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.     

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.     

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.     

Repair of urinary bladder rupture through a urethrotomy and urethral sphincterotomy in four postpartum mares

OBJECTIVE: To report the clinical findings, surgical technique, and outcome after repair of urinary bladder rupture through a urethral incision in postpartum mares. STUDY DESIGN: Retrospective study. ANIMALS: Four Thoroughbred broodmares. METHODS: Medical records were reviewed for clinical signs, surgical technique, medical therapy, and outcome. The bladder was everted into the vagina through a urethral incision that included a sphincterotomy. The bladder defect was repaired with absorbable suture material in a single-layer, full thickness, simple, continuous pattern. The urethral incision was closed similarly. RESULTS: Depression, inappetence, signs of shock, dehydration, azotemia, and serum electrolyte abnormalities were consistent findings that increased temporally after bladder rupture. Each bladder defect was repaired successfully, and metabolic derangements were corrected with supportive medical therapy. All mares survived, conceived, and had more foals without further complications CONCLUSION AND CLINICAL RELEVANCE: Bladder rupture associated with parturition in mares can be repaired in a standing position by eversion of the bladder through a urethrotomy and urethral sphincterotomy.     

Surgical technique to repair grade IV rectal tears in post-parturient mares

Objective— To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome.
Study Design— Clinical report.
Animals— Horses (n=6) with grade IV rectal tears.
Methods— Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving ∼5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares).
Results— Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact.
Conclusion— In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern.
Clinical Relevance— Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.     

Ovariohysterectomy in Six Mares

Six mares had ovariohysterectomy performed for chronic pyometra associated with cervical abnormalities, uterine neoplasia, or removal of a macerated fetus. Ovariohysterectomy was performed through a ventral midline incision with access to the ovarian and uterine vessels aided by traction on the uterus and retraction of abdominal viscera. Abdominal pain, the most common complication after surgery, occurred in four mares but resolved within 36 hours. Peritonitis occurred in two mares; one mare was subsequently euthanatized. Other complications that resolved with treatment included infection of the uterine stump (two mares), abdominal hemorrhage (one mare), diarrhea (one mare), and incisional infection (one mare). Complications after surgery can be reduced by removing as much of the uterus as possible, minimizing peritoneal contamination with uterine contents, and providing a secure closure of the caudal reproductive tract.     

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.     

Postpartum partial cystectomy through the vagina in a mare with everted partially necrotic bladder.

The bladder of a 750-kg Clydesdale mare had everted through the urethra into the vagina immediately after parturition. The bladder was reinverted into the peritoneal cavity by an attending veterinarian, but 4 days later, the bladder was everted again in the vagina. The mare was able to void urine through both ureters, which could be seen in the mucosal surface of the bladder. The everted bladder had become edematous and could not be reinverted through the urethra. A considerable portion of the fundus was necrotic. The mare was administered xylazine epidurally to induce perineal analgesia, and the necrotic portion of the bladder was resected and healthy bladder tissue was opposed with a double layer of simple continuous sutures. The urethral sphincter was longitudinally incised through the vaginal mucosa to allow reinversion of the bladder through the urethra. A purse-string suture inserted in the urethral opening decreased the urethral diameter and prevented recurrence of the condition. An inflated Foley catheter was maintained in the bladder for 5 days. The mare recovered normal urination after the catheter was removed.     

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.     

Urinary bladder rupture in a two-year-old horse: sequel to a surgically repaired neonatal injury

After routine cryptorchid castration, a 2-year-old Thoroughbred colt was admitted 72 hours later because of depression, abdominal distention, and pollakiuria, with production of small quantities of urine. A diagnosis of a ruptured bladder was made on the basis of a large volume of abdominal fluid and a disparity between the urea nitrogen and creatinine concentrations in the serum (70 mg/dl and 8.4 mg/dl, respectively) and in the abdominal fluid (154 mg/dl and 43 mg/dl, respectively). The colt had undergone surgical correction of a ruptured urinary bladder at 4 days of age, and a 5-cm tear through one of the previous scars was identified and repaired during exploratory celiotomy. The previous injury to the bladder was extensive and may have left an inherent weakness in the bladder wall. Evidence of adhesion formation or urethral obstruction was not found. The combination of a full bladder and the trauma associated with induction of anesthesia may have contributed to the recurrence of bladder rupture.     

Anesthetic management of an incisional dehiscence in recovery following exploratory laparotomy in a horse.

A 5-year old Arabian mare fell during recovery from general anesthesia after an exploratory laparotomy. This fall resulted in dehiscence of the abdominal closure, and a substantial amount of intestines were exteriorized. Chemical and manual restraints were rapidly used to prevent trauma to the exposed intestines. A second general anesthesia was initiated to clean the intestines and close the incision. Multiple anesthetic problems were encountered, including arterial hypotension and hypoxemia. The horse recovered from the second general anesthesia and surgery, and all complications gradually resolved. The horse was discharged and has not had further problems to date.     

Standing hand-assisted laparoscopic ovariectomy in 65 mares

Objective: To review the efficacy and safety of unilateral ovariectomy by use of a standing hand‐assisted laparoscopic approach and evaluate the effect of ovary size on posttransection hemorrhage after application of a linear stapling device. Study Design: Case series. Animals: Horses (n=65) aged 2–20 years. Methods: Medical records of mares that had ovariectomy performed by use of a standing hand‐assisted laparoscopic approach were reviewed. Data retrieved were signalment, ovary removed (left, right), ovarian size, ovarian pathology, intraoperative and postoperative complications, and length of hospitalization. Results: Mean ovarian diameter was 17 cm. Histopathology (52 mares) confirmed 41 granulosa cell tumors (79%), 8 ovarian cysts (15%), 1 teratoma (2%), and 2 ovaries (4%) without abnormalities. Hemorrhage was observed laparoscopically in 16 mares after transection of the mesovarium. Complications encountered during surgery included 1 mare collapsing in the stocks and 1 mare that hemorrhaged excessively from the incision. Postoperative complications included 2 cases of mild colic. Overall complication rate was 6%. Conclusions: All attempts to remove the target ovary were successful. The approach is safe for the mare, as complications encountered were similar to those recently reported for other approaches.     

Hand-assisted laparoscopic ovariohysterectomy in the mare

OBJECTIVE: To develop a minimally invasive, hand-assisted laparoscopic ovariohysterectomy (HALS-OHE) technique in the mare and to evaluate safety and any associated complications. STUDY DESIGN: Experimental study. ANIMALS: Eight, 11-24-year-old mares with anatomically normal urogenital tracts. METHODS: The surgical technique was developed in 2 non-survival mares and subsequently evaluated in 6 survival procedures. Food was withheld for 48 hours, then mares were anesthetized and positioned in dorsal recumbency for laparoscopic surgery. A hand access device (Omniport) was placed followed by 4 laparoscopic portals. Transection of the ovarian pedicles and broad ligaments was achieved using a combination of a laparoscopic stapling instrument (Endo GIA II), an ultrasonically activated instrument (Harmonic Scalpel), and endoscopic clips (Endo Clip II ML). The genital tract was exteriorized through the laparotomy, and the uterus transected and sutured in a conventional pattern. Horses were evaluated through postoperative day 14 when a necropsy was performed. RESULTS: Four mares recuperated well after surgery, 1 mare was euthanatized because of bilateral femur fracture during anesthetic recovery, and another developed severe pleuropneumonia. At necropsy all but 1 abdominal incision was healing routinely. One mare had abscessed along the celiotomy incision and developed visceral adhesions. Uncomplicated healing of transected mesovarial, mesometrial, and uterine remnants was observed. CONCLUSIONS: Ovariohysterectomy in horses can be accomplished using HALS technique. CLINICAL RELEVANCE: HALS-OHE technique represents a minimally invasive and technically feasible alternative for conventional OHE. Careful patient selection and preparation may reduce the complications observed. The HALS technique may be useful in other laparoscopic surgical procedures.     

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.     

Use of pneumocystoplasty for overinflation of the swim bladder in a goldfish

A Ryukin goldfish was evaluated because of a 6-month history of progressive abdominal distention and positive buoyancy. Overinflation of the swim bladder was diagnosed, and the fish was anesthetized with tricaine methanesulfonate. Archimedes' principle was used to determine the volume of swim bladder that was removed surgically. The caudal swim bladder was exteriorized through an abdominal incision and 2 surgical clips were placed across it to limit its size. After surgery, the fish remained in a state of negative buoyancy in sternal and lateral recumbency on the bottom of the tank. Sutures were removed 15 days after surgery, but the fish died 24 days after surgery. A full necropsy could not be performed because of autolysis of the tissues, but the surgical clips and the swim bladder appeared unremarkable. Pneumocystoplasty may be a viable treatment for this condition.     

Vaginal rupture associated with herniation of abdominal viscera in pregnant ewes

Seventeen cases of vaginal rupture with herniation of abdominal organs were examined. The injury consisted of a dorsal tear in the vagina and, most frequently, evisceration of the bowel. The tear was accompanied by extensive vaginal bleeding. Serum calcium concentrations were low in the affected cases and the concentrations of beta-hydroxybutyric acid and urea were high. The average age of the affected ewes was four years (range 3 to 6). They were generally in poor condition and carrying more than one fetus (2.7 lambs per ewe) although younger ewes and ewes in good condition were also affected. No primiparous ewes were affected. Ten of the 17 ewes were found dead and six were humanely destroyed; in one, the injury was repaired surgically but the ewe died 48 hours later.     

Cystic calculus in a mare due to a misplaced uterine glass marble

A 9-year-old Quarter Horse mare was referred for evaluation of continuous oestrus, polyuria and suspected pyometra after a glass marble was placed in the uterus by the owner. Palpation per rectum and transrectal ultrasonography confirmed the presence of a spherical object, but it was not possible to discern whether it was located within the lumen of the uterus or urinary bladder. Thus, an endoscopic examination of both uterus and bladder was carried out and a spherical, spiculated surface urolith was found on the floor of the bladder. The cystic urolith with suspected marble core was removed using a 12-mm specimen retrieval bag with endoscopic guidance. Follow-up with the owner one month after discharge revealed that the mare had not shown any signs of discomfort while urinating nor signs of oestrus.     

Vaginal evisceration of the small intestine in three mares

Three mares were treated for vaginal evisceration of a portion of the small intestine. Evisceration occurred in 2 mares shortly after breeding accidents in which the stallion's penis penetrated the vaginal fornix dorsal to the cervix. The affected bowel was replaced through the laceration, and the vaginal defects were sutured with the mares standing, utilizing epidural anesthesia. One mare recovered without complications, was subsequently bred, and delivered a foal with no difficulty. The other mare developed signs of a strangulating small intestinal obstruction 24 hours after the injury, necessitating exploratory celiotomy. Two meters of small intestine had become devitalized secondary to avulsion of the mesentery and adjacent vascular supply during the evisceration. The affected portion was resected and a jejunocecostomy was performed. Recovery was uncomplicated and 21 months later the mare was 9 months in foal. A third mare was treated unsuccessfully for evisceration of several meters of small intestine through the external urethral orifice after rupture of the urinary bladder.