Castration Complications Flashcards
Why is castration the easiest most difficulty surgery you will do?
Most common cause of malpractice claims
What is the complication rate of castrating a horse?
Up to 38%
Are castration complications usually very severe?
No, most are mild or self-limiting
What is the best way to avoid complications and treat them well when they occur?
Know your anatomy
When does the worst swelling occur after castration?
3-5d post-op
When should swelling post-castration resolve?
10-12d post-op
What are additional clinical signs that might indicate the excessive swelling is more complicated than just swelling?
Stiff gait reluctance to urinate or move
What demographic of horses are at higher risk of having an excessive swelling complication?
Older horses
Not enough scrotal skin removed, infection, lack of exercise or skin/SQ stretch
Excessive swelling
How do you treat excessive swelling?
Establish drainage, NSAIDs, forced exercise to get lymphatics moving
How will the swelling migrate over time if it persists?
Moves forward to the prepuce
What can excessive swelling lead to?
Infection, dysuria, paraphimosis
What are sources of hemorrhage assoc. w/castration?
Testicular a. cremaster m. SQ vessels
What causes hemorrhage?
Faulty emasculators or improper use of emasculators
How can you determine if hemorrhage is normal or excessive?
Should drip, not flow, but drip should not persist for more than a couple days
How do you treat hemorrhage?
ID and ligate source or pack w/sterile gauze and suture
What meds can you give to help stop hemorrhage?
Aminocaproic acid
When should you refer a hemorrhage complication?
Hypovolemic shock, intra-abdominal hemorrhage
How often should you check bloodwork for changes assoc. w/intra-abdominal hemorrhage?
Every 6h
Why won’t bloodwork demonstrate PCV drop w/intra-abdominal hemorrhage immediately?
Splenic contraction
Presents as swelling, fever, lameness, discharge anywhere from days to years after castration
Septic funiculitis
How do you dx septic funciculitis?
Decreased serum amyloid A response
What is septic funiculitis?
Chronic infection of the spermiatic cord
What is the most common bacteria cultured from septic funiculitis cases?
Staphylococcus
How do you correct septic funiculitis?
Strip back to unaffected region and emasculate (remove infected tissue)
When should you refer a septic funiculitis case?
Non-responsive to tx, CS present months post-op, sepsis/endotoxemia
How can you prevent clostridial infections when castrating?
Booster w/tetanus toxoid peri-operatively
Treat this uncommon complication by IDing, ligating, and transecting tissue and confirming anatomic normalcy via rectal palpation
Omental eventration
What complication is an inherent risk that happens within 4h of castration and is often life-threatening?
Intestinal eventration
How do you treat an intestinal eventration?
Lavage and replace through scrotum and suture/sling closed - REFER
How do you refer an intestinal eventration?
Sedation, IV abx, banamine
Uncommon complication of an open castration that is not an infectious process - treatment is cosmetic
Hydrocele
How do you treat a hydrocele?
Remove the rest of the parietal tunic
Presents with colic, fever, depression, and anorexia
Peritonitis
How do you dx peritonitis?
MDB and abdominocentesis
Why should abdominocentesis not be the sole method used to dx peritonitis?
WBC should be >100k for 3-4d after castration anywah
What parameters of abdominocentesis other than WBC can indicate peritonitis?
Intracellular bacteria, degenerate PMNs, glucose
How do you treat peritonitis?
Intensive ICU care
Occurs when the surgeon is inexperienced and doesn’t know basic anatomy
Penile damage
How do you treat penile/urethral transection?
Refer for sx intervention
How do you treat nerve damage and subsequent paraphimosis assoc. w/penile damage?
Sling, hydrotherapy, NSAIDs
Inadvertent removal of epididymal tail but not testes
Incomplete castration
Why might an incomplete castration occur?
Cryptorchid epididymis looks like hypoplastic testis to an inexperienced clinician
What % of horses demonstrate aggressive behavior toward other horses post-castration?
20-30%
What % of horses demonstrate aggressive behavior toward humans post-castration?
5%
