Cervical wedge resection for treatment of pyometra secondary to transluminal cervical adhesions in six mares.
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CASE DESCRIPTION: 6 mares with pyometra secondary to transluminal cervical adhesions were examined. CLINICAL FINDINGS: Reasons for hospital admission included infertility (5 mares) and acute colic (1 mare). In the 6 mares, palpation per rectum of the reproductive tract revealed uterine distention, and transrectal ultrasonography confirmed the presence of echogenic fluid accumulation within the uterus. Cervical palpation during vaginal speculum examination indicated transluminal cervical adhesions. Three mares had severe distortion of the cervix as a result of diverticula and fibrosis. All 6 mares had a diagnosis of pyometra secondary to transluminal cervical adhesions. TREATMENT AND OUTCOME: Initially, the cervical adhesions were manually broken down to establish a patent cervical lumen to accommodate a uterine lavage catheter. A sample of the uterine content was obtained for bacteriologic culture and antimicrobial susceptibility testing, and the uterus was lavaged with 0.05% povidone-iodine solution to remove the mucopurulent exudate. Once the uterus was evacuated, cervical surgery was performed in standing mares following sedation and caudal epidural anesthesia. A full-thickness wedge-shaped defect was made in the dorsolateral aspect of the cervix that created a permanent opening to the uterus. Postoperative care included applying topical medication to the cervix to reduce the recurrence of adhesion formation. All 6 mares had patent cervices and resolution of pyometra following surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Cervical wedge resection enabled treatment of pyometra in mares with transluminal cervical adhesions, without the need for ovariohysterectomy.
