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EQUINE VETERINARY EDUCATION / AE / MAY 2018
wall, the ventral pelvis and the ipsilateral uterine horn. The rest of the visible peritoneum appeared healthy, with no evidence of fibrin accumulation, or purulent material. Breakdown of the adhesions between the right ovary and the body wall was attempted using blunt dissection with laparoscopic artery forceps and laparoscopic Metzenbaum scissors (Bleyaert et al. 1997); however, gross contamination of the abdomen with purulent material occurred due to rupture of the ovarian capsule, and it was opted to perform a flank laparotomy for better visualisation. The laparoscopic instruments were removed. Additional local anaesthesia was provided by paravertebral thoracolumbar anaesthesia with 2% lignocaine hydrochloride (50 ml) (Moon and Suter 1993). Laparotomy was performed by vertical skin incision made midway between the last rib and the ventral aspect of the tuber coxa, incorporating the caudal instrument portal. Muscle layers were then bluntly dissected, and the peritoneum entered bluntly. Laparotomy revealed a large amount of purulent material contaminating the abdomen from the right ovary due to rupture of the abscessed ovarian capsule, as well as extensive adhesion formation between the ovary and the abdominal wall, pelvis and right uterine horn.
Discussions with the owner included the fact that the
mare would have to undergo removal of most of the right uterine horn and, additionally a peritonitis had been created during the surgery which would require potentially expensive and prolonged post-operative treatment. The owner’s goal for this mare was that of a breeding animal and therefore they made the decision to proceed with humane euthanasia.
Post-mortem findings/gross pathology
Post-mortem examination revealed the right ovary to be 18 9 10 cm with fibrous adhesions to the right uterine horn (Fig 1). Bisection of the ovary revealed a thick, fibrous capsule with necrotic debris and purulent material in the centre. Within the abscess, a metallic foreign body was discovered, a thin, linear piece of wire measuring 4 9 3mm (Fig 2). No fistulous tracts were evident on serosal surfaces of the abdominal organs and, while there was purulent
Fig 2: Image of the thick capsuled abscess bisected, revealing linear metallic foreign body within necrotic debris (arrow).
contamination of the peritoneal cavity from the surgery and manipulation of the ovary, there was no evidence of chronic peritonitis or inflammation. Multiple fibrous adhesions were present between the ovary, uterine horn and body wall. Sections of the ovarian mass were fixed in 4%
formaldehyde and submitted for histopathological examination. A sample of the purulent material around the foreign body was submitted for aerobic and anaerobic bacterial culture and antibiogram.
Histopathology and culture
Histopathology of the submitted tissue showed that there was almost complete obliteration of normal ovarian tissue. There was extensive neutrophil infiltration with necropurulent and haemorrhagic exudate with interstitial lympho-plasma cellular accumulates present in the deeper smooth muscle and connective tissue bands (Fig 3).
Fig 1: Post-mortem image of the grossly enlarged right ovary with extensive adhesions (arrow) between the ovary and the right uterine horn.
© 2016 EVJ Ltd
Fig 3: Histopathology images of the right ovary with ovarian tissue obliterated. Extensive interstitial lympho-plasma cellular accumulates with necro-purulent and haemorrhagic exudate (Image courtesy of Dr Sophette Gers, Western Cape Provincial Veterinary Laboratory).
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