EQUINE VETERINARY EDUCATION Equine vet. Educ. (2018) 30 (5) 237-240 doi: 10.1111/eve.12618
Case Report Metallic foreign body in the ovary of a broodmare
P. K. Randleff-Rasmussen* and A. S. Gray Drakenstein Veterinary Clinic – Equine, Paarl, South Africa. *Corresponding author email:
drpi42@gmail.com
Keywords: horse; wire foreign body; ovarian abscess; laparoscopy
Summary A 12-year-old Thoroughbred broodmare was presented for laparoscopic removal of an abnormal ovary. Rectal examination and ultrasound revealed firm attachment of the enlarged right ovary to the ventral pelvis and right abdominal wall, and gas accumulation within the right ovary. Laparoscopic examination revealed extensive adhesion formation between the abnormal ovary, ispilateral uterine horn, ventral pelvis and the right abdominal wall. A flank laparotomy was then performed to improve visualisation of the area. Due to contamination of the abdomen during attempts to detach adhesions, the complexity of the structures involved and the poor prognosis for further reproduction, the decision was made to subject the mare to euthanasia. Post-mortem evaluation revealed a large encapsulated abscess of the right ovary, with a small, linear wire foreign body within the centre of the abscess.
Introduction
While horses are more selective feeders than other grazers such as cattle, metallic foreign bodies are still occasionally consumed, and can pass through the alimentary tract and either become encapsulated within the gut lumen or perforate the intestinal wall, leading to peritonitis, adhesions or abscess formation (Monteiro et al. 2011). Metallic foreign bodies are most commonly reported lodged in the upper alimentary tract or tongue (Bayly and Robertson 1982; Kiper et al. 1992; Pusterla et al. 2006). In addition, the metallic objects can be swallowed, and pass through the gastrointestinal tract (Elce et al. 2003) to extraintestinal sites, where abscesses are formed (Dehlinger et al. 2006; Saulez et al. 2009). This paper describes a case of a metallic foreign body
that potentially migrated through the intestinal tract, penetrating into the right ovary where it formed a large encapsulated abscess, with multiple adhesions forming between the ovary and the body wall, as well as the right uterine horn.
Case history
A 12-year-old Thoroughbred broodmare was referred to the Drakenstein Veterinary Clinic for removal of an enlarged right ovary. The referring veterinarian was suspicious of a granulosa cell tumour due to the mare being unable to conceive during this and the previous breeding season and an enlarged ovary had been palpated on rectal examination. There was no recorded history of colic symptoms, fever or behavioural changes.
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Case description
On presentation, the mare was bright and alert, and all vital parameters were within normal limits, with a heart rate of 40 beats/min (reference range [rr] 36–44 beats/min), a respiratory rate of 14 breaths/min (rr 12–16 breaths/min) and rectal temperature of 37.3°C (rr 36.5–38°C). Haematology and serum chemistry showed no abnormalities, with white cell count, neutrophil count, packed cell volume and fibrinogen all within normal limits. Rectal palpation revealed a grossly enlarged right ovary
that was immobile, with only the dorsal border of the ovary palpable. The ovary appeared to be anchored within the pelvis, and unusually firmly attached to the cranial ipsilateral uterine horn. Transrectal ultrasonography showed the large right ovary with a gas pocket within the stroma; infection was suspected. A decision to perform laparoscopic evaluation and removal was made.
Surgical findings
The mare was starved for 2 days prior to laparoscopy being performed. She was premedicated with 1.1 mg/kg bwt i.v. flunixin meglumine1, 6.6 mg/kg bwt intravenous gentamicin2
and 22,000 iu/kg bwt i.m. procaine penicillin2. She received a loading dose of 4 mg detomidine hydrochloride3 (0.006 mg/ kg bwt) and 4 mg butorphanol tartrate4 (0.006 mg/kg bwt), and was then placed under constant rate infusion sedation with detomidine hydrochloride3 and butorphanol tartrate4 at 5 lg/kg bwt/h (Van Dijk et al. 2003; Solano et al. 2009). The right flank of the horse was clipped and aseptically
prepared for surgery and the skin and muscles at the sites for laparoscopic instrument insertion were infiltrated with 2% lignocaine hydrochloride5 (10 ml per site). Laparoscopy was performed using a 57 cm long rigid
laparoscope with a 30° viewing angle, connected to a video monitor. The laparoscope was introduced into the abdominal cavity using a 10 mm trocar inserted just dorsal to the crus of the internal abdominal oblique muscle, approximately 2 cm caudal to the last rib. The abdomen was insufflated with carbon dioxide via an insufflator with a flow rate of 6 l/min (Latimer et al. 2003), and an intra-abdominal pressure cut-off at 10 mmHg. A 5 mm trocar was introduced approximately 10 cm caudal to the laparoscope port and directed caudally and ventrally, to act as an instrument port. The 30° viewing angle enabled a craniomedial
visualisation of the affected right ovary (Gottschalk and Berg 1997). The ovary was located dorsally in the abdomen, extending caudally into the pelvic canal. Extensive adhesions were visible, tightly adhering the ovary to the right abdominal
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