Occurrence
•
Breeding
o
Rectal tears
•
Palpation
•
Penetration by stallion
o
Vaginal Tears
•
Penetration by stallion
•
Peri-parturient
o
Dystocia
o
Hemorrhage
o
Uterine
•
Torsion
•
Prolapse
•
Rupture / tear
•
Retained fetal membranes
•
Metritis
o
Vagina
•
Rectovaginal Tears
o
Gastro-intestinal
•
Damage to viscera
•
Rectal prolapse
Breeding associated emergencies
•
Rectal Tears
o Associated with:
•
Palpation
•
Penile penetration of rectum by stallion
o
Signs
•
"Feeling" of release of rectal tissue around arm
•
Blood on sleeve or penis
•
Onset of shock
•
Signs of peritonitis
•
Usually colic
•
Straining to defecate
o
Types
•
Grade 1
-
Involves only rectal mucosa and submucosa
•
Grade 2
-
Through muscular layer
•
Mucosa and submucosa intact
-
No bleeding
-
Forms diverticulum
•
Grade 3a
-
Only serosal layer is intact
•
Grade 3b
-
Occurs dorsally
-
Mesorectum and retroperitoneal tissues are intact
•
Grade 4
-
All layers disrupted
-
Fecal contamination of peritoneum
o
Incidence
•
Most occur dorsally
•
15 – 55 cm from the anus
•
In one retrospective study of 85 horses with rectal tears (Eastman TG et al Equine Vet Edu 2000 12(5):263-266.)
-
47/85 associated with routine pregnancy exams
-
Grade 1 - 93% survived to discharge
-
Grade 2 – 66% (2/3) survived to discharge
-
Grade 3a – 70%
-
Grade 3b – 69%
-
Grade 4 – 6%
•
Few cases of penile penetration in literature
-
2 at MDS-EMC in last 5 years
-
Both lateral wall
-
Grade 3b
-
Both survived
o
First-Aid for Rectal Tears
•
Exam of tear
•
Sedation
•
Buscopan
•
Careful palpation
•
Remove feces
•
Pack rectum
-
20 cm cranial to tear
•
Close anus
•
Epidural
-
Transportation concerns
•
Antibiotics
-
Broad spectrum
-
Penicillin (potassium or sodium penicillin 22,000 IU; IV)
- Gentamicin – 6.6 mg/kg IV
-
Metronidazole – 15 mg/kg PO
• Flunixin meglumine – 1.1 mg/kg IV
•
Tube with oil
•
IV fluids
-
If in shock
•
Withhold food
•
Refer for evaluation
•
Vaginal Tears
o
Occur during intromission
o
Uncommon
o
Mild to severe trauma to vagina
o
Vaginal rupture
•
Usually adjacent to cervix
•
Dorsolateral
•
Can also affect lateral wall of vestibule
•
Semen is not sterile
•
Results in peritonitis
•
Evisceration (Tulleners EP et al JAVMA 1985 186(4): 385-7)
o
Partial thickness
•
Peri-vaginal abscessation if not identified acutely
o
Signs
•
Vaginal bleeding
•
Colic
-
Minutes to hours post-breeding
•
Straining
•
Peritonitis (signs)
•
Fever
•
Depression
•
Lethargy
o
First Aid for Vaginal Rupture
•
Broad spectrum antibiotics
•
Peritonitis
•
Flunixin meglumine
• If evisceration:
-
Reduce and pack with sterile soaked towels
-
Large enough so they won't pass into the abdomen through the tear
-
Close vulva
-
Clamps or suture closed
•
Treat shock
•
Refer for medical and surgical treatment
