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Management of uterine torsion in a bitch with unilateral ovariohysterectomy.

Introduction

Twisting of uterus on its own long axis results in torsion of uterus. Uterine torsion is occasionally seen in canines. It is caused by lack of fetal fluid and violence such as sudden fa lls or rolling. Roberts (1982) and Jackson (2004) reported that uterine torsion was corrected by caesarean operation in bitch. The incidence of the disorder is higher in gravid than non gravid uterus. Kumru et al. (2011) observed a quickly deteriorating shock like state associated with severe abdominal pain, hemorrhagic vulval discharge, tachycardia and signs of shock in uterine torsion. It is reported in both pregnant and nonpregnant uteri in dogs, despite the fact that dogs have relatively long and freely movable uterine horns torsion of these structures is relatively uncommon. Torsion causes uterine veins to be obstructed and with continued inflow of arterial blood, marked congestion and edema occurs, cyanotic condition and necrosis of uterine horn is seen in present case of torsion of uterine horn.

History

A four year old second parity Boxer bitch was presented with history of 64 days gestation period from 2nd matting. She started whelping 14 hours back and delivered two live pu ps. Last pup delivered more than 12 hour back, subsequently bitch was not showing any signs of abdominal contractions and labor pains, mammary glands was contracted towards abdomen. Clinical examination revealed body temperature was 103.50F, blackish colour discharge from vagina, tense and distended uterine horns. On abdominal palpation, abdomen was tightly contracted, fetuses were not felt clearly. Ultra sound scanning found 2 dead fetuses with no fetal heart rate. She failed to show any abdominal and uterine contractions even after administration of i nj. 10% Calcium borogluconate 10 ml, plus inj. Dextrose 25% 100ml I.V. and inj. Oxytocin 5 IU, IV. Per vaginal examination of bitch, it was confirmed that pup had not progressed into birth canal. In vaginal feathering with help of fingers also failed to stimulate uterine and abdominal contractions. The condition was diagnosed as uterine torsion and decided to perform emergency c esarean operation.

Surgical Treatment and Discussion

Bitch was prepared aseptically for surgery by shaving mid ventral abdominal site and disinfected with antiseptic scrub and cleaned with surgical spirit. Bitch was surgically draped and a ventral midline incision was made from umbilicus to pubis. The aim was to incise precisely through linea alba and to avoid rectus abdominis muscle on each side. After skin incision, subcutaneous tissue is reflected and lenea alba identified. Once the abdominal cavity is entered the incision is extended with scissors, so care is taken not to incise underlying organs. The uterus was exteriorized and isolated from abdomen with moistened laparatomy sponges. Right uterine horn contained fetus and had 180[degrees] uterine torsion on its longitudinal axis caudal to caudate fetus, left uterine horn is found empty (Fig. 1). A incision was made in right uterine horn, care was taken not to lacerate a fetus. The two fetuses in right uterine horn were removed by bringing fetuses into incision site by gentile peristaltic motion on uterine horn with non dominant hand. Later grasped the fetus intraluminally with dominant hand and exerted gentile traction. The right uterine horn is in cyanotic and ischemic condition, uterine horn was peeling off when started suturing it. So it find difficult to suture the uterine horn incision. The owner requested not to neuter bitch due to high line of pedigree. Torsioned right uterine horn and right side ovaries were removed surgically by unilateral ovario hysterectomy. Later healthy portion of right side uterine horn serosa and incisions were wiped clean in preparation for closure. Retained placenta removed immediately before closure of incision of healthy uterus, it is closed with 2-0 chromic catgut suture material in double layer closure, first layer a simple continuous suture pattern followed by a second layer continuous cushing pattern. The abdominal contents are inspected for any signs of diseases and then lavaged with 100-200 ml of normal saline/kg b. wt. The abdominal wall was closed routinely by using Polyglycolic acid (Truglde (a)) synthetic absorbable suture material size 1 and subcutaneous in second layer. Third layer for skin suturing by using polyamide suture material, in interrupted mattress suture pattern. A course of antibiotics inj. Ceftriaxone (Intacef (b)) @ 20 mg/kg IM daily were administered for seven days. The bitch made an uneventful recovery and the sutures were removed on the 10th post-operative day. This bitch conceived in the subsequent season and delivered four pups normally.

Geigenmuller (1965) observed a 180 degree uterine torsion of right horn which containes one pup after normal whelping of 4 live pups. Joshi et al. (1967) noticed uterine torsion in a dog with uterine carcinoma. Brown et al. (1974) reported on a young pregnant bitch with torsion of the right uterine horn and it had subsequently herniated through the mesometrium of the non gravid left horn. Rendano et al. (1994) reported on a young bitch that was pseudo pregnant and had haemorrhagic placental sites. Shull et al. (1978) reported a nulliparous bitch that had torsion of both uterine horns--One was wrapped around the other 108[degrees] degrees and other one was twisted 270 degrees deDreu et al. (1980) reports on a single case of uterine torsion involving the left horn of a nulliparous bitch without obvious underlying disease, although t here was a hematoma in the affected portion. Homer et al. (1980) reported on a single case of a nulliparous bitch that had 180 degree torsion of the left uterine horn and 135 degree torsion of the left ovary. Ritt and Fossum (1997) reported a young dog that had torsion of the left horn of the uterus, which contained two retained fetuses. Lenarduzzi et al. (2002) reported a clinical case of a nonpregnant bitch that had torsion of the right uterine horn and ovary, with involvement of the uterine body. The horn was estimated to have twisted 360 degrees. England et al. (2007) observed a uterine torsion of 120 degrees around the body of the uterus in a pyometra bitch, which failed to respond to medical treatment. Barrand (2009) reported on a single case of a Mastiff dog with haematometra of about 20cm diameter and cystic endometrial hyperplasia that had torsion of the left horn. Chambers et al., (2011) reported one bitch with cystic endometrial hyperplasia, an endometrial polyp and pyometra with torsion of one uterine horn. Nakamura et al. (2012) reported torsion of a pus filled portion of uterine horn in a bitch having bilateral segmental aplasia of the uterus. Rautt et al. (2008) recorded abdominal rupture of torsion uterine horn detected during surgery.

In the present case, bitch delivered 4 pups in subsequent whelping. Similarly after unilateral ovario hysterectomy of uterine torsion bitches, Kumru et al. (2011) recorded 2 and 3 pups from same bitch in two deliveries, Seyrek et al., 2004 and Kelly 2001 reported two an d three pups respectively in following breeding period. Which was lower than the usual mean litter size in large breed dogs (seven puppies/litter) [Kelly 2001, Johnson 2008]. In conclusion, unilateral ovario hysterectomy seems to provide a practical opportunity to maintain breeding ability of precious bitches with unilateral uterine torsion with necrosis. Thus, owner satisfaction may be achieved despite reduced future litter size. Additional studies involving larger numbers of dogs are required to further establish possible complications and potential risks.

References

Barrand, K.R. (2009). Unilateral uterine torsion associated with haematometra and cystic endometrial hyperplasia in a bitch. Vet. Rec. 164: 19-20.

Brown, A.J. (1974). Torsion of the gravid uterus in a bitch. Vet Rec 94: 202.

Chambers, B.A., Laksito, M.A., Long, F. and Yates, G.D. (2011). Unilateral uterine torsion secondary to an inflammatory endometrial polyp in the bitch. Aust Vet J. 89: 380-84

De Dreu, P.J., Finkensieper. A.H. and van Essen, G.J. (1980). Uterine torsion in a German shepherd. Tijdschr Diergeneeskd 105: 208-09.

England, G.C., Freeman, S.L. and Russo, M. (2007).Treatment of spontaneous pyometra in 22 bitches with a combination of cabergoline and cloprostenol. Vet Rec. 160: 293-96.

Geigenmuller, H. (1965). Contribution on the uterine torsion in a pregnant dog. Wien Tierarztl Monatsschr. 52: 707-10.

Homer. B.L., Altman, N.H. and Tenzer, N.B. (1980). Left horn uterine torsion in a nongravid nulliparous bitch. J Am Vet Med Assoc. 176: 633-34.

Jackson, P.G.G. (2004). Postparturient problems in the dog and cat. In: Jackson P.G.G .: Handbook of veterinary Obstetrics, 2nd ed. W.B. Saunders Company, Philadelphia. P. 141-66.

Johnson, C.A. (2008). Pregnancy management in the bitch. Theriogenology. 70:1412-17.

Joshi, K.V., Sardeshpande, P.D., Jalnapurkar, B.V. and Ajinkya, S.M. (1967). A case of uterine adenocarcinoma in dog. Indian Vet J 44: 114-16.

Kelly, R.L. (2001). Canine reproductive management: Factors influencing litter size. Proc. Soc. Theriogenology, September 12 to 15, Vancouver, Canada.p. 263-82.

Kumru, I.H., Seyrek-Intas, K., Seyrek-Intas, D., Tek, H.B. and Wehrend, A. (2011). Clinical case: unilateral en bloc ovariocornuectomy as a treatment for uterine torsion in a bitch. Revue Med. Vet. 162: 76-78.

Lenarduzzi, T.A., Norton, J.C., Clark. B., McCoy, C.P. and Cantwell, H.D. (2002). What is your diagnosis? A large mass in the mid-portion of the abdomen with a tubular component extending into the caudal portion of the abdomen. J Am Vet Med Assoc. 221: 1687-88.

Nakamura, K., Yamasaki, M., Os aki, T., Ohta, H., Sasaki, N., Aoshima K, Kimura, T. and Takiguchi, M. (2012). Bilateral Segmental Aplasia with Unilateral Uterine Horn Torsion in a Pomeranian Bitch. J Am Anim Hosp Assoc. 48: 327-30.

Raut, B.M., D.S. Raghuwanshi, S.V., Upadhye, B.M. Gahlod., A.P., Gawande, P.R. S irsat and P.R. Wankhade. (2008). Uterine Torsion in a Bitch. Veterinary World 1: 212.

Rendano, V.T., Juck, F.A. and Binnington, A.G. (1994). Hematometra associated with ps eudocyesis and uterine torsion in a dog. J. Amer. Anim. Hosp. Assoc. 10: 557-80.

Ritt, M.G. and Fossum, T.W. (1997). Successful treatment of uterine torsion and fetal retention in a postparturient Great Pyrenees bitch with septic peritonitis and prothrombotic complications. J Am Anim Hosp Assoc 33: 537-39.

Roberts, S, J.C. (1982). Torsion of uterus. In: Veterinary Obstetrics & Genital Diseases. 2nd ed. CBS publishers and Distributors. p. 182-89.

Seyrek, K., Wehrend, A, Nak, Y., Tek, H.B., Yilmazbas, G.., Gokhan T. and Bostedt (2004). Unilateral hysterectomy (cornuectomy) in the bitch and its effect on subsequent fertility. Theriogenology. 61:1713-17.

Shull, R.M., Johnston. S.D., Johnston, G.R., Caywood. D. and Stevens, J.B. (1978). Bilateral torsion of uterine horns in a nongravid bitch. J Am Vet Med Assoc 172: 601-03.

K. Ramchandra Reddy (1), G. Arunakumari and C. Latha

Department of Veterinary Gynaecology and Obstetrics College of Veterinary Science Sri P.V. Narsimha Rao University for Veterinary, Animal and Fisheries Sciences Rajendranagar Hyderabad--500030 (Telangana)

(1.) Associate Professor and Head and Corresponding author. E-mail: krcreddy_scientist@yahoo.co.in

(a)--Brand of Sutures India Pvt. Ltd., Bengaluru

(b)--Brand of Intas Animal Health, Ahmedabad
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Title Annotation:Short Communication
Author:Reddy, K. Ramchandra; Arunakumari, G.; Latha, C.
Publication:Intas Polivet
Article Type:Report
Geographic Code:9INDI
Date:Jul 1, 2014
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