Diagnosis and treatment of abdominal wall hernia complicated with uterine pus in dogs

Canine uterine pus accumulation (caninepyometra) refers to the accumulation of a large amount of pus in the uterine cavity of dogs, accompanied by abnormal endometrial hyperplasia and bacterial infection. According to whether the cervix is open or not, it can be divided into open type and closed type. The disease mostly occurs in adult bitches without mating, pregnancy and ligation (ovariectomy), and mostly occurs in middle-aged bitches over 6 years old. The disease occurs within 3 to 8 weeks after estrus, and may be accompanied by a long history of estrus disorder or endometritis. The etiology of uterine pus comes from endocrine disorder, estrus, mating, bacterial infection caused by unclean behavior during delivery, history of hormone therapy, history of endometritis and so on.

Hernia is a common disease in which the viscera of the abdomen is protruded from the natural foramen or disease rupture to the subcutaneous or other anatomical cavity. Abdominal wall hernia refers to the appearance of a localized swelling in the abdominal wall, which is mostly protruded organs, and the hernia wheel can be felt by hand. In clinic, abdominal wall hernia is mostly formed by blunt external force, and the contents of hernia are mostly intestines and omentum, and prolapsed uterus is relatively rare. The clinical report of uterine pus accumulation complicated with abdominal wall hernia in dogs is as follows.

1 morbidity

The sick dog is a 12-year-old brown-and-black Peking Dog. Body weight 13.5kg. Three days before the onset of the disease, it was found that there was bleeding from the vagina, and there was an oval swelling about 10cm in length and about 5cm in width in the left lower abdominal wall. Pressing the protuberance with hand felt that there was a tubular content in it, but it could not be restored and had a sense of fluctuation. The initial diagnosis was abdominal hernia. The contents of the uterus examined by B-ultrasound were empyema. Decide on surgical treatment.

2Surgical methods

2.1 preoperative preparation

General anesthesia was given by intramuscular injection of Canmianbao injection with 0.05mg/kg dose. The sick dog lies on its back in Baoding, and its limbs are fully expanded and fixed. Surgical department hair shearing disinfection.

2.2 hysterectomy

Cover the scarf and cut along the midline of the retroumbilical abdomen. The length of the incision is 10cm. Cut open the skin and its subcutaneous adipose tissue to expose the abdominal wall muscle and abdominal basement membrane. The left hand holds tooth tweezers to hold and lift the midline of the abdomen, and the right hand pokes the scalpel through the midline of the abdomen into the abdominal cavity and then withdraws the scalpel, cuts a strand of the operation, and cuts the midline of the abdomen through a small incision to enlarge the incision. After exposing the abdominal cavity, explore the uterine horn, pull the uterine horn out of the incision, cover the uterine horn with normal saline gauze, and hold it by hand. The ovaries are derived forward, the uterine body is exported backward, and the contralateral uterine horn and ovary are derived along the uterine body. After double ligation of the uterine arteries on the bilateral broad ligaments, the bilateral broad ligaments were ligated together to cut off the broad ligaments of the uterus. The ovarian suspension ligament was ligated and then cut off. Finally, the uterine body was cut through the ligated uterine body, which was cut off at the 1.5cm near the ligation line. The ovaries and the uterine horn with pus were removed completely. Cut open the removed uterus and you can see a large amount of yellow-white pus flowing out.

2.3 treatment of abdominal hernia

It was found that the hernia was a peritoneal rupture, and because it was close to the left inguinal side, all the hernias were done at the 4cm on the left side of the original incision, and the hernia was sutured. After the operation was washed with penicillin saline, the muscle tissue under the skin was continuously sutured, the skin on both sides of the incision was lifted and tubercle sutured, the skin wound edge was disinfected with iodine tincture, and the bandage was tied externally.

3 postoperative nursing

3.1 6 days after operation, ampicillin and normal saline were injected intravenously. The stitches were removed at 6d and 8d.

3.2 reduce the amount of feeding after operation and properly feed the digestible fluid food. Restrict the movement of sick dogs, keep them as quiet as possible, and keep the kennel warm and clean.

4 summary and discussion

4.1 abdominal wall hernia is mostly caused by blunt external force, which tears the muscle, but the outer skin remains intact, so that the abdominal organs fall into the rupture hole to form a package with protruding body surface and clear boundaries, and most of the hernia contents are omentum and intestinal canal. The probability of entering the hernia sac in the corner of the uterus is very small. The uterus is located below the pelvic rectum and rarely droops to the middle of the abdominal cavity. However, the content of the hernia in this case is the uterine horn with empyema, which may be caused by the severe empyema in the uterine horn which causes the center of gravity to move forward and fall into the abdominal cavity.

4.2 grasp the timing of hernia operation, congenital hernia may gradually reduce its hernia hole to achieve self-healing with the increase of age. However, in some cases, on the contrary, this case is characterized by older dogs and more complications, a long history and a long history of sley hernia. If the sley is not operated as soon as possible, the organs closed in the hernia sac will be oppressed. Blood circulation is blocked and prone to ischemia or even necrosis, and the success rate of operation is very low, which increases the difficulty and danger of operation. However, for reducible abdominal wall hernia, the appropriate operation time should be chosen. The operation cannot be performed within 10 days after the onset of abdominal hernia in sick dogs, because it is in the stage of acute inflammation, it is easy to tear during suture, and the success rate of operation is low.

4.3 uterine empyema in dogs is more common in clinic, and there are two common treatment methods: conservative therapy and surgical treatment. The former is mainly treated with hormone therapy combined with antibiotics, but the cure rate of this treatment is not high, easy to relapse, and hormones have certain side effects on most dogs. The latter is mainly surgical sterilization, ovariectomy and hysterectomy, which is not easy to relapse and has a high cure rate, so it is the first choice. When the bilateral uterine horn is seriously empyema and a uterine horn has been oppressed to a certain extent in the hernia sac, surgical removal must be taken.

4.4 uterine empyema can be diagnosed by B-mode ultrasonic examination and vaginal smear examination. B-ultrasound examination can be used to diagnose uterine empyema quickly and accurately. The main clinical manifestations of diseased dogs are sexual cycle disorder, weight loss, poor appetite and sometimes elevated body temperature. If it is open, drip-like discharge from the vulva to a large number of uterine purulent secretions, showing cheese color, gray, reddish brown and so on, often accompanied by fishy smell. The coat near the vulva, tail and hocks of the affected dog was contaminated. The vulva is red, swollen and even ulcerated, with a slight increase in abdominal circumference. If it is closed, the vulva does not change much and the five secretions flow out, and the abdominal circumference increases. The pus-storing uterus oppresses the diaphragm, resulting in an increase in respiratory frequency. The skin of the abdomen is tense, the veins are angry and like to lie down.