoscopic facilitated dissection and haemostasis of uterine and ovarian structures, and inversion of the uterus through the cervix. Removal of the uterus was performed vaginally. No post operative complications were noted. Standing laparoscopic-assisted vaginal OHE is an alternative to traditional OHE techniques. This technique allowed for excellent direct visual observation during dissection and ligation and did not require general anaesthesia.     

Complete uterine prolapse without uterine mucosal eversion in a queen

A five‐year‐old female cat weighing 3 kg was presented by the owner after noticing a large pink, bilobed mass protruding through the vulva during labour. The cat was in good condition, with appropriate lactation, and the newborn kittens were nursing normally. The uterus was not reverted or invaginated at examination, and there was rupture of the mesovarium, mesometrium and uterine‐vaginal connection around the cervix. Manual reduction of the prolapsed uterus was not possible because of torn ligaments. A coeliotomy was performed to remove the ovaries, and the apex of the uterine horns was passed by the vaginal route. The remaining part of the mesometrium was disconnected, and the prolapsed uterus was removed. The queen and kittens were discharged from the hospital on the second day after surgery. An unusual feature of this case is that the prolapse was complete, without eversion of any part of the uterus through a vaginal tear.     

Uterine torsion in a Sprague Dawley rat (Rattus norvegicus)

Uterine torsion is a twisting of the uterus or uterine horn perpendicular to its long axis. We report a case of uterine torsion in an adult breeding Sprague Dawley rat. The rat died a month after her last recorded delivery. Post mortem examination of the rat revealed 270 degrees torsion of the right uterine horn. The uterus contained a single foetus. The liver was pale and enlarged. The rest of the viscera appeared normal. Histopathological examination showed acute hepatic necrosis and pulmonary congestion with mild lymphocytic infiltrates peribronchially. The acute hepatic necrosis may have been associated with septicaemia due to compromised blood vessels following the uterine torsion. The presence of a single foetus could have resulted in foeto-maternal disproportion with resultant uterine torsion. Torsion of the uterus can be accompanied by haemostatic and metabolic complications, which could have caused the death of the rat. Although uterine torsion is a rare condition in rats, it should be considered as a potential complication of gestation in animal breeding units.     

Identification of focal adenomyosis as a uterine lesion in two dogs

A focal uterine adenomyosis is described in two bitches. In both cases, the uterus showed knobbly enlargements of 4 to 8 cm in diameter, which resulted in distinct clinical symptoms. Other pathological changes of the uterus were not present. One bitch was presented because of a history of vaginal discharge of several months' duration. Radiographs, as well as ultrasonography, revealed a soft tissue lesion at the cervix. The other bitch showed a marked reduction in its general condition and a sudden onset of a tense abdomen. Radiologically, a lesion of soft tissue opacity was observed in the mid-abdomen and was seen to originate from the left uterine horn during exploratory laparotomy. A torsion of the lesion was present, which explained the clinical signs in this second case.     

Dystocia in a Grevy's zebra

Dystocia in a Grevy zebra, caused by faulty position of the fetus, resulted in complete prolapse of the uterus and rupture of the uterus wall. Suturing, reposition and vaginal obstruction led to the total recovery of the Grevy zebra mare.     

RADIOGRAPHIC AND ULTRASONOGRAPHIC EVALUATION OF THE NORMAL FELINE POSTPARTUM UTERUS

The radiographic and ultrasonographic appearance of the normal involution process of the feline postpartum uterus has not been previously described. Six queens were examined to determine the normal radiographic and ultrasonographic appearance of the involuting postpartum uterus. Radiographic and ultrasonographic examinations were performed daily from days one through ten, then on days 12, 14, 18, 24, and 28 postpartum. Radiographically the mean total uterine thickness was 16.5 mm at day one postpartum. By day 14 the mean total uterine thickness was 10.5 mm and by day 24 postpartum the uterus was not radiographically visible. Ultrasonographically at day one postpartum the mean total uterine thickness was 16.6 mm and the mean uterine wall thickness was 2.7 mm. At day 14 postpartum the mean total uterine thickness was 6.2 mm and the mean wall thickness was 2.1 mm. At day 28 postpartum the uterus could still be identified ultrasonographically however individual wall layers were not discernable.     

Septic metritis secondary to torsion of a pedunculated uterine fibroleiomyoma in a filly.

A 2-year-old Arabian filly was referred for evaluation of a serosanguineous vaginal discharge. Palpation per rectum revealed a large, fluid-filled uterus and a uterine mass. The filly developed septic metritis and secondary laminitis as a result of torsion and necrosis of a pedunculated uterine mass. Ovariohysterectomy was performed. The entire cervix was removed with the uterus. Gross examination of the excised uterus revealed 3 intraluminal masses. Histologic evaluation identified the tumors as fibroleiomyoma. The filly recovered completely, and there was no recurrence of the tumor.     

Ventrocaudal cystorrhaphy without urethral sphincterotomy in two broodmares

Two broodmares were diagnosed with rupture of the urinary bladder. One mare revealed abnormalities post partum and the other associated with ante partum uterine torsion. The clinical symptoms included mild abdominal pain, anorexia, decreased urinary volume and increased peritoneal fluid. In one mare, based on the creatinine level of the peritoneal fluid and serum biochemical abnormalities, uroperitoneum was diagnosed. In the other mare, the bladder rupture was found during the celiotomy for surgical repair of uterine torsion that was diagnosed upon rectal examination. Surgery was performed without a urethral sphincterotomy. The vaginal floor was incised in a standing position and the bladder was diverted into the vagina in order to suture the tears located in the ventrocaudal aspect of the bladder. Both mares survived after treatment for uraemia. Bladder rupture, although uncommon, may affect peripartum mares. Approach to the ruptured bladder without urethral sphincterotomy in a standing position should be considered as a choice for surgical repair.     

The Pathology of Unilateral Pyometra in the Bitch

Abstract— —Twelve cases of Unilateral Pyometra are described with particular reference to the pathology of the genital tract.
As a result of this study, it was concluded that the disparity in size between the two uterine horns was due to interference with drainage from one horn. The causes of obstruction of the uterine lumen are discussed, in particular, torsion of the uterus and stenosis of the lumen which is of significance in all forms of pyometra.
One case that might be described as true Unilateral Pyometra was observed.     

A study of 55 field cases of uterine torsion in dairy cattle

Two-hundred and seventy-three animals were enrolled in a case-case comparison of uterine torsions and other dystocias. The purpose of the study was to describe field cases of uterine torsion and their clinical management, compare them with other types of dystocia attended by field veterinarians, and evaluate the effect of season and housing on the incidence of torsions. Fifty-five cases of uterine torsions representing 20% of the dystocias were diagnosed. Most cases of uterine torsion were successfully corrected and followed by the vaginal delivery of a live calf. When compared with other types of dystocia, cows were at greater risk for uterine torsion than were heifers (OR = 5.2; P < 0.0001), while animals suffering from fetopelvic disproportion or carrying twins were at a lesser risk (OR = 0.05; P < 0.0001 and OR = 0.09; P = 0.007, respectively). Heifers had a lower risk when calving alone in a pen versus a tie-stall (OR = 0.2, P = 0.04). There was no significant effect of season on the risk of uterine torsion.     

Uterine torsion in cattle - frequency, clinical symptoms and theories about the pathogenesis

Aim of the present study was to summarize the available literature about the incidence, frequency, clinical symptoms and ideas as to the pathogenesis of uterine torsion in the cow. MATERIALS AND METHODS: Analysis of the literature using electronic libraries (Pub Med, Medline), German veterinary medicine journals and obstetrical textbooks. RESULTS: Uterine torsion is a very important maternal reason for dystocia as most cases occur during parturition. The post-cervical torsion (combined uterine and vaginal torsion, Torsio uteri and vaginae) is more commonly diagnosed than an intra-cervical or pre-cervical torsion. Torsions to the left occur more frequently than to the right. Clinical symptoms clearly vary depending on the degree of torsion. The frequency in relation to all parturitions is described as between 0.5 and 1%, whereas the percentage of uterine torsions presented to the veterinarian as a reason for dystocia varies between 2.7 and 65%. The pathogenesis of uterine torsion remains unclear; however, general agreement exists that the cow is predisposed to uterine torsion due to its anatomy. It appears that the Brown Swiss is more often affected than other cattle breeds.     

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.     

Clinical signs and treatment of chronic uterine torsion in two mares

Two mares were evaluated because of chronic uterine torsions of 2 and 4 weeks' duration; both were pyrectic, anemic, tachycardic, and anorectic, had signs of depression, and had an abnormal uterus and contents on transrectal examination. Both mares underwent cesarean section for lysis of adhesions from the uterus to the peritoneum, correction of the torsion, and ovariohysterectomy Both mares recovered with only minor complications and returned to be used as riding horses. Chronic uterine torsion should be considered in mares in late stages of gestation that have vague clinical signs and transrectal palpation findings that are unlike those described in typical cases of uterine torsion. Prognosis for life can be good after treatment by ventral midline celiotomy, cesarean section, correction of the torsion, and ovariohysterectomy.     

A spontaneous uterine sarcoma in a rhesus monkey (Macaca mulatta)

In primates, little has been reported about malignant mesenchymal uterine tumours. A case of a spontaneous metastasising uterine sarcoma in a 17-year-old rhesus monkey is presented. Clinically, transient abdominal pain, spasms, nausea, anaemia, a firm uterus and bloody vaginal discharge were noted. In a diagnostic laparoscopy, both massive adhesions in the lesser pelvis and 10 ml of ascites fluid were detected. In necropsy, in addition to peritonitis with massive adhesions, a cauliflower-shaped, irregular, tough, greyish-white uterine tumour was seen. Two cherry-sized tumour metastases were noticed in the greater omentum. In histology, both in the uterus and the metastases, a sarcoma with a low amount of connective tissue and well-differentiated cell nuclei was identified.     

Uterine activity in cows during the oestrous cycle, after ovariectomy and following exogenous oestradiol and progesterone

Uterine activity was monitored in three, 2-year-old nulliparous Ayrshire heifers using intrauterine balloon-tipped catheters and pressure transducers during the oestrous cycle, after ovariectomy and following the intravenous infusion of progesterone and oestradiol-17 beta. During the oestrous cycle uterine activity, as measured by the frequency and amplitude of contractions, was greatest around oestrus and declined during the luteal phase of the cycle; there was a close correlation with peripheral progesterone concentrations. In two animals after bilateral ovariectomy spontaneous uterine activity persisted, whilst in the third animal the uterus was quiescent. In the first two heifers intravenous progesterone infusions reduced the spontaneous uterine activity, eventually completely abolishing it. There was evidence of a dose response effect at the two infusion rates. Oestradiol benzoate infusions initially inhibited spontaneous uterine activity before stimulating contractions with some evidence of a dose relationship. As demonstrated in normal cyclical and steroid-infused animals, uterine activity appears to be under the influence of both hormones although the influence of progesterone is greater.     

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.     

Pyometra and unilateral uterine horn torsion in a sheep

A 13‐year‐old Romanov sheep presented for evaluation of vaginal discharge, depression and anorexia. Blood work demonstrated mature neutrophilia and marked hyperlactatemia. Transrectal and transabdominal ultrasound revealed echogenic fluid (pus) within the uterus. Purulent uterine fluid culture yield Escherichia coli. A diagnosis of pyometra was made. After medical treatment without clinical improvement, an exploratory laparotomy was performed, and a 360‐degree uterine left horn torsion was identified with the pyometra and multiple corpora lutea on both ovaries. Ovariohysterectomy was performed and the ewe recovered uneventfully.