Equine Uterine and ovarian surgery

Question 1

Ovariectomy indications

Answer 1

ovarian disease

behavior

genetic

uterine malformation

Question 2

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

Answer 2

Large ovary: hematoma, abscess, neoplasia, cyst

small ovary: anestrus, functional tumor on other ovary

Question 3

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

Answer 3

Granulosa cell tumor

secretes inhibin>testosterone>estrogen

other ovary nonfunctional

rarely malignant

Question 4

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?

Answer 4

Colpotomy

laparoscopic removal

flank incision

ventral celiotomy

Question 5

Surgical choice for : Best client’s best horse for granulosa cell tumor

Answer 5

laparoscopic

less hemorrhage

Question 6

surgical choice for: a backyard “rescued” mare (low dollar value) that gets an attitude with each heat cycle

Answer 6

colpotomy

cheap

Question 7

Colpotomy

Answer 7

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

Question 8

Flank laparotomy

Answer 8

standing

may be able to reach ovaries from one side

best for smaller ovaries

crush pedicle or use stapler

Question 9

Complications of flank laparotomy

Answer 9

hemorrhage-keep quiet for 2-3 days

incisional problems-edema, dehiscence

peritonitis

colic-prevent with mineral oil

Question 10

Ventral laparotomy

Answer 10

oblique paramedian

direct visualization of pedicle

Question 11

complications of ventral laparotomy

Answer 11

hemorrhage-esp with tumors

peritonitis, incisional infection

incisional hernia-stall rest 4-6 weeks

colic-prevent with mineral oil

Question 12

laparoscopy

Answer 12

standing

hemorrhage is controlled-coagulation

may need bilateral approaches

small incisions

preferred technique

Question 13

complications of laparoscopy

Answer 13

colic-gas insufflation

incisional problems-related to size of ovary

Question 14

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?

Answer 14

uterine torsion

typical presentation

8-9 mo gestation

normal vaginal exam

clockwise torsion

DDx colic

Question 15

Tx options for uterine torsion

Answer 15

detorse using fetus

roll

sx: flank, ventral midline

Question 16

uterine torsion: detorse using fetus

Answer 16

vaginal approach, grab foal, rock foal until torsion corrects

usually can’t get to foal because cervix is not open

Question 17

uterine torsion: roll

Answer 17

roll the mare to catch up with the uterus

in direction of torsion

repeat rectal to confirm detorsed

complications: uterine rupture, recurrence (camelids)

Question 18

Uterine torsion: flank surgery

Answer 18

standing through PLF

complications: uterine tear, peritonitis, incisional problems

Question 19

uterine torsion: ventral midline

Answer 19

if big foal, big horse, damaged uterus, emphysematous fetus

easier for C-section and repair of uterus

Question 20

Uterine torsion Prognosis

Answer 20

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

Question 21

Uterine torsion in Camelids

Answer 21

more like cows-later gestation with vaginal twist

tx: rolling, female does it on their own, C-section

Question 22

Cesarean section: semielective

Answer 22

planned C-section: anticipated dystocia, poss trauma to mare

dying mare: quick delivery, sterility not crucial, low flank approach just after mare is anesthesized

Question 23

Cesarean section: semiemergency

Answer 23

dead foal: need to remove witin 3-4 hours of membrane rupture

Question 24

Cesarean section: emergency

Answer 24

foal alive or poss alive

need to remove within 45-60 min of membrane rupture

Question 25

cesarean section details

Answer 25

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

Question 26

Cesarean section: post op

Answer 26

oxytocin until placenta is expelled watch feet for laminitis Abx +NSAIDS 3-5d uterine lavage after 12-24 h exercise montiro manure

Question 27

Cesarean section: complications

Answer 27

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

Question 28

cesarean section: prognosis

Answer 28

foal-low mare high decreased fertility

Question 29

C-section Camelids

Answer 29

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

Question 30

peripartum hemorrage

Answer 30

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

Question 31

peripartum hemorrhage clin sxa

Answer 31

colic anxious pale inc HR dec Temp weakness blood on abd tap

Question 32

peripartum hemorrhage: tx

Answer 32

r/o colic fluids: hypertonic, blood aminocaproic acid, formalin don't stress or rebreed referral

Question 33

causes of uterine rupture

Answer 33

dystocia (esp camelids) uterine torsion hydroamnois normal delivery

Question 34

uterine rupture

Answer 34

dorsal aspect palpate per vagina peritonitis hemorrhage if large death after lavage supportive therapy Refer'

Question 35

hysterectomy

Answer 35

rare pyrometric tumor macerated fetus structural anomaly

Question 36

uterine cyst

Answer 36

interfere with implantation DDY preg TX: laser ablation