A case of vaginal prolapse and torsion uteri complicated by leiomyoma in a pregnant Aksaray malaklı dog

Abstract

In this case report, a case of prolapsed vagina with torsio uteri in a pregnant Aksaray malaklısı breed dog, aged 7.5 months and weighing 38 kg, is described. A female dog was brought to our clinic with a complaint of a mass protruding from the vagina for one month. In the anamnesis, dog's first proestrus bleeding occurred at the age of six months, no vaginal pathology was observed during this period, and the patient owner did not observe the dog mating. During vaginal examination, necrotic areas were detected in the completely prolapsed vaginal tissue. Urinary bladder was catheterized, and it was determined in normal position. Complete blood count and some biochemical parameters were evaluated. As a result, moderate leukocytosis and anemia were observed, but no abnormality was detected in biochemical parameters. In ultrasonographic examination, it was determined that the dog, was approximately 40 days pregnant and that there was no heartbeat in the puppies. For treatment ovariohysterectomy and surgical intervention to the prolapsed vagina were performed. During laparotomy, it was observed that the posterior side of the right uterine horn had a 180° torsion both around its own axis and the left uterine horn. After ovariohysterectomy, the fully prolapsed vaginal tissue was extirpated and sent to pathology for histopathological examination. As a result of histopathology, severe inflammation and leiomyoma were detected in the vaginal tissue. It is thought that due to the increasing progesterone during pregnancy, growth occurs in vaginal leiomyoma and the prolapsed part of the vagina increases and becomes more apparent. It is estimated that torsio occurs in the uterus, which is stretched due to this growth and has an increase in volume due to pregnancy. In the presented case, it was concluded that prolapsed vagina cases in dogs can be seen in the first cycle, can be accompanied by benign tumors, and can cause torsio uteri in pregnant dogs. It was recommended that such complicated cases should be evaluated with detailed clinical and histopathological examination.

Keywords

• bitch
• leiomyoma
• vaginal prolapse
• torsio uteri

Aksaray malaklısı gebe bir köpekte leiomyom ile komplike vajinal prolapsus ve torsiyo uteri olgusu

Öz

Bu olgu raporunda, 7,5 aylık, 38 kg ağırlığındaki Aksaray Malaklısı ırkı gebe bir köpekte torsiyo uteri ile birlikte seyreden prolapsus vajina olgusu anlatılmaktadır. Dişi köpek, kliniğimize bir aydır vajinadan prolabe olan kitle şikayetiyle getirildi. Köpeğin ilk proöstrusunun altı aylıkken şekillendiği, bu süreçte herhangi bir vajinal patolojinin gözlemlenmediği ve hasta sahibi tarafından köpeğin çiftleştirilmediği bilgisi alındı. Vajinal muayenede, tam prolabe olan vajina dokusunda nekroze alanlar tespit edildi. Hasta sondalanarak, idrar yollarının normal pozisyonda olduğu belirlendi. Tam kan sayımı ve bazı biyokimyasal parametreler değerlendirildi. Ultrasonografik muayenede köpeğin, yaklaşık 40 günlük gebe olduğu ve yavrularda kalp atımı olmadığı belirlendi. Tedavi amacıyla, ovariohisterektomi ve prolabe olmuş vajinaya cerrahi müdahale uygulandı. Ovariohisterektomi sırasında sağ kornu uterininin arka tarafının hem kendi ekseni hem de sol kornu uterinin çevresinde 180° torsiyona uğradığı görüldü. Ovariohisterektomi sonrasında tam prolabe olan vajina dokusu ekstirpe edildi ve histopatolojik inceleme için patolojiye sevk edildi. Histopatoloji neticesinde, vajina dokusunda şiddetli yangı ve leiomiyom tespit edildi. Gebelik süresince artan progesteron nedeniyle vaginal leiomyomda büyüme şekillendiği ve vajinadan prolabe olan dokuların büyüklüğünün artarak belirgin bir hal aldığı düşünülmektedir. Bu büyüme sebebiyle gerilen ve gebelik nedeniyle hacimsel artışa sahip uterusta torsio şekillendiği tahmin edilmektedir. Sunulan olguda, köpeklerde prolapsus vajina olgularının ilk siklusta görülebileceği, iyi huylu tümörlerle birlikte seyredebileceği ve gebelik şekillenen köpeklerde torsiyo uteriye sebep olabileceği kanısına varıldı. Bu tarz komplike vakaların detaylı klinik ve histopatolojik muayene ile değerlendirilmesi gerektiği sonucuna varıldı.

Anahtar Kelimeler

• köpek
• torsiyo uteri
• vajinal prolapsus
• leiyomyoma

Kaynakça

1. Manothaiudom K, Johnston SD. Approach to vaginal/vestibular masses in the bitch. Vet Clin North Am Small Anim Pract. 1991;21(3):509-21.
2. Schuette AP. Vaginal prolapse in bitch. J S Afr Vet Assoc. 1967;38(2):197-203.
3. Sontas HB, Ekici H, Romagnoli S. Canine vaginal fold prolapse: a comprehensive literature review. Eur J Comp Anim Pract. 2010;20(2):127-35.
4. Soderberg SF. Vaginal disorders. Vet Clin North Am Small Anim Pract. 1986;16:543-59.
5. Post K, Haaften BV, Okkens AC. Vaginal hyperplasia in the bitch: Literature review and commentary. Can Vet J. 1991;32(1):35-7.
6. Troger CP. Vaginal prolapse in the bitch. Mod Vet Prac. 1970;51:38-41.
7. Yesilkaya OF, Ciftci MF, Satilmis F, Parlak K, Alkan H, Erdem H. Vaginal prolapse complicated with urinary bladder retroflexion and colonic herniation in a dog. Vlaams Diergeneeskd Tijdschr. 2020;89(5).
8. Johnston SD, Root Kustritz MV, Olson PNS. Canine and Feline Theriogenology. 1st ed. Philadelphia: W.B. Saunders Company; 2001. p. 225-42.

9. Alan M, Cetin Y, Sendag S, Eski F. True vaginal prolapse in a bitch. Anim Reprod Sci. 2007;100(3):411-4.
10. Darbaz I, Ergene O, Canooglu E, Gultekin C, Aslan S. The assessment of diagnostic and ultrasonographic findings in a bitch with true vaginal prolapse. Kafkas Univ Vet Fak Derg. 2017;23(5):843-6. doi: 10.9775/kvfd.2017.17721.
11. Canoğlu E. Köpeklerde vaginal hiperplazi: tanı ve tedavi seçenekleri. Erciyes Univ Vet Fak Derg. 2013;10(3):177-83.
12. Günay Uçmak Z, Ateş A, Erdoğan Bamaç Ö, Öztürk Gürgen H, Kırşan İ, Tek Ç, et al. Determination of estrogen receptor, progesterone receptor and epidermal growth factor receptor in canine vaginal tumors and vaginal fold prolapse: A preliminary study. J Istanbul Vet Sci. 2022;6(1):35-41.
13. Singh K, Bodh D, Gopinathan A, Mohsina A, Sangeetha P. A case of concurrent inguinal hernia and vaginal leiomyoma in a bitch successfully treated surgically. Res J Vet Pract. 2014;2(1):1-4. doi: 10.14737/JOURNAL.RJVP/2014/2.1.1.4.
14. Rollon E, Millan Y, Martin Delas MJ. Effects of aglepristone, a progesterone receptor antagonist, in a dog with a vaginal fibroma. J Small Anim Pract. 1997;49:41-3.
15. Kustritz MVR. Clinical management of pregnancy in cats. Theriogenology. 2006;66:45-150.
16. Kacprzak KJ, Jurka P, Max A, Czerniawska-Piatkowska E, Bart- yzel BJ. Etiology, symptoms and treatment of uterine torsion in domestic animals. Folia Pomer Univ Technol Ste- tin Agric Aliment Pisc Zootech. 2014;315:21-30.
17. Şendağ S, Dinç DA, Ucar M, Tekeli T. Use of Real-time linear ultrasonography in dog reproduction I. examination of uterus in nonpregnant bitches. 1997;13(2):139-147.
18. Kırşan İ. Köpeklerde vajinal hiperplazi ve prolapsus. TVJD Eğitim Seminerleri. 2020.
19. Johnston SD, Root Kustritz MV, Olson PNS. Disorders of the canine vagina, vestibule and vulva. In: Johnston SD, Root Kustritz MV, Olson PNS, editors. Canine and feline theriogenology. Philadelphia: WB Saunders; 2001. p. 225-42.
20. Nak D, Nak Y, Yilmazbas G. First report of vaginal prolapse an in ovariohysterectomised Bitch: a case report. Bull Vet Inst Pulawy. 2008;52:397-8.
21. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. Philadelphia: W.B. Saunders; 2004. p. 901-18.
22. Vermeirsch H, Van den Broeck W, Simoens P. Immunolocalization of sex steroid hormone receptors in canine vaginal and vulvar tissue and their relation to sex steroid hormone levels. Reprod Fertil Dev. 2002;14:251-8.
23. Millan Y, Gordon A, De Los Monteros AE, Reymundo C, Martin De Las Mulas J. Steroid receptors in canine and human female genital tract tumours with smooth muscle differentiation. J Comp Pathol. 2007;136:197-201.
24. Rollón E, Millán Y, de las Mulas JM. Effects of aglepristone, a progesterone receptor antagonist, in a dog with a vaginal fibroma. J Small Anim Pract. 2008;49(1):41-3.
25. Kang TB, Holmberg DL. Vaginal leiomyoma in a dog. Can Vet J. 1983;24:258-60.
26. Jubb KVF, Kennedy PC, Palmer N. Neoplastic diseases of the tubular genitalia. In: Jubb KVF, Kennedy PC, Palmer N, editors. Pathology of Domestic Animals. 3rd ed. Florida: Academic Press Inc.; 1985. p. 374.
27. Fiorito DA. Hyperestrogenism in bitches. Compend Contin Educ Pract Vet. 1992;14:727-9.
28. Kula H, Günay Uçmak Z, Kırşan İ, Yüzbaşıoğlu Öztürk G, Gülçubuk A. Clinicopathological evaluation of vaginal leiomyoma and ovarian luteoma in a bitch. J Adv VetBio Sci Tech. 2022;7(2):269-73.
29. Kurt S, Salar S, Baştan A. Effect of vaginal fold prolapse occurrence in a pregnant bitch on parturition process. Vet Hekim Der Derg. 2019;90(1):50-4.
30. Stone EA. Ovary and uterus. In: Slatter D, editor. Textbook of Small Animal Surgery. Philadelphia: W.B. Saunders; 2003. p. 1487-502.
31. Kumru IH, Seyrek-Intas K, Seyrek Intas D, Tek HB, Wehrend A. Clinical case: unilateral en bloc ovariocornuectomy as a treatment for uterine torsion in a bitch. Rev Med Vet. 2011;162:776-86.
32. Jutkowitz LA. Reproductive emergencies. Vet Clin North Am Small Anim Pract. 2005;35:397-420.
33. John J, Mathew DP. Surgical management of unicornual torsion in a dog. Intas Polivet. 2014;15:261-2.
34. Chambers BA, Laksito MA, Long F, Yates GD. Unilateral uterine torsion secondary to an inflammatory endometrial polyp in the bitch. Aust Vet J. 2011;89:380-2.