CHAPTER I:
INTRODUCTION
Pyometra is an acute or chronic supportive inflammation of the uterine wall in intact queens. It is characterized by endometrial hyperplasia with cystic dilation of endometrial glands and accumulation of purulent exudates in the uterine lumen. The disease is most often observed in di-oestrus condition or ‘pseudo-pregnancy’ in the queen, which is a phase of progesterone dominance that lasts approximately 40 days.
The relatively long progesterone-dominated di-oestrous phase occurs in queens that undergo ovulation (induced or spontaneous) and predisposes them to the development of cystic endometrial hyperplasia (CEH) and subsequent pyometra caused by infection from bacteria ascending from the vagina.
The most common bacterium involved in pyometra is Escherichia coli. Similar to the bitch, regardless of the underlying cause, the presence of progesterone (endogenous or exogenous in source) facilitates the development of pyometra (Fiona and Natali, 2016).
A recent study from Sweden reported that 2.2% of intact queens were diagnosed with pyometra by the age of 13 years (Hagman et al., 2014). The incidence of pyometra is considered to be lower in queens than in bitches, as queens are induced ovulators.
However, underestimation of disease incidence is likely because queens often do not express clinical signs to the same extent as seen in bitches (Verstegen and onclin, 2006).
Furthermore, it seems that, despite of being induced ovulators, spontaneous ovulation is not as uncommon in queens as originally thought.
There have been various reports of spontaneous ovulation in the queen, with incidence ranging from 30% up to 87% (Lawler et al. 1993). Despite many hypotheses, the underlying cause of spontaneous ovulation in the queen is still unknown, but may be influenced by breed, increasing age and parity.
Recently, a breed predisposition has been reported, with Oriental purebred cats having a higher incidence of pyometra than domestic and random-bred cats (Hagman et al., 2014).
This has also been observed by the authors. Oriental purebred cats are additionally known to come into oestrus year-round and often have short inter-oestrus intervals (associated with overlapping follicular waves) (Verstegen, 2003) compared with domestic shorthair and random-bred cats. Furthermore, Oriental queens have a higher incidence of spontaneous ovulation than other cats. Therefore, the uterus of Oriental queens is exposed to more frequent oestrogen priming and periods of high progesterone concentration. These two factors are hypothesized to contribute to the higher incidence of pyometra in young Oriental breed cats compared with other cats of similar age (Hagman et al. 2014). The median age of diagnosis of pyometra in oriental/exotic purebred queens (Sphynx, Siberian, Ocicat, Korat, Siamese, Ragdoll, Maine Coon and Bengal) was significantly lower (4 years; P <0.05) than that reported for the general cat population (>7 years) (Fiona and Natali, 2016)
Queens with pyometra often go undiagnosed as there may be few or only very mild clinical signs and laboratory changes. For example, the classic sign of muco-purulent bloody vulvar discharge often goes unnoticed. Abdominal ultrasound is the best tool for diagnosis of pyometra. Pyometra is believed to be facilitated by an oestrogenic phase that is followed by a relatively long non-pregnant progesterone-dominated phase (di-oestrus caused by spontaneous or induced ovulation). Pyometra can be treated surgically or medically and in some cases, a combination of the two approaches may be the most effective and safest solution. For example, medical treatment of systemically unwell or older patients to assist with uterine emptying prior to surgery is appropriate to reduce the morbidity and mortality that can be associated with immediate surgical treatment.
Ovariohysterectomy with resection of the entire cervix is the treatment of choice in all queens not intended for breeding.
This report is aimed at clinicians working in small animal practice to describe the method of ovariohysterectomy and post operative care of an open pyometra affected queen which is not intended for breeding.
CHAPTER II:
MATERIALS AND METHODS
2.1. Study area and duration:
My study was conducted at CVH (Central Veterinary Hospital), Dhaka, Bangladesh during my internship placement from 5th July to 4th August, 2017.
2.2. Methodology:
During the internship period at Central Veterinary Hospital (CVH) a 2 years old DSH (domestic short hair) breed queen was brought to the hospital. Case history, clinical findings, clinical examinations, diagnostic techniques, surgical management, post operative care and follow up of this case was maintained by direct contact with the owner.
Various clinical parameters were recorded prior to operation. The values recorded before operation was considered as control. Respiratory rate, rectal temperature, heart rate, hematological report, ultrasound, X-ray had done before surgery.
2.3. Case history:
A 2 years old DSH breed black and white color queen was brought to CVH with a history of purulent vaginal discharge, abdominal pain, anorexia, depression and lethargy. The queen was administered hormonal drug (progesterone contained) before 2 months because owner didn’t want to breed her cat. 16 days after administration of that drug these abnormalities started.
2.4. Physical examination of patient:
Table 1: Physical examination of the patient
SL no Criteria Condition
1 Mental status Depress, Weakness, Lateral recumbency
2 General appearance Abdominal cramping pain
3 Hydration status 7%
4 MM color pale
5 Cardiovascular HR 120 bpm, CRT < 2 sec
6 Body temperature 99.8 F
7 Weight 3.5 kg
8 Respiratory rate 16 bpm (increase lung sound)
2.5. Clinical Examination:
Diagnostic plan:
1. Haematology
2. Radiography of abdomen 3. Ultrasound of abdomen
Table 2: Haematological examination of the patient
Parameter Result Reference
RBC( x106/µl) 9 6.8-10.5
Wbc( x103/µl) 35 5-15.5
Hb (g/dl) 11.5 10.5-14.6
Platelets( x103/µl) 350 350-600
Blood parasite examination Not found
Radiographic Image:
Figure 1. Dorsoventral radiographic image of the queen with pyometra. The arrows shows the fluid filled uterus of the queen
Ultrasonographic Image:
Figure 2. Ultrasonographic image of a queen with open pyometra
2.6. Patient preparation:
The patient was kept fast from the night before the surgery. The queen was placed on the table in patient preparation room in dorsal recumbency and was restrained physically by the assistants. The operation site was clipped, shaved and cleaned with antiseptic
2.7. Anaesthesia:
1.5 ml Ketamine Hcl at the dose of 20-22 mg/kg body weight (Trade name: G-Ketamine®) was injected intramuscularly for anaesthetized the patient.
2.8. Surgical technique:
The patient was kept on the operation table at operation theatre and draped the whole body (without surgery area) with towel. Surgery area was soaked with tincture iodine. A small skin incision was done at the ventral abdominal midline at the exact midpoint of umbilicus and anterior brim of pubis. Subcutaneous tissue and muscles were incised by scissor.
Abdominal wall was elevated by thumb forcep and exteriorized the uterine horn and identified the suspensory ligament at the cranial edge of the ovarian pedicle. Ligature was done across the proximal pedicle of the ovary and proper ligament. Transected the ovarian pedicle and suspensory ligament. Same procedure was followed for another ovary. the uterine horn was separated from broad ligament. a ligature was placed closed to the cervix and a forcep was placed distal to the ligature. Then transaction was done between the forceps and ligature. So the pus filled uterus with horn and ovaries was removed from the queen. The abdominal muscles were sutured in the pattern of simple interrupted suture with chromic catgut 3/0. And the skin was closed by vertical mattress suture with the help of nylon and the sutured area was bandaged.
2.9 Post operative care:
Antibiotics (Amoxicillin), Antihistamine (Pheniramine maleate) and Painkiller (Meloxicam) were given to the animal after surgery continuously for 5 days. The queen was kept as quiet as possible for few days. After 14 days the skin suture was removed and there was no infection, swelling or bleeding from the suture area. There was no complain of vaginal discharge of the queen and there was no post operative complication
Chapter III:
RESULTS AND DISCUSSION
Historically, surgery is the treatment of choice for the majority of pyometra cases.
Medical treatment is best for the young and healthy queen which is intended for breeding.
(Fiona and Natali, 2016). But this queen is not intended for breeding that’s why surgery was the best solut ion for the recovery of the patient and save the life of the queen from sepsis.
CHAPTER IV:
LIMITATION OF THE CASE STUDY
In a good clinical case report there should be included parameters after surgery like haematology, imaging, biochemical findings of the blood. But in this case, post operative laboratory examination was not done, so it is the limitation of this case study.
,
CHAPTER V:
CONCLUSION
Ovariohysterectomy is practiced for the queen which have not significant reproductive values and the queens not intended for breeding. So, this surgical management was the best solution for that queen.
Image Gallery
Figure 3: After clipping and shaving of the surgical area
Figure 4: Exteriorized the pus filled uterus of queen
Figure 5: Transected pus filled uterus
REFERRENCES
Fiona H and Natali K. 2016. Pyometra in the queen: To spay or not to spay? Journal of
Gudermuth DF, Newton L, Daels P and Concannon P. 1997. Incidence of spontaneous ovulation in group-housed cats based on serum and faecal concentrations of progesterone. Journal of Reproduction and Fertility Supplement, Volume 51, Pages 177–184.
Hagman R, Holst BS, Möller L, and Egenvall A. 2014. Incidence of pyometra in Swedish insured cats. Theriogenology, Volume 82, Pages 114–120.
Lawler DF , Johnston SD , Hegstad RL , Keltner DG , Owens SF. 1993. Ovulation without cervical stimulation in domestic cats. Journal of Reproduction and Fertility Supplement, Volume 47, Pages 57–61.
Pelican KM, Brown JL, Wildt DE, Ottinger MA and Howard JG .2005. Short term suppression of follicular recruitment and spontaneous ovulation in the cat using levonorgestrel versus a GnRH antagonist. General and Comparative
Endocrinology, Volume 144, Pages 110–121.
Verstegen J and onclin K. 2006. The mucometra–pyometra complex in the queen.
Proceedings of the North American Veterinary Conference.
Verstegen J. 2003. Estrous cycle regulation, estrous induction and pregnancy termination in the queen. Proceedings of the Society for Theriogenology, Pages 334–339.
ACKNOWLEDGMENTS
The author wishes to acknowledge the immeasurable grace and profound kindness of Almighty “ALLAH” the supreme authority and supreme ruler of universe, who empowers the author to handle the case and to complete the case report successfully.
The author wishes to express his deep sense of gratitude and thanks to Dr. Mohammad Alamgir Hosssain, Professor, Department of Pathology and Parasitology, Faculty of Veterinary Medicine of Chittagong Veterinary and Animal Sciences University for his skillful supervision and guidance to make this report.
The author is also grateful to Dr. Maqsudul Hassan Howlader, VO, CVH for his cordial information and help at the time of handling the case. Special thanks to Dr.
Sridhar Kannaiapan, MS fellow, Madras Veterinary College, India.
Finally the author expresses thanks and warmest sense of gratitude to his parents and all well-wishers.
The Author October, 2017
BIOGRAPHY
passed four years academic career in faculty of Veterinary Medicine and attended several clinical training programs on Veterinary Medicine in Bangladesh and India and Malaysia.
As a student of Veterinary science,. I with a passion for animal welfare, a high interest in the natural sciences, a desire to be involved in education, and a dedication to life-long learning, my goal is to be a competent and contributing member of the veterinary profession.
