Chronic intermittent colic in a mare attributed to uterine marbles

A 13‐year‐old Quarter Horse mare presented for evaluation of chronic intermittent colic. Following extensive diagnostics, abdominal radiographs revealed two round, radiopaque objects in the caudal abdomen. Palpation per rectum and transrectal ultrasonography of the reproductive tract confirmed that the round objects were uterine marbles. Dinoprost tromethamine (Lutalyse, 5 mg i.m. q. 24 h for 2 days) was administered to bring the mare into oestrus, and both uterine marbles were manually removed from the uterus following digital dilation of the relaxed cervix. Follow‐up with the owner 12 months after discharge revealed that the mare had shown no further signs of abdominal discomfort since having the uterine marbles removed. To the authors' knowledge, this is the first published report of chronic intermittent colic attributed to uterine marbles in a mare.     

Complications associated with the presence of two intrauterine glass balls used for oestrus suppression in a mare

This report describes the identification and removal of 2 glass balls, both of which had fragmented, from the uterus of a mare. The glass balls had been placed into the uterine lumen to prolong function of the corpus luteum for suppression of oestrous behaviour. This report adds to a growing body of evidence that severe complications can result from the use of intrauterine glass balls for oestrus suppression in mares, particularly if they are retained for a prolonged time.     

A review of oestrus suppression techniques in mares

Many fillies and mares are accused of behaving badly by their owners or trainers, and their reproductive hormones and ovaries are commonly blamed for this. Overt oestrus behaviour, however natural, is undesirable when a horse is being ridden, trained and competed. More subtle behaviours may be attributed to the reproductive cycle and presented as the cause of poor performance in the elite competition mare. Sometimes behaviours are complex, perhaps at odds with what one expects for normal reproductive behaviour and in many cases may not be associated with the reproductive cycle at all, rather associated with pain of musculoskeletal or soft tissue origin. The situation represents a diagnostic dilemma to positively associate undesirable behaviours with the ovarian hormones or ovarian pain, before an attempt can be made to modify the behaviour through the suppression of oestrus. This article will review the reasons for presentation, the behavioural patterns of the reproductive cycle and the diagnosis of reproductive behavioural problems. The range of techniques for oestrus suppression will be reviewed along with their clinical application and any known current regulatory issues associated with their use.     

Sustained-release deslorelin acetate implants disrupt oestrous cyclicity in the mare

There is a need for a safe, effective and practical method of oestrus suppression in the mare. The aim of this study was to monitor ovarian activity in mares exposed to either 9.4 or 28.2 mg deslorelin acetate, a GnRH agonist, in the form of a sustained-release implant. Following oestrus synchronisation, mares were randomly assigned to one of three groups (n = 4 per group) and administered either one (Des1 group; 9.4 mg) or three (Des3 group; 28.2 mg) implants of deslorelin acetate (Suprelorin-12, Virbac Australia) or one blank implant (Control group; Virbac Australia). Mares underwent weekly blood sampling for 12 weeks following implant placement (Day 0–Day 84), with transrectal palpation and ultrasonography of the reproductive tract at all sampling timepoints except Days 56, 70 and 77. All mares showed baseline serum progesterone concentrations (SPC; ≤1.3 nmol/L or 0.4 ng/ml) on Day 0. Cycling Control mares showed typical oestrous cyclicity characterised by peaks and troughs in SPC over time. Four of eight treated mares demonstrated a sustained elevation in SPC after the initial ovulation after implant placement; SPC declined to baseline levels (Des1 group; 2 mares) or remained elevated (Des3 group; 2 mares) at the final sampling timepoint on Day 84. Oestrous cyclicity was erratic in three of the remaining four treated mares. In total, 87.5% (7 of 8) of treated mares showed atypical oestrous cyclicity after implant placement. These results suggest that deslorelin acetate disrupts oestrous cyclicity in the mare, which warrants further research.     

Complications associated with transurethral endoscopic‐assisted electrohydraulic lithotripsy for treatment of a bladder calculus in a gelding

A cystic calculus approximately 6 cm in diameter was diagnosed by ultrasonography and endoscopy in a 12‐year‐old Trakehner gelding with a history of haematuria and dysuria. Transurethral endoscopic lithotripsy with electrohydraulic shock waves was performed as a minimally invasive treatment option. Fragmentation of the calculus was achieved, the fragments of the calculus left in the bladder and excretion assisted by infusion of Ringer's solution. Twenty‐four hours after the third lithotripsy, the horse suffered a recurrence of dysuria and pollakiuria due to partial obstruction of the urethra by the calculus fragments. The treatment was repeated within the urethra until clearance of the fragments was achieved. The sharp fragments had produced a zone of urethral mucosal trauma, approximately 10 cm in length. At the follow‐up visit 4 weeks later, the patient had developed inflammation and swelling of the urethral mucosa, which was successfully treated with a 14 day course of anti‐inflammatory drugs. This resulted in normal urination. At the last follow‐up, the horse had been recurrence‐free for 12 months.     

Modified parainguinal approach for cystic calculus removal in five equids

This report describes a modification of the parainguinal approach for removal of cystic calculi: a ventral midline laparotomy‐guided parainguinal laparocystotomy. The ventral midline approach to the abdomen is rapid and routinely used by equine surgeons. With an arm introduced to the abdomen via the ventral midline, the surgeon is able to select the ideal parainguinal laparotomy incision location that allows bladder exteriorisation with the minimum amount of tension. Because the surgeon's hand is introduced via the ventral midline incision, the parainguinal incision can be sized to just allow exteriorisation of the urinary bladder and urolith, increasing extra‐abdominal bladder security during cystotomy while reducing incision size in the parainguinal region. Finally, an assistant's hand via the ventral midline incision can maintain bladder stability within the parainguinal incision during cystotomy closure.     

Abortion due to Bacillus safensis in a mare

A 16-year-old Westphalian mare aborted a dead fetus at 7 months of gestation without prodromal signs. The chorioallantois was diffusely thickened and discoloured, with fibrinous plaques, congestion and haemorrhage. Small colonies of 1-μm, Gram-positive bacilli were scattered throughout the exudate overlying the chorionic epithelium, and within macrophages. Bacillus safensis was isolated from the fetal lungs and from a swab sample of the mare's uterus. This strain represents the first case of a B. safensis-associated equine abortion and the first case of any infection caused by this bacterium.     

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.     

Successful laparoscopic surgery for a uterine leiomyoma in a mare

Leiomyomas are the most common of uterine tumours in mares but large tumours are rare. A case with a 15 cm uterine leiomyoma diagnosed by rectal palpation and ultrasound examinations with apparent adverse effects on fertility is reported. Management of the case was by hand assisted laparoscopic tumour removal and unilateral ovariectomy. Complications included post operative pain, tachycardia and wound infection. The mare was confirmed to be in foal after her first cover post surgery.     

The effects of an advanced uterine environment on embryonic survival in the mare

Reasons for performing the study: During embryo transfer (ET) the equine embryo can tolerate a wide degree of negative asynchrony but positive asynchrony of >2 days usually results in embryonic death. There is still confusion over whether this is due to the inability of the embryo to induce luteostasis or to an inappropriate uterine environment. Objectives: To assess embryo survival and development in an advanced uterine environment. Hypothesis: Embryo–uterine asynchrony, not the embryo's inability to induce luteostasis, is responsible for embryonic death in recipient mares with a >2 days chronologically advanced uterus. Methods: Experiment 1: Thirteen Day 7 embryos were transferred to the uteri of recipient mares with luteal prolongation, occasioned by manual crushing of their own conceptus, such that donor–recipient asynchrony was between +13 and +49 days. Experiment 2: Day 7 embryos were transferred to recipient mares carrying their own conceptus at Days 18 (n = 2), 15 (n = 2), 14 (n = 4), 12 (n = 4) or 11 (n = 4) of gestation. In addition, Day 8 embryos were transferred to 4 pregnant recipient mares on Day 11 of gestation. Results: No pregnancies resulted following transfer of Day 7 embryos to recipients in prolonged dioestrus with asynchronies between +13 and +49 days. However, the use of early pregnant mares as recipients resulted in 5/20 (25%) twin pregnancies, 4 of which came from the transfer of a Day 8 embryo to a Day 11 recipient. All transferred embryos showed retarded growth, with death occurring in 4/5 (80%). Conclusions and potential relevance: The results emphasise the importance of an appropriate uterine environment for embryo growth and the inability of equine embryos to survive transfer to a uterus >2 days advanced even when luteostasis is achieved. It is possible that in normal, non‐ET equine pregnancy, embryo–uterine asynchrony may account for some cases of embryonic death.     

Polypoid cystitis as a cause of haematuria in a pony mare

A 15-year-old pony mare was presented for investigation of haematuria of 2 weeks' duration. On cystoscopy, multiple small pedunculated soft tissue structures were observed on the bladder mucosa. Histopathological analysis of the masses was consistent with chronic polypoid cystitis. The polypoid lesions and associated haematuria resolved following prolonged antibiotic treatment. Polypoid cystitis has not previously been described in horses. This condition should be considered a differential for haematuria, requiring cystoscopy and biopsy to confirm a diagnosis.     

Uterine prolapse in a mare leading to metritis,systemic inflammatory response syndrome,septic shock and death

This Case Report describes severe complications associated with uterine prolapse in a mare. A 6‐year‐old Trakehner mare was examined for depression, moderate pain and vaginal discharge 3 days after correction of a uterine prolapse. The clinical examination and haematology revealed that the mare had an infection with systemic inflammatory response syndrome and shock. Due to the uncontrollable, persistent pain, an exploratory celiotomy was performed which revealed severe metritis. During anaesthesia, the mare developed severe cardiovascular compromise and died in recovery. In previously reported cases of uterine prolapse in the mare, the authors warn of uterine injury, broad ligament haemorrhage, metritis, endotoxaemia and laminitis but often have a successful outcome with conventional therapy. This case describes a mare that developed severe complications and death after uterine prolapse. Mares with uterine prolapse require appropriate treatment and vigilant monitoring post treatment to prevent life threatening complications.     

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.     

Laparoscopic repair of a ruptured bladder in an adult mare

A bladder rupture suffered by an adult mare during parturition was repaired, using a laparoscopic approach with the mare in dorsal recumbency. During the laparoscopic approach, the bladder was empty, inverted and had a rent on the dorsal apical surface. The bladder was located far caudally within the pelvis. By grasping the left lateral ligament and exerting gentle traction, it proved possible to manoeuvre the bladder more cranially where the rupture could be sutured. The benefits of the laparoscopic approach are reduction in incision size, visualisation of the tear, reachability of the empty bladder and the tear, and reduced reconvalescence time.     

Resection cystoplasty of a squamous cell carcinoma in a mare

A 22‐year‐old Arabian mare was examined for evaluation of haematuria of 2 months' duration. Complete blood cell count and chemistry revealed anaemia of chronic disease (i.e. normocytic, normochromic) and hypoproteinaemia. Cystoscopy revealed a haemorrhagic mass protruding into the lumen of the urinary bladder in the apical region. The mass was surgically removed by partial cystectomy performed through a caudal ventral midline laparotomy. Histological examination of the mass confirmed the diagnosis of squamous cell carcinoma. Tumours of the equine urinary bladder are rare, and when a partial cystectomy is indicated, a caudal ventral midline laparotomy may provide adequate surgical exposure even in adult horses.     

Haemoabdomen secondary to granulomatous periarteritis due to parasitism with Halicephalobus gingivalis in a mare

A 22‐year‐old Quarter Horse mare exhibited neurological signs consisting of head pressing, central blindness, minimal ataxia and dysphagia. Despite treatment, the mare collapsed and died shortly after onset of signs. On necropsy, there were approximately 15 l of free blood in the abdominal cavity. A 12 × 4 cm diameter, irregularly‐shaped, nodular, firm, tan/yellow mass was found adhered to the outer surface of the right lateral aspect of the caudal abdominal aorta. A similar mass also affected the caudal aspect of the right kidney. Histopathology of the aortic and renal masses revealed multiple coalescing granulomas containing intralesional nematodes compatible with Halicephalobus gingivalis. Inflammatory cells disrupted the aortic tunica adventitia as well as the outer tunica media. Similar exudate also affected the cerebrum, cerebellum and brainstem. Polymerase chain reaction amplification and sequencing of a portion of the large subunit ribosomal ribonucleic acid gene were performed using previously published primers for H. gingivalis to confirm the identity of the nematode. Although rupture of a blood vessel could not be demonstrated grossly, the histological findings suggest that inflammation may have breached a small calibre artery and caused the haemoabdomen.     

Removal by laparoscopic partial ovariohysterectomy of a uterine leiomyoma assumed to have caused fetal death in a mare

A 13‐year‐old pluriparous Dutch Warmblood mare presented to Utrecht University's Department of Equine Sciences 4 weeks after suspected abortion at 3.5 months gestation, to investigate the nature of a uterine mass and persistent vulval discharge. Transrectal ultrasonographic examination revealed copious flocculent fluid and fetal remnants within the uterus and a 5–6 cm heterogenous mass in the uterine wall at the tip of the right horn. Expulsion of fetal parts and resolution of the coexisting endometritis were effected by a combination of repeated PGF_2a analogue injections to induce oestrus, application of PGE₂ gel to aid cervical relaxation, and daily uterine lavage and antibiotic instillation. The presence of the mass in the uterine wall was confirmed by hysteroscopy and the suspected tumour subsequently removed by partial laparoscopic ovariohysterectomy under standing sedation and local anaesthesia. The histological appearance of the tumour was consistent with a leiomyoma or moderately malignant leiomyosarcoma. Although a follow‐up examination 6 months post surgery revealed uncomplicated healing of the uterus, the owner decided to retire the mare from breeding. Uterine neoplasia is an extremely unusual cause of fetal death in the mare but, in the present case, laparoscopic partial ovariohysterectomy proved a promising, minimally invasive technique for salvaging sufficient uterus to make subsequent breeding a realistic proposition.