A Clinical Case of Foetal Maceration and Posttraumatic Uterine Rupture in a Bitch

Öz

A clinical case of uterine rupture following external trauma and macerated foetuses, which were diagnosed 20 days after parturition and without signs of sepsis in a 10-year-old Bulgarian Scenthound bitch is described. On physical examination, there were no changes in the general condition of the animal. Complete blood counts and blood biochemistry results did not show any deviations from reference values and did not indicate sepsis development. After ultrasonography, foetal debris was observed and radiography confirmed the presence of parts of two foetuses in the abdominal cavity. Median laparotomy revealed macerated foetus (hair and bones) in the abdominal cavity, ruptured left uterine horn near to the bifurcation and a macerated foetus inside the horn. Due to the adhesions between the omentum and the uterus and pathological alterations of the uterine wall in the ruptured area, ovariohysterectomy was performed. The clinical examination had been performed for ten days until the bitch showed good recovery.

Key Words: Rupture, uterus, maceration, bitch

Anahtar Kelimeler

• Rupture, uterus, maceration, bitch

BİR DİŞİ KÖPEKTE GÖRÜLEN KLİNİK FÖTAL MASERASYON VE POSTTRAVMATİK UTERUS RUPTURU VAKASI

Öz

Bu klinik vakada; 10 yaşındaki Bulgar Scenthound ırkı dişi bir köpekte, eksternal travmayı takiben oluşan, doğumdan 20 gün sonra teşhis edilen ve sepsis gözlenmeyen uterus rupturu ve fötus maserasyonu anlatılmaktadır. Yapılan fiziksel muayenede hayvanın genel durumunda bir değişiklik gözlenmemiştir. Total kan sayımı ve kan biyokimyasal test sonuçlarında referans değerlerden herhangi bir sapma veya sepsis gelişimi görülmemiştir. Ultrasonda fötal kalıntılar gözlendikten sonra yapılan radyografide, abdominal boşlukta iki fötusa ait parçalar bulunduğu tespit edilmiştir. Yapılan median laparatomi ile bifurkasyo noktasından yırtılmış sol uterus boynuzu içerisinde masere olmuş ve abdominal boşlukta bulunan (saç ve kemikten oluşan) iki adet fötus ortaya çıkarılmıştır. Yırtılan bölgedeki uterus duvarında gerçekleşen patolojik değişiklikler ve uterus ile omentum arasında oluşan yapışmalar nedeniyle ovariyohisterektomi operasyonu gerçekleştirilmiştir. Tedaviden 10 gün sonra yapılan klinik muayenede hayvanın iyileştiği gözlenmiştir.

Anahtar Kelimeler: Ruptur, uterus, maserasyon, dişi köpek 

Anahtar Kelimeler

• Ruptur, uterus, maserasyon, dişi köpek

Kaynakça

1. Values* Biochemistry Parameter Result Reference values # HGB 122 120-180 Total protein 69 0-0 HCT 1 37-55 Glucose 5 61-55 RBC 99 5-5 ASAT 28 23-66 MCV 64 60-77 ALAT 25 21-102 PLT (x10 9 /l) 258 200-500 Urea (mmol/l) 13 67-33 WBC (x10 9 /l) 6 0-0 Creatinine (µmol/l) 7 2-132.6 NS (x10 9 /l) 8 0-5 LYMP (x10 9 /l) 2 0-8 EOS (x10 9 /l) 0.2 0.1-25 MON (x10 9 /l) 0.4 0.15-35 BASO (x10 9 /l) 0-0.1 Legend: HGB = hemoglobin; HCT = hematocrit; RBC = red blood cells; MCV = mean corpuscular volume; PLT = platelets; WBC = white blood cells; NS = neutrophils; LYMP = lymphocytes; EOS = eosinophils; MON = monocytes; BASO = basophils # Kaneko et al., 2008; Weiss and Wardrop, 2010 Operative intervention After aseptic operation site preparation, the patient was premedicated subcutaneously with 0.04 mg/kg atropine sulphate (Atropinum sulfuricum; Sopharma; Bulgaria). Fifteen minutes later anaesthesia was induced by intravenous injection of 0.4 mg/kg diazepam
2. (Diazepam; Sopharma; Bulgaria) and 10 mg/kg ketamine (Кetaminol 10; Intervet; Holland). After endotracheal intubation, general anaesthesia was maintained with isoflurane (Forane; Abbott Laboratories Ltd; United Kingdom). The operative approach included median laparotomy that revealed macerated foetal debris (hair and bones) in the abdominal cavity after opening of the peritoneum. The inspection of the uterus showed ruptured left uterine horn adjacent to the bifurcation (Figure 4), adhesions between the omentum and the uterus and a macerated foetus inside the uterine horn (Figure 5). Figure 2. Sonographic visualization of foetal debris. Şekil 2. Fötal kalıntıların sonografik görüntüsü. Figure 3. Lateral abdominal radiography showing debris of two fetuses. Şekil 3. İki fötusa ait kalıntıların bulunduğu lateral abdominal radyografi. Figure 4. Rupture of the left uterine horn adjacently to the bifurcation and adhesions between the omentum and the uterus. Şekil 4. Uterusun sol boynuzunda bifurkasyo bölgesindeki ruptur ve omentum ile uterus arasındaki yapışmalar. Figure 5. Maceration of a foetus in the left uterine horn. Şekil 5. Uterusun sol boynuzundaki masere olmuş fötus. There was no exudate within the abdominal cavity, or pathological alterations of the peritoneum and the other visceral organs. On the basis of these findings, ovariohysterectomy was performed. The abdomen was washed twice with sterile saline and closed with interrupted No 1 absorbable polyglycolic acid sutures (Marlin; Catgut GmbH; Markneukirchen), and the skin was sutured with simple interrupted non-absorbable sutures No 0 (Vitalon; Dr Hammer & Co. GmbH; Hamburg). Post-operative treatment included 7-day antibiotic treatment with 30 mg/kg lincomycin/spectinomycin (Lincomycin Spectinomycin 5/10; Alfasan International; Holland) applied intramuscularly and 3-day administration of non-steroidal antiinflammatory drug - 2 mg/kg ketoprofen (Ketofen; Merial; Lion; France). A protective Elizabethan collar was placed. Skin sutures were removed ten days later. The clinical examination performed until the bitch showed good recovery. Discussion The rupture of the gravid uterus in the bitch is a rare complication. This is supported by the surveys of Darvelid and Linde-Forsberg (1994) and Stolla et al. (1999) who did not report ruptured uterus in 182 and 337 dystocia cases in dogs. In the opinion of Hajurka et al. (2005) the uterine rupture which occurs just before the parturition, is due to external trauma. They describe a clinical case of a spontaneous uterine rupture in a bitch at parturition, with evisceration of puppy intestines. In the case presented here, uterine rupture has probably occurred following external trauma (road accident) 5 days after the bitch has given birth to one live puppy. Foetal retention at parturition is considered as a rare condition. Nevertheless, the retention of dead foetuses could induce uterine inertia, intrauterine infection, emphysema or foetal maceration (Johnston et al., 2001). The occurrence of foetal debris (hairs and bones) in the abdominal cavity allows assuming that in this case, foetal maceration has probably occurred before the rupture of the uterus.
3. Gonzalez-Dominguez and Maldonado-Estrada (2006) reported foetal maceration in a bitch with post-term pregnancy due to application of progestins. Johnston et al. (2001) believe that cases of foetal retention and maceration are accompanied by uterine discharge of a foul and putrid smell, with signs of toxaemia or septicaemia. In this case, similarly to asymptomatic uterine rupture in a bitch reported by Gonzalez-Dominguez et al. (2010), no signs of sepsis were present. The patient was with normal rectal body temperature, heart and respiratory rates, preserved appetite and painless abdomen. There were no deviations in complete blood counts and blood biochemical indices, the odour of the genital discharge was not specific or unpleasant, and there were no signs of septic peritonitis after median laparotomy. It could be affirmed that in this case, aseptic foetal maceration was similar with Serin and Parinʼs report (2009) in a bitch with vaginal discharge due to retention of foetal bones without uterine rupture.
4. The detection of retained foetal debris was made by the ultrasonography scan and conformed by radiography that showed parts from two foetuses in the abdominal region. Only after the median laparotomy it was observed that a foetal maceration had occurred as well as a rupture of the left uterine horn. Because of the adhesions between the omentum and the uterus and the long time interval since the trauma, we have chosen to perform ovariohysterectomy. According to Serin and Parin (2009), the detection of foetal debris in the uterus is an undisputed indication for this operative intervention. Conclusions
5. The presented clinical case provided that the evidence of the simultaneous uterine rupture and foetal maceration in the bitch without worsening of the general condition and sepsis development. Although it was rarely seen in the clinical practice, such conditions are important as the inadequate diagnosis would finally result in a poor outcome. REFERENCES Allcock, J., Penhale, B.M., 1952. Rupture of the uterus in the bitch. Veterinary Record 64, 3573
6. Bomzon, L., 1977. Rupture of the uterus following caesarean section in a bitch. Veterinary Record 101, Darvelid, A.W., Linde-Forsberg, C., 1994. Dystocia in the bitch: A retrospective study of 182 cases. Journal of Small Animal Practice 35, 402-407.
7. Dunn, T.J., Foster, R.C., 1977. Perforated uterus in a bitch. Modern Veterinary Practice 58, 240-241.
8. Gonzalez-Dominguez, M.S., Hernandez, C.A., Maldonado-Estrada, J.G., 2010. Protective compromise of great omentum in an asymptomatic uterine rupture in a bitch: a case report. Revista Colombiana de Ciencias Pecuarias 23, 369-376.

9. Gonzalez-Dominguez, M.S., Maldonado-Estrada, J.G., 2006. Prolonged pregnancy associated to an inappropriate medroxiprogesterone acetate prescription in a bitch: Is rational and ethics the use of exogenous progestin in the bitch? Revista Colombiana de Ciencias Pecuarias 19, 442-450.
10. Hajurka, J., Macak, V., Hura, V., Stavova, L., Hajurka, R., 2005. Spontaneous rupture of uterus in the bitch at parturition with evisceration of puppy intestine - a case report. Veterinarni Medicina 50 (2), 85-88.
11. Hayes, G., 2004. Asymptomatic uterine rupture in a bitch. Vetеrinary Record 154, 438-439.
12. Humm, K., Adamantos, S.E., Benigni, L., ArmitageChan, E.A., Brockman, D.J., Chan, D.L., 20 Uterine rupture and septic peritonitis following dystocia and assisted delivery in a Great Dane bitch. Journal of American Animal Hospital Association 46, 353-357. Johnston, S.D., Kustritz, M.V.R., Olson P.N.S., 200 Canine and feline theriogenology. Philadelphia, W. B. Saunders, p. 117. Kaneko, J.J., Harvey, J.W., Bruss, M.L., 2008. Clinical biochemistry of domestic animals, 6 th edn. Oxford, Elsevier Academic Press, pp. 8898
13. Morey, D.L., 2005. Acute peritonitis secondary to traumatic breeding in the bitch. Journal of Veterinary Emergency and Critical Care 16, 128-1
14. Oelzner, J., Munnich, A., 1997. Diagnostic and therapeutic aspects of the pyometraendometritis complex in dogs. Tierarztliche Praxis 25, 249-253.
15. Serin, G., Parin, U., 2009. Recurrent vaginal discharge causing by retained foetal bones in a bitch: a case report. Veterinarni Medicina 54, 287-2
16. Stolla, R., Dusi-Farber, B., Stengel, B., Schmid, G., Braun, J., 1999. Dystocia in the bitch: a retrospective study. Wiener Tierarztliche Monatsschrift 86, 145-149.
17. Weiss, D.J., Wardrop, K.J., 2010. Schalm’s veterinary hematology, 6 th edn. Iowa: Blackwell Publishing, pp. 801.