Ultrasound-guided pervaginal drainage of abscesses associated with rectal tears in four mares.

The research article discusses a new therapeutic approach for reducing large pelvoabdominal abscesses in mares, using ultrasound-guided pervaginal drainage. This technique managed to effectively treat four mares exhibiting symptoms such as anorexia, pyrexia and recurrent bouts of colic with notable abscesses along the rectal wall.

Method of Processing the Abscesses

• The abscesses presented in the four mares were notably large, posing a challenge to equine clinicians due to potential complications including peritonitis, fistulation, or the laceration of crucial blood vessels.
• The mares were sedated and intravenously administered with detomidine, buprenorphine, and hyoscine butylbromide to manage stress and pain.
• A caudal epidural catheter was inserted and various drugs were administered including lidocaine, xylazine, and morphine.
• Each mare underwent rectal palpation, endoscopic inspection, and ultrasonography to detect the abscesses, which appeared as encapsulated, fluid-filled multiloculated masses.
• A specific technique called transrectal/transvaginal ultrasonography proved invaluable in determining the location of large blood vessels and identifying the best site to create a draining opening in the vaginal wall.
• After creating a vaginal incision, the abscesses were drained, followed by the application of povidone-iodine solution, and, where possible, curettage. The cavity was then filled with gauze soaked in the same solution.

Post-Drainage Treatment and Outcomes

• After drainage, the mares were given various treatments including broad-spectrum antibiotics, metronidazole, and flunixin meglumine (a non-steroidal anti-inflammatory drug).
• To help with postoperative pain, a mixture of bupivacaine and xylazine was administered every six hours, or bupivacaine every four hours and morphine every eight hours.
• Preventing rectal prolapse was a focus post-operation, accomplished through the use of a purse-string suture for the first 48 hours after surgery.
• Interestingly, after draining the abscesses, the location of causative rectal lacerations was found to be more cranial than initially thought.
• All the mares recovered successfully with vaginal incisions healing uneventfully and were discharged within three weeks. Notably, two mares were even able to produce foals in subsequent years following the surgery.

Post-Drainage Conclusions

• The study suggests the new pervaginal approach has numerous advantages, including a reduced risk of complications, superior accessibility and improved drainage assistance.
• The researchers discovered it’s crucial to consider mare’s reproductive status as a factor, particularly in the use of antiseptic solutions to avoid causing inflammation, oedema or fibrosis in the uterus.
• The research stresses the important role of transrectal/transvaginal ultrasonography not only in locating abscesses and viable blood vessels but in establishing optimal drainage locations.