Day 8 - Surgery of the peritoneum, ovaries and uterus in mares

Question 1

Most injuries in dystocia happens ..?

Answer 1

Hymen (btw vestibulum and vagina)

Question 2

Blood supply and nerves

Answer 2

• A. / V. pudenda interna: most important blood supply to the genitals
• N. pudendus, n. rectus caudalis

Question 3

Sedation

Answer 3

Detomidine, xylasine, butorphanol in combo

Acepromacine

Question 4

Epidural anesthesia

Answer 4

2nd intercoccygeal space, 30 degree angle of needle,

lidocaine, xylacine or combo

Question 5

Disorders of the external genitalia

Answer 5

• Laceration (during dystocia)
• Perforation (in intromission: Vestibulum, vagina, rectum)
• Pneumovagina
• Rectovagina (dystocia)

Question 6

Pneumovagina - Tx

Answer 6

Caslick procedure - insert stitches to prevent aspiration of air.

Ford interlocking sutures

Question 7

Retrovagina

Answer 7

• Epidural
• Fasting for 2-3 days
• To step procedure
• Three layer suture: Interrupted and continuous

Question 8

Surgery of the ovaries and uterus - ovariectomy

Answer 8

1. Colpotomy: Écraseur technique
2. Laparotomy (flank, linea alba, diagonal paramedian)
3. Laparoscopy

Question 9

Surgery of the ovaries and uterus - Uterus

Answer 9

1. Uterine torsion
2. Uterine tear
3. Uterine prolapse
4. Broad ligament hemorrhage
5. Hysterectomy/ ovariohysterectomy
6. Cesarian section

Question 10

Indications of ovariectomy

Answer 10

• Theca granulosa cell tumor (85% of the cases of ovariectomy)
  (adenoma, melanoma, adenocarcinoma, teratoma, cystadenoma)
• “sport career”: estrus cycle can interfere with the career of the mare
• Oophoritis: very rare
• Hematoma, abscess
• In nymphomania: when the mare is in continuous heat causing abnormal behavior and aggression

Question 11

Colpotomy

Answer 11

• Standing procedure, must be in anoestrus (small vessels)
• No epidural - doesnt reach
• Flush and topical analgesia of the vagina
• Cut dorsolat, reach in and soak ovary in analgesic.
• use a loop to pull ovary out and cut.
• Incision is healed on its own

Not for tumors

Question 12

Laparotomy

Answer 12

Gold standard in removing ovaries and theca tumors

• Standing position (flank): Grid technique (cut along fibers), local ana, remove ovaries
• Midline laparotomy caudally from umbilicus
• Diagonal paramedian approach

Question 13

Laparoscopy

Answer 13

Standing or GA. Go through umbilicus with rigid scope, make two holes!

Question 14

Uterine torsion

Answer 14

8-10m pregnant. Torsion in front of the cervix.

Dx:
* Rectal examination
* Broad ligament overlapping (see picture)
* Rotates the small colon with (by 360 °)
* Cervix and vagina is not involved

Surgical: midline laparotomy

Question 15

Uterine rupture

Answer 15

Due to dystocia, uterine torsion

CS: paracentesis

Tx:
* Small perforations → can heal itself
* (standing from flank approach)
* In narcosis: from midline laparotomy

Question 16

Uterine prolapse

Answer 16

Due to dystocia, abortion, placental retention
Complications: Uterine tears, haem., bladder prolapse

Tx:
- Obs shock!
- Standing or GA.
- Elevation or replacement of the uterus
- Vulva closure

Question 17

Broad ligament hemorrhage:

Answer 17

Due to a. uterina!, a. ovarica, a. iliaca externa.

Tx: Limited, transfusion, pallative th.

Question 18

C-section

Answer 18

Hysterotomy.
Postop. complications: Abd pain, anaemia, placental retention

Dont breed for a year, 50/50 after one year. Cause of abortions; endometrial fibrosis, intrauterine adhesions

Question 19

Placental retention - Tx

Answer 19

Oxytocin and US control

Question 20

Fetotomy

Answer 20

Head must be in uterus.

More damage, longer. C-section is better.