Total Hysterectomy as Treatment for Recurrent Chronic Pyometra in Mares With Total Cervical Adhesion–Case Report

Abstract

Radical hysterectomy is indicated as a last resource in pyometra that does not respond to pharmacological therapy, uterine torsion with vascular involvement and onset of necrosis, neoplasia, ruptures of impossible synthesis and rarely, segmental aplasia with accumulation of secretion. The incidence of pyometra is multifactorial, being an unusual condition in this species. Generally, it is originated by failure of the physiological draining of the uterine fluid, which may be due to the presence of cervical adherences or to a sinuous or irregular cervical canal, as well as due to its stenosis. The diagnosis is conducted by a complete gynecological exam, which consists of rectal palpation, ultrasound examination, culture and antibiogram of the content, and can be complemented by uterine biopsy when it is possible. Differential diagnosis should be conducted to confirm the absence of gestation, mucometra and pneumometra. The present report is about an equine female, Mangalarga breed, 23 years old, body weight of 470 kg, diagnosed with recurrent chronic pyometra that was unsolved by conventional methods, and surgical intervention was performed for hysterectomy as a treatment of selected.

Occurrence of a vaginal septum in a foal diagnosed with pyometra

“…The occurrence of pyometra, an accumulation of purulent material within the uterine lumen, is regarded as uncommon in the equine species (Lu 2011; Wilborn 2012). Development of pyometra in this 10‐week‐old unweaned filly was unique because all previous reports of pyometra in this species have been described in mares of breeding age (Abou‐Gabal et al 1977; Pugh and Caudle 1987; Wilborn 2012; Rais et al 2013; Arnold et al 2015; El‐Bahr and El‐Deeb 2016; Pasch et al 2017; Prestes et al 2018).…”

“…and Propionibacterium spp. (McKinnon et al 1993; Prestes et al 2018). Rarely, fungal pathogens have also been reported to cause pyometra (Abou‐Gabal et al 1977).…”

“…In many cases, pyometra is associated with a persistent corpus luteum that secretes progesterone and causes functional closure of the cervix (Lu 2011). Known physical causes of obstruction include cervical or vaginal adhesions (complications of antecedent reproductive activities, birth trauma, dystocia and fetotomy), intra‐abdominal adhesions that affect uterine position or neoplasia (Santschi et al 1995; Lu 2011; Wilborn 2012; Pasch et al 2017; Prestes et al 2018). Other reported predisposing factors for pyometra have included suboptimal perineal conformation (inadequate vulval seal predisposing to faecal bacterial contamination), vesicovaginal reflux (urine pooling), administration of exogenous progestins (such as progesterone and altrenogest) in the face of underlying chronic endometritis and immunosuppression (pyometra may be more likely in older mares affected with pituitary pars intermedia dysfunction) (Pugh and Caudle 1987; Johnson et al, 2011; Wilborn 2012; El‐Bahr and El‐Deeb 2016; Prestes et al 2018).…”

“…In the mare, pyometra most commonly arises as a complication of obstruction within the reproductive tract such that uterine drainage is impaired and ascending infection by local commensal opportunists arises (Santschi et al 1995; Wilborn 2012; Prestes et al 2018). In many cases, pyometra is associated with a persistent corpus luteum that secretes progesterone and causes functional closure of the cervix (Lu 2011).…”

“…equisimilis , Escherichia coli , Actinomyces spp., Pasteurella spp., Pseudomonas spp., Propionibacterium spp. and Candida rugosa (Abou‐Gabal et al 1977; McKinnon et al 1993; Rais et al 2013; Prestes et al 2018).…”