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.     

A two-step ovariohysterectomy with unilateral left flank laparoscopic assistance in a Quarter Horse mare

This case report describes the technique and outcome of a two-step laparoscopic-assisted ovariohysterectomy in a Quarter Horse mare performed through the left paralumbar fossa for the treatment of chronic pyometra. Ovariohysterectomy is a procedure uncommonly performed in the horse. It is surgically demanding, invasive and can be associated with significant complications when a ventral midline approach is performed. Laparoscopic-assisted techniques reduce the invasiveness and some of the complications associated with ovariohysterectomy through ventral midline alone. The described modification further reduces the invasiveness of laparoscopic-assisted ovariohysterectomy and has the potential to reduce the overall surgical time of the procedure. Further work is needed to determine if the technique could be extrapolated to large-sized mares.     

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.     

Laparoscopically‐assisted ovariohysterectomy in three mares with pyometra

Open surgical ovariohysterectomy in the mare provides limited visualisation and a long surgical incision. Laparoscopically‐assisted ovariohysterectomy has been performed by the authors in 3 mares with pyometra. This approach does seem to offset some of these disadvantages.     

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.     

A review of fungal endometritis in the mare

Fungal endometritis is a relatively rare cause of infertility in the mare, accounting for only 1–5% of all cases of endometritis. However, it remains a challenge to the clinician due to difficulties in diagnosing and effectively treating affected mares, resulting in a high rate of recurrence and a guarded prognosis for ongoing fertility. Often occurring as an opportunistic infection, the most common causes of fungal endometritis in the mare are yeasts (Candida spp.) and moulds with septated hyphae (Aspergillus spp.). Early detection and identification of the causative agent are vital when choosing appropriate treatment as sensitivities to commonly used antifungals vary significantly. Assessing in vitro sensitivity for each isolate is accordingly recommended. Treatment of mares with fungal endometritis is multifaceted and includes; correction of any anatomical defects, uterine lavage and systemic and/or intrauterine infusion of antifungals. Concurrent bacterial infection is common so anticipation and subsequent treatment of bacterial endometritis is also often required.     

Breeding the mare with frozen semen

Breeding with frozen semen has become more commonplace. For a successful outcome, it is important to select fertile mares and to use quality frozen semen. The method/timing of insemination will be determined primarily by the number of semen doses available per cycle. Direct insemination of semen straws is preferred as this technique results in less loss of spermatozoa in insemination equipment. Ovulatory agents are crucial to help with timing of ovulation with respect to insemination. A post breeding examination should be performed to confirm ovulation and to examine the mare for possible complications such as post mating induced endometritis. With attention to details, frozen semen can be used with very good results.     

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.     

Prepubic tendon rupture in the mare

The following article discusses the clinical appearance, diagnosis, management and prognosis of abdominal wall tearing and prepubic tendon (PPT) ruptures of mares.     

Surgical resection of a dysgerminoma in a mare

A mare was referred for further evaluation of a mass found in the left caudal abdomen during a routine postpartum reproductive palpation. The mare was clinically normal with no history of health problems. Ultrasonographic examination of the mass confirmed its presence, but the origin of the mass could not be accurately determined. Routine haematology and serum biochemistry results were within normal limits. The mare was initially treated conservatively with antibiotics, but the mass continued to increase in size, so it was surgically excised. The mass involved the left ovary. The mare showed transient abdominal pain after surgery, but developed no other complications and was in foal 7 months later. On histology, the mass was diagnosed as a dysgerminoma, a rare ovarian tumour of germ cell origin.     

Birth of live triplets in a mare

An 11‐year‐old American Buckskin mare gave birth to live triplets unattended at approximately 300 days gestation. All foals were small and dysmature, requiring intensive care. The smallest foal died 4 days after admission, the second was subjected to euthanasia 24 days after admission due to poor healing of a third metatarsal fracture. The remaining foal survived to discharge and was considered small but otherwise normal at age one year.     

Uterine B cell lymphoma in a mare

In this report, we describe the diagnostic findings and outcome of a uterine B cell lymphoma in a mare. A well circumscribed uterine mass with significant peripheral vascularisation was identified by transrectal ultrasonography during the reproductive examination of an 8‐year‐old Thoroughbred mare. Subsequent hysteroscopy revealed that the uterine mass was located intramurally and contained a protruding polyp‐like structure. A diagnosis of uterine B cell lymphoma was established by histopathological examination of a hysteroscopically‐obtained tissue sample. Additional diagnostics demonstrated that the uterus was a site of metastasis. Due to her deteriorating condition, extensiveness of the tumour and poor prognosis, the owner decided that the mare should be subjected to euthanasia.     

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.     

The uterus and early pregnancy failure in the mare

The environment the equine conceptus finds itself in when it arrives in the uterus some 6 days after ovulation will determine if it will thrive or die. The uterus will be its home for approximately the next 11 months and as such it needs to both coordinate the growth of the placenta and ensure there is enough nourishment passing to this organ for the fetus to develop normally. The trophoblast, endometrium, maternal ovaries and, later in pregnancy, the fetal gonads, all play roles in the hormonal changes that orchestrate these events. Although failures of these processes later in pregnancy can have catastrophic effects for the fetus, it is in early gestation that the foundations for a successful pregnancy are laid. This paper therefore concentrates on some of the noninfectious influences the uterus may have on survival of the young conceptus.     

Incompetent cervix and pneumouterus in a maiden mare

This case report describes an uncommon case of a congenitally incompetent cervix and a resulting pneumouterus in a 5‐year‐old maiden Quarter Horse mare. The mare was presented for artificial insemination at the Clinic for Animal Reproduction, Freie Universität Berlin, Germany. Routine vaginal and rectal examinations revealed a shortened cervix of 3 cm length and a dilated uterus filled with a considerable amount of air. During ultrasonographic examination, ovaries of normal size with regular cyclic activity were detected. Chromosomal analysis could not confirm any genetic anomalies such as an expected XO karyotype. The mare was excluded from breeding due to its anatomical constitution.     

Hand‐assisted laparoscopic adhesiolysis of extensive small intestinal adhesions in a mare after breeding injury

In this article we report the course of disease in a mare following severe vaginal injury during natural cover. Although the genital injury healed completely, the mare developed extensive intra‐abdominal intestinal adhesions causing complete small intestinal obstruction 2 years after the incident. The adhesion was not accessible during initial emergency laparotomy and a standing, hand‐assisted laparoscopic adhesiolysis and jejuno‐jejunal end‐to‐end anastomosis were subsequently performed. The mare was subjected to euthanasia 10 weeks after surgery due to recurrence of abdominal pain. The pertaining literature is discussed in regards to this case.     

Monitoring of the mare during the perinatal period at the clinic and in the stable

Complications in late gestation are challenging problems for the equine clinician and are causes of considerable distress to owners. Health problems in a pregnant mare in each stage of gestation can adversely affect the pregnancy. It is important to obtain a thorough history and perform a detailed and systematic examination of the pregnant mare so that the mare may be classified as normal or high-risk. However, even after a thorough examination, practitioners may face problems with the interpretation and assessment of risk. Normal mares should foal in the stable or pasture. Mares classified as having a high-risk pregnancy need to be monitored precisely for signs of oncoming foaling with attendance of trained personnel when labour begins. A valuable method for monitoring of the high-risk mare is assessing fetoplacental well-being. Fetoplacental well-being is most accurately assessed with ultrasonography as well as several available hormone profiles. We are proposing our scoring system of the mare's health, which may be useful in the assessment of risk during pregnancy and help clinicians to decide whether sending the mare to the clinic is reasonable or unnecessary.     

Gastric and small intestinal ileus as a cause of acute colic in the post parturient mare

REASONS FOR PERFORMING STUDY: Ileus (functional obstruction of aboral gastrointestinal transit) is an uncommon cause of gastrointestinal dysfunction and colic in the horse. A number of specific conditions have been previously reported in association with ileus. This report describes the recognition of primary gastric and small intestinal ileus of undetermined cause in a series of post parturient mares. OBJECTIVES: To describe the clinical features, treatment and outcome of a series of episodes of primary gastric and small intestinal ileus. METHODS: A retrospective study was performed of colic episodes seen in an equine practice in Newmarket, UK over a 6 year period (2002-2007). RESULTS: Seventeen episodes of gastric and small intestinal ileus were identified, which occurred in 15 horses. All episodes occurred in post parturient mares. No previously reported cause of ileus was identified in any of the episodes. Fifteen of the 17 episodes received medical treatment (medical support and nasogastric decompression) and, in addition, surgical decompression was performed in 9 episodes. Two mares were subjected to euthanasia before treatment due to the presence of gastric rupture and the remaining 13 mares survived with a follow-up period of at least 10 months. Two mares suffered a further episode of gastric and small intestinal ileus, one 4 days and the other 2 years after the initial episode. CONCLUSIONS: Gastric and small intestinal ileus of, as yet, unknown aetiology appears to be a potential cause of acute colic in the post parturient mare. The outcome following treatment by decompression is good.     

Malignant fibrous histiocytoma of the mammary gland in a mare

Mammary tumours are uncommon in mares. Sarcomas of the breast account for less than 1% of all human primary malignancies and, among these types of tumours, malignant fibrous histiocytoma (MFH) is very rare. This report describes a 6‐year‐old uniparous Paint mare that was presented for investigation of right mammary gland enlargement of 3 weeks' duration. The clinical and histopathological findings in this mare with malignant fibrous histiocytoma of the mammary gland as well as complications of bilateral mastectomy are detailed. At one year follow‐up there were no clinical signs of recurrence.     

Surgical correction of entrapment of the large colon and caecum through a mesoduodenal rent with standing laparoscopic repair in a mare

A 12-year-old Tennessee Walking Horse mare displaying signs of severe colic for 48 h was found during an exploratory celiotomy to have entrapment of a cranially displaced large colon and the caecum through a rent in the mesoduodenum. The entrapment was relieved, and 24 h later, the mesoduodenal rent was closed laparoscopically, with the mare standing. The owner reported 6 months later that the mare had displayed no signs of colic since being discharged from the hospital 11 days after surgery.