Equine Uterine and ovarian surgery Flashcards
Ovariectomy indications
ovarian disease
behavior
genetic
uterine malformation
REBA
7 yo pony mare with stallion like behavior for 6 months, have not observed in heat
repro exam: left ovary >10 cm diameter, right ovary very small
U/s left ovary cystic appearance
DDx for large ovary? DDx for small ovary
Large ovary: hematoma, abscess, neoplasia, cyst
small ovary: anestrus, functional tumor on other ovary
REBA
7 yo pony mare with stallion like behavior for 6 months, have not observed in heat
repro exam: left ovary >10 cm diameter, right ovary very small
U/s left ovary cystic appearance
CBC/chem: WNL
Progesterone: low
Testosterone: high
inhibin: high
What does REBA have
Granulosa cell tumor
secretes inhibin>testosterone>estrogen
other ovary nonfunctional
rarely malignant
REBA
7 yo pony mare with stallion like behavior for 6 months, have not observed in heat
repro exam: left ovary >10 cm diameter, right ovary very small
U/s left ovary cystic appearance
CBC/chem: WNL
Progesterone: low
Testosterone: high
inhibin: high
She has granulosa cell tumor
What are the surgical options?
Colpotomy
laparoscopic removal
flank incision
ventral celiotomy
Surgical choice for : Best client’s best horse for granulosa cell tumor
laparoscopic
less hemorrhage
surgical choice for: a backyard “rescued” mare (low dollar value) that gets an attitude with each heat cycle
colpotomy
cheap
Colpotomy
remove fecal ball or end of uterus-hold off feed
vaginal incision left open-keep cross tied
ovarian pedicle crushed-incomplete crush can lead to hemorrhage
risk of peritonitis, abscesses
colic postop-prevent with mineral oil prepop
Flank laparotomy
standing
may be able to reach ovaries from one side
best for smaller ovaries
crush pedicle or use stapler
Complications of flank laparotomy
hemorrhage-keep quiet for 2-3 days
incisional problems-edema, dehiscence
peritonitis
colic-prevent with mineral oil
Ventral laparotomy
oblique paramedian
direct visualization of pedicle
complications of ventral laparotomy
hemorrhage-esp with tumors
peritonitis, incisional infection
incisional hernia-stall rest 4-6 weeks
colic-prevent with mineral oil
laparoscopy
standing
hemorrhage is controlled-coagulation
may need bilateral approaches
small incisions
preferred technique
complications of laparoscopy
colic-gas insufflation
incisional problems-related to size of ovary
Ramona
8 yo QH mare
8 mo gestation
colic signs: intermittent, moderate
vaginal exam: normal, cervix closed
rectal exam: band running over top of uterus from left to right, band running on right ventrally, foal seems to be further forward than normal, impaction of small colon and twisted to the right
What’s going on?
uterine torsion
typical presentation
8-9 mo gestation
normal vaginal exam
clockwise torsion
DDx colic
Tx options for uterine torsion
detorse using fetus
roll
sx: flank, ventral midline
uterine torsion: detorse using fetus
vaginal approach, grab foal, rock foal until torsion corrects
usually can’t get to foal because cervix is not open
uterine torsion: roll
roll the mare to catch up with the uterus
in direction of torsion
repeat rectal to confirm detorsed
complications: uterine rupture, recurrence (camelids)
Uterine torsion: flank surgery
standing through PLF
complications: uterine tear, peritonitis, incisional problems
uterine torsion: ventral midline
if big foal, big horse, damaged uterus, emphysematous fetus
easier for C-section and repair of uterus
Uterine torsion Prognosis
mare survial: 73-84%, with no impairment on fertility
foal survival-54-70% if alive at time of surgery, may have maladjustment syndrome
better survival if <320 d gestation at time of torsion, able to correct via flank incision
Uterine torsion in Camelids
more like cows-later gestation with vaginal twist
tx: rolling, female does it on their own, C-section
Cesarean section: semielective
planned C-section: anticipated dystocia, poss trauma to mare
dying mare: quick delivery, sterility not crucial, low flank approach just after mare is anesthesized
Cesarean section: semiemergency
dead foal: need to remove witin 3-4 hours of membrane rupture
Cesarean section: emergency
foal alive or poss alive
need to remove within 45-60 min of membrane rupture
cesarean section details
ventral midline
good anes team
start caudal to umbilicus and extend forward
find limb
exteriorize so stable
pack off abdomen, stay sutures on uterus
chains ready, foal team ready, cut
tilt horse or table
hemostatis stitch to control hemorrhage-close uterus in 2 layers, don’t suture in placenta
Cesarean section: post op
oxytocin until placenta is expelled
watch feet for laminitis
Abx +NSAIDS 3-5d
uterine lavage after 12-24 h
exercise
montiro manure
Cesarean section: complications
related to trauma of dystocia and manipulation: uterine, cervical or vaginal tear; interstinal bruising; postpartum straining; retained placenta
related to sx: incisional complications, anes complications, retained placenta, hemorrhage from uterine incision, myopathy, uterine adhesions
cesarean section: prognosis
foal-low
mare high decreased fertility
C-section Camelids
ventral midline or left flank
if no cria within 10 min of starting manipalution
always check for twin
placenta easier to remove
excellent future fertility
peripartum hemorrage
includes external iliac a, uterine a & its branches
often older mares
if external to broad ligament, will bleed out
if internal to broad ligament, may live
peripartum hemorrhage clin sxa
colic
anxious
pale
inc HR
dec Temp
weakness
blood on abd tap
peripartum hemorrhage: tx
r/o colic
fluids: hypertonic, blood
aminocaproic acid, formalin
don’t stress or rebreed
referral
causes of uterine rupture
dystocia (esp camelids)
uterine torsion
hydroamnois
normal delivery
uterine rupture
dorsal aspect
palpate per vagina
peritonitis
hemorrhage if large
death after lavage
supportive therapy
Refer’
hysterectomy
rare
pyrometric
tumor
macerated fetus
structural anomaly
uterine cyst
interfere with implantation
DDY preg
TX: laser ablation
