Non-surgical management of rectal tears in two mares

Two mares presented with life-threatening rectal tears were successfully treated with intensive medical management. Although surgery has been regarded as mandatory for grade 3 or 4 rectal tears in the past, recent reports have indicated the value of medical management alone. The case reports presented in this article detail the use of antibiotics, flunixin meglumine, laxative diets and faecal softeners in the medical management of two mares presented with grade 3 rectal tears.     

Laparoscopic surgical technique for repair of rectal and colonic tears in horses: an experimental study

OBJECTIVE: To determine the efficacy of laparoscopic surgical techniques for repair of rectal lacerations in horses. STUDY DESIGN: Experimental study. ANIMAL OR SAMPLE POPULATION: Thirty-two segments of equine bowel placed in an equine pelvitrainer, 8 equine cadavers, and 3 normal horses. METHODS: In experiment 1, 3 laparoscopic intestinal-repair techniques were evaluated in an equine pelvitrainer: suturing with needle holders, with an automatic suture device, and stapling with a hernia stapler. In experiment 2, descending colon lacerations were sutured laparoscopically using needle holders in a pelvitrainer and in equine cadavers. In experiment 3, iatrogenic rectal lacerations were sutured laparoscopically with needle holders in horses under general anesthesia. These horses were evaluated for 7 days' postoperatively by clinical examination and blood and peritoneal fluid analysis. The horses were euthanatized 7 days' postoperatively and necropsied. The repaired colonic segments were collected for determination of bursting pressures, degree of luminal narrowing, and microscopic examination of the suture line. RESULTS: For the 3 techniques, there was no significant difference in repair time or degree of luminal narrowing, but bursting pressure was higher in segments repaired by use of needle holders or with the suture device. Colonic and rectal lacerations were sutured successfully with laparoscopic needle holders. No major complications were recorded. At necropsy, adequate healing was confirmed by a high bursting strength (>140 mm Hg) and by histologic examination. CLINICAL RELEVANCE: A novel laparoscopic method can be used to repair iatrogenic rectal lacerations in horses. Whether this method may be used for clinical cases of rectal tears must be investigated.     

A vaginal mucosal pedicle flap technique for repair of rectovaginal fistula in mares

OBJECTIVE: To describe the use of a vaginal mucosal pedicle flap for repair of rectovaginal fistulae (RVF) in mares. STUDY DESIGN: Clinical case report. ANIMALS: Three mares with RVF. METHODS: After debriding the RVF, a dorsally based U-shaped mucosal and submucosal pedicle flap (2-4 mm thick) was dissected from the vaginal wall, rotated approximately 90 degrees angle to close the ventral aspect of the fistula and sutured in position with 10-13 single sutures that did not penetrate the rectal mucosa. This positioned the vaginal mucosa so that it was continuous with the rectal mucosa. RESULTS: Two RVF healed by 1st intention whereas for the 3rd RVF, 2 additional single sutures were required to repair partial dehiscence after 10 days. At 6 weeks and 6 months all RVF were healed. One mare subsequently foaled without complications. CONCLUSIONS: RVF can be closed by use of a rotation flap of vaginal tissue. CLINICAL RELEVANCE: Tension-free closure of RVF can be achieved by rotating a pedicle flap of vaginal mucosal tissue without undue wound tension, and should be considered as an alternative to conventional appositional techniques.     

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.     

Surgical stapling for repair of a rectal tear in a horse

A grade-4 rectal tear in a mare was successfully repaired per rectum, using a surgical stapling device. The mare had only minor postoperative complications. This technique has some advantages over previously described procedures, but should be reserved for use in selected cases.     

Surgical treatment of grade IV patellar luxation in the neoambulatory dog.

A wire-suture method was used for correcting grade IV medial and lateral luxations of the patella. In seven operated stifles, the method resulted in a normal gait and minimal valgus and varus deformity of the distal femur and proximal tibia.     

Surgical repair of rectovaginal fistulae in mares: Twelve cases (1983-1991)

The case records of 12 mares at the Ontario and Atlantic Veterinary Colleges were reviewed to evaluate the success rates of surgical techniques used to repair rectovaginal fistulae. A modified horizontal perineal technique was used in eight mares; it was unsuccessful in one mare, but the fistula was subsequently successfully repaired using the same technique. One rectovaginal fistula that was converted to a third-degree perineal laceration was successfully repaired on the third attempt, using the suture principles of the modified horizontal perineal technique. A modified transvaginal technique was used in three mares, in two of which it failed; their fistulae were subsequently converted to third-degree perineal lacerations and repaired using a one-stage closure. We conclude that the modified horizontal perineal technique is a one-stage procedure that is technically easy to perform, results in less tension on the suture lines, and is effective in modifying poor vulvar conformation.     

Temporary indwelling rectal liner for use in horses with rectal tears

A temporary indwelling liner was surgically installed in 17 horses with grade III or grade IV rectal tears. The rectal tears of 9 of the horses healed. The remaining 8 horses developed peritonitis as a result of peritoneal contamination before surgery, a change in grade of the tear, or material failure.     

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 rectovaginal fistula in mares and subsequent fertility

Objective To evaluate the fertility of mares bred at various intervals relative to surgical management of rectovaginal fistula (RVF). Materials and Methods Surgical repair of RVF was performed in 28 mares at variable times relative to foaling (30 days to 24 months) and also relative to rebreeding (same cycle or delayed). Postoperative fertility was then evaluated. Results Two mares were already pregnant at the time of surgery and 20 of 23 mares (87%) that were bred immediately prior to or following surgery conceived from their first service. When mares were bred in the same cycle as surgery, the next cycle following surgery or in the following breeding season after surgery the pregnancy rate was 5/5, 5/6 and 10/12, respectively, and the foaling rates were 4/5, 4/6 and 7/12. The two mares already pregnant at the time of surgery foaled successfully. Conclusions Excellent fertility can be achieved following surgical repair of RVF and our results suggest that delaying breeding until the following breeding season is not necessary. In addition, breeding in the same cycle as the surgical repair is a previously unreported technique that should be considered to maintain normal fertility and a yearly foaling interval.     

Repeated manual evacuation for treatment of rectal tears in four horses

Horses with tears that involve all layers of the rectum except the mesocolon (grade IIIb) have a poor prognosis for survival because of the difficulty in treating these wounds and the propensity for them to progress to full perforations (grade IV). Most treatments for grade-IIIb rectal tears involve surgery of some kind, but not all grade-IIIb rectal tears require surgical intervention. We report on 4 horses with grade-IIIb rectal tears that were evaluated via palpation per rectum and endoscopy. Two of 4 horses were admitted with signs consistent with shock and endotoxemia, and evaluation of all peritoneal fluid samples was indicative of nonseptic peritonitis. Horses were treated via administration of antibiotics and anti-inflammatory drugs and repeated manual evacuation of the terminal portion of the small colon and rectum. Treatment centered on preventing further enlargement of the rectal tear by eliminating the storage function of the terminal portion of the small colon and rectum. None of our horses had worsening of the original injury, and horses were discharged within 2 weeks of admission with full resolution of the rectal tear. Outcomes in the horses of our report indicate that repeated manual evacuation can be successful for treatment of horses with grade-IIIb rectal tears.     

Evaluation of a modification of the McKinnon technique to correct urine pooling in mares

The urethral fold of 30 mares was split transversely into dorsal and ventral shelves, and the ventral shelf was used to help create a urethral extension. The dorsal shelf was stretched caudally and sutured to the roof of the extension so that it covered at least the cranial half of the extension. For 20 mares, a relaxing, vaginal incision was created cranial to the external urethral orifice to enable the dorsal shelf to be retracted further caudally. Ten of the 30 mares (33.3 per cent) developed a defect, but none developed a defect in that portion covered by the dorsal shelf of the urethral fold. Two of the 30 mares (6.7 per cent) developed a defect so small that the defect could be detected only by inserting a dye, under pressure, into the tunnel. The total number of mares that developed only a grossly visible and palpable defect was eight of 30 (26.6 per cent). Four of the 10 mares that did not receive the relief incision and six of 20 mares that did receive the relief incision developed a defect in the extension. Modifying the McKinnon technique by transversely splitting the urethral fold and retracting the dorsal half helps prevent a defect from forming in the cranial portion of the extension. The dorsal shelf can be retracted further caudally by creating a relief incision on the floor of the vagina.     

A urethral extension technique to correct urine pooling (vesicovaginal reflux) in mares

A surgical technique involving reconstruction of the caudal vaginal vault was used to correct vesicovaginal reflux in 32 of 34 mares. After surgery, 22 of 24 mares became pregnant, and embryos were harvested for transfer from 6 of the other 10 mares. It was concluded that the procedure was safe and efficacious.     

Surgical results and fertility following correction of vesicovaginal reflux in mares

Objective To evaluate the surgical results and fertility of mares bred at various intervals relative to surgical management of urovagina. Design Sixty-one mares underwent surgery to correct vesicovaginal reflux. Surgery was performed at varying times relative to breeding and postoperative fertility was evaluated. Results Five mares were lost to follow-up and a further four were electively not bred. Of the remaining 52 mares, seasonal pregnancy and live foaling rates were 67% (35/52) and 54% (26/48), respectively. When mares were bred in the same cycle as the surgery, the first cycle following surgery, the second cycle following surgery or the following breeding season after surgery the seasonal pregnancy rates were 89% (8/9), 63% (10/16), 67% (2/3) and 63% (15/24), respectively. After censoring four mares that died of natural causes pre-foaling, the foaling rates were 88% (7/8), 50% (7/14), 0% (0/3), 52% (12/23), respectively. All mares bred in the same cycle as surgery or in the next cycle were bred once only that season, so the pregnancy rate per cycle of 72% (18/25) was identical to the seasonal pregnancy rate. Conclusions Good fertility (comparable to a normal population of mares) was achieved following surgery and the results suggest that delaying breeding until the following breeding season is not necessary. In addition, breeding in the same cycle as surgical repair is a previously unreported technique that should be considered to maintain a yearly foaling interval.     

Body wall tears during late pregnancy in mares: 13 cases (1995-2006)

OBJECTIVE: To review management of pregnant mares with body wall defects and assess the effect of various management strategies on the outcome of mares and their foals. DESIGN: Retrospective case series. ANIMALS: 13 mares. PROCEDURES: Medical records of eligible mares were reviewed. Signalment, history, admitting complaint, clinical findings, parity, type of body wall defect, concurrent diagnoses, postpartum complications, outcome of fetus, outcome of mare, and type of clinical case management were recorded. RESULTS: 8 mares received conservative management and 5 mares received interventional management. Survival of mares to discharge was good, and no difference in mare survival was identified on the basis of type of management, type of body wall defect, or presence of hydrops. Foal survival was significantly better in the conservative management group, compared with those managed by interventional management, and was also better without hydrops. CONCLUSIONS AND CLINICAL RELEVANCE: Foal survival can be improved in mares with body wall defects that occur during parturition without compromising mare survival by use of conservative management strategies that avoid induction of parturition or elective caesarian section and allow for natural parturition. Potentially, improved fetal readiness for birth may play a role.