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Veterinary Sciences Oct 2022Fetal maceration and pyometra were diagnosed in a 16-year-old maiden Welsh pony mare. Due to anatomical and surgical difficulties encountered throughout treatment,...
Fetal maceration and pyometra were diagnosed in a 16-year-old maiden Welsh pony mare. Due to anatomical and surgical difficulties encountered throughout treatment, previously reported techniques including both per-vaginum removal of fetal remnants and ovariohysterectomy were attempted and resulted in novel complications. Fetal bones were unable to be removed completely transcervically due to failure of cervical dilation despite repeated attempts. Subsequent surgical complications such as inadequate exposure of the uterus and incorporation of fetal bones into the uterine stump following ovariohysterectomy also occurred. This case highlights some of the difficulties in managing rare cases of mid-term fetal loss and retention that result in maceration. Ultimately, this may provide useful insights to practitioners when managing similar cases in future.
PubMed: 36356061
DOI: 10.3390/vetsci9110584 -
Journal of the American Veterinary... May 2022To compare the outcome of canine pyometra surgeries performed at referral hospitals with those performed at community clinics (outpatient settings), and to evaluate...
OBJECTIVE
To compare the outcome of canine pyometra surgeries performed at referral hospitals with those performed at community clinics (outpatient settings), and to evaluate factors that impact outcome.
ANIMALS
133 client-owned dogs with pyometra treated with ovariohysterectomy (OHE) at 2 community clinics or 2 referral hospitals between July 1, 2017, and June 30, 2019.
PROCEDURES
A retrospective electronic medical record search was used to identify eligible cases. Data about patient demographics and clinical characteristics were collected and analyzed for factors that could have impacted outcome.
RESULTS
Eighty-three dogs were treated at referral hospitals; 50 dogs were treated at community clinics. Survival to hospital discharge for all dogs was 97% (129/133) and did not differ between treatment facility type. Dogs treated at both types of facilities were similar in age, body weight, and clinical signs. Median duration between diagnosis and OHE was significantly shorter for dogs treated at referral hospitals (0 day; range, 0 to 0.7 days) versus community clinics (1.0 day; range, 0 to 14.0 days); however, delay was not related to survival to hospital discharge. Duration of hospitalization did not impact survival to hospital discharge nor survival for at least 1 week after surgery.
CLINICAL RELEVANCE
Results indicated that OHE for pyometra in dogs has a good outcome and that, although prompt surgical treatment remains a goal, in cases where limitations to performing surgery exist, a delay until surgery or discharging patients the same day is still associated with a high degree of success.
Topics: Animals; Community Medicine; Dog Diseases; Dogs; Female; Humans; Outpatients; Ovariectomy; Pyometra; Retrospective Studies
PubMed: 35389875
DOI: 10.2460/javma.21.06.0320 -
Infection, Genetics and Evolution :... Nov 2020Endometrial pathogenic E. coli (EnPEC) isolates are involved in endometrial infections in animals and humans. Besides the high aggressiveness of the endometrial...
Endometrial pathogenic E. coli (EnPEC) isolates are involved in endometrial infections in animals and humans. Besides the high aggressiveness of the endometrial infections, the EnPEC virulence profile and pathogenesis are still little known. In this study, we have sequenced and analyzed an EnPEC strain from canine pyometra (E. coli_LBV005/17), following a molecular characterization of the virulence profile and phylogenetic evolution of an EnPEC collection from canines and felines (45 strains). Most of the strains belonged to phylo-group B2, and display a high virulence profile. In particular we highlight the classification of the E. coli_LBV005/17 as sequence type 131 (ST131), in addition to other five strains, as observed by gyrB phylogenetic analysis. Also, the phylogenetic position of EnPEC strains from pyometra in companion animals suggests that their origins are from both extraintestinal and commensal E. coli strains. Accordingly to Principal Coordinates Analysis (PCoA) and phylogenetic analysis we can propose that EnPEC strains have neither the same genetic profile, nor a unique common ancestral. In summary, the present work characterize an EnPEC genome from bitch pyometra and the genetic profile of 45 EnPEC strains from companion animals pyometra, being the commonest virulence pattern: fimA, papC, hlyA, hlyE, cnf1, entB, iroN, irp1, bssS, bssR, and hmsP. These data improving the background knowledge of this E. coli pathotype related to pyometra in companion animals and may support new methods to prevent the disease evolution.
Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Dog Diseases; Dogs; Endometrium; Escherichia coli; Escherichia coli Infections; Female; Genome, Bacterial; Genotype; Humans; Microbial Sensitivity Tests; Pets; Phylogeny; Pyometra; Virulence; Virulence Factors
PubMed: 32649994
DOI: 10.1016/j.meegid.2020.104453 -
BMC Veterinary Research Jun 2023Pyometra is a common infectious condition, especially in elderly bitches. In addition to an infected uterus, dogs may have concurrent urinary tract infection (UTI). The...
BACKGROUND
Pyometra is a common infectious condition, especially in elderly bitches. In addition to an infected uterus, dogs may have concurrent urinary tract infection (UTI). The preferred treatment is surgical removal of the ovaries and uterus, whereupon the general prognosis is excellent. In addition, antimicrobial therapy is frequently prescribed for postoperative treatment. However, no research exists on the benefit of postoperative antimicrobial treatment in uncomplicated canine pyometra. Antimicrobial resistance has become a major challenge in treatment of bacterial infections. Diminishing overuse of antimicrobial agents is essential for controlling the development of antimicrobial resistance in both animals and humans.
METHODS
This double-blinded, randomized, placebo-controlled two-arm clinical trial is designed to compare the incidence of postoperative infections associated with surgical treatment of uncomplicated pyometra followed by two different treatment protocols. For the study, 150 dogs presenting with an uncomplicated pyometra and that are to undergo surgical treatment will be recruited. Dogs with body weight < 3 or > 93 kg, complicated pyometra, primary disease increasing the risk of infection, or immunosuppressive medication will be excluded. All dogs will receive one dose of sulfadoxine-trimethoprim intravenously as an antimicrobial prophylaxis. Postoperatively, dogs will be randomized to receive either a five-day course of placebo or an active drug, sulfadiazine-trimethoprim orally. During the surgery microbiological samples will be taken from urine and uterine content. The follow-up includes a control visit in 12 days and an interview of the owner 30 days after surgery. If bacteriuria is detected at the time of surgery, a urinary sample will be cultured for bacterial growth at the control visit. The primary outcome is the incidence of a postoperative surgical site infection (SSI), and the secondary outcome is the occurrence of clinical UTI with bacteriuria. Intention-to-treat and per-protocol analyses will be performed to compare outcome incidences between the treatment groups.
DISCUSSION
Research-based evidence is necessary to create treatment guidelines for judicious use of antimicrobials. The goals of this study are to provide evidence for reducing the use of antimicrobials and targeting the treatment to patients proven to benefit from it. Publishing the trial protocol will increase transparency and promote open science practices.
Topics: Female; Humans; Dogs; Animals; Bacteriuria; Pyometra; Urinary Tract Infections; Bacterial Infections; Trimethoprim; Dog Diseases; Clinical Trials, Veterinary as Topic
PubMed: 37340459
DOI: 10.1186/s12917-023-03629-w -
Journal of Surgical Case Reports Aug 2022Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of...
Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of the cervical tract are the most common cause of pyometra, several benign conditions can contribute to this diagnosis. Traditionally hysterectomy has been the surgical approach of choice for this clinical entity; however, in the setting of septic shock, temporizing techniques may offer the opportunity to stabilize patients and complete a thorough work up before committing to definitive resection. This report explores a case of septic shock secondary to spontaneous perforation of pyometra that was definitively managed with peritoneal lavage and wide drainage. Intraoperative hysteroscopy and uterine biopsy were performed, and no malignancy was identified on final pathology. Intraoperative hysteroscopy along with peritoneal lavage and wide drainage may reduce the morbidity and mortality associated with sepsis from spontaneous perforation of pyometra and potentially avoid unnecessary hysterectomy.
PubMed: 36051005
DOI: 10.1093/jscr/rjac388 -
Journal of Mid-life Health 2019Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes,...
Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes, lymphocytes, plasma cells, multinucleated giant cells, fibrosis, calcification, and accompanying polymorphonuclear leukocytes. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. We report the case of a 61-year-old postmenopausal female who presented with pyometra, bulky uterus, and cervical stenosis, and histopathology revealed XGE.
PubMed: 31942158
DOI: 10.4103/jmh.JMH_6_18 -
Veterinary Sciences Sep 2021Female dogs, especially intact or neutered lately, are at increased risk for reproductive disorders including mammary tumors (MTs). This retrospective study evaluated...
Female dogs, especially intact or neutered lately, are at increased risk for reproductive disorders including mammary tumors (MTs). This retrospective study evaluated the prevalence of reproductive pathology and associated mortality in a cohort of female dogs presented at a single veterinary clinic. The medical records of female dogs born in 2000-2003 were reviewed. The study included 599 cases, of which 293 were followed up until death. Causes of death were analyzed according to the spaying status. Among the 599 female dogs, 306 were intact (51%), 50 (8%) had been spayed before 2 years of age (ES, early spaying), and 243 (41%) after 2 years (LS, late spaying). During their lifetime, 79 dogs (13.2%) developed pyometra, and 160 (26.7%) a mammary tumor. Among the 293 dogs with complete follow-up, 103 (35.1%) had at least one MT during their lifetime, of which 53 (51.5%) died of their mammary cancer. Spayed (ES + LS) female dogs had a 4-fold decreased risk of dying from mammary cancer (OR = 0.23, 95% CI 0.11-0.47, < 0.0001) compared to intact females. In this low-sterilization rate population, MTs developed in 35.1% of female dogs over their lifetime and was the cause of death in half of them.
PubMed: 34564579
DOI: 10.3390/vetsci8090184 -
Journal of Medical Case Reports Dec 2020Pyometrocolpos is accumulation of infected fluid in the uterus and vagina. It is rare in children, mostly seen after menarche as a result of obstructive congenital...
BACKGROUND
Pyometrocolpos is accumulation of infected fluid in the uterus and vagina. It is rare in children, mostly seen after menarche as a result of obstructive congenital genital malformation that impairs free drainage of the uterine secretions. In a child, it may present as an acute illness that necessitates urgent and appropriate management and treatment of the underlying cause, which can be a challenge in a resource-limited setting.
CASE PRESENTATION
We report a case of pyometrocolpos in an 8-month-old African infant who presented with fever, vomiting, decreased urine output, and abdominal distension of 12 days' duration. An abdominal examination revealed a subumbilical midline incision scar and a midline lower abdominal mass. She appeared to have presented at the emergency department with similar complaints 2 months earlier and had been diagnosed with pyometra, which was managed by emergency laparotomy for pus drainage, and she was kept on antibiotics. Recovery was established after 10 days of admission, and the patient was discharged to home. Her symptoms reappeared 2 months after the first presentation. Her blood work showed significant leukocytosis with neutrophilia, and abdominal ultrasound depicted bilateral hydronephrosis with hydroureters and a fluid-filled uterus. Examination under anesthesia in the operating theater revealed normal-looking female genitalia with a cribriform hymen, beneath which lied a transverse vaginal septum. Foul-smelling pus was aspirated through the septum, and septectomy was performed to allow 350 ml of pus to drain. A pus sample was sent for culture and sensitivity, and Escherichia coli sensitive to ceftriaxone and gentamicin was isolated.
CONCLUSION
Pyometrocolpos is rare in childhood but should be suspected in a girl presenting with a midline lower abdominal mass accompanied with urinary obstructive symptoms associated with fever and gastrointestinal symptoms. Escherichia coli seems to be the most probable offending organism, but pus culture is crucial for antibiotic stewardship in proper management of the infection. Definitive treatment should focus on correcting the obstructive anatomical congenital deformity that caused the obstruction in order to avoid recurrence.
Topics: Child; Female; Humans; Infant; Neoplasm Recurrence, Local; Pyometra; Ultrasonography; Vagina
PubMed: 33287893
DOI: 10.1186/s13256-020-02543-1 -
Medicina (Kaunas, Lithuania) Mar 2023Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including...
Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including cervical stenosis, have been identified. Medical therapy using intravenous antibiotics and surgical evacuation are the conventional treatment options for pyometra. Here, we present a unique case of a novel therapy for pyometra in a geriatric patient; percutaneous alleviation of the causative cervical stenosis was performed using balloon dilatation, along with endometrial drainage of the infected fluid through her vagina, a natural route. This technique has overcome the need for other invasive therapies. The patient's clinical condition improved significantly after this minimally invasive treatment. Percutaneous balloon dilatation of the cervix for stenosis or occlusion in patients with pyometra facilitates drainage of the infected endometrial fluid. This alternative management technique ensured a satisfactory postoperative course and tolerance in the short-term follow-up. Furthermore, the technique ensured good aesthetic results, with its minimally invasive approach in selected patients, compared to other means of evacuation.
Topics: Humans; Female; Aged; Pyometra; Constriction, Pathologic; Uterus; Vagina; Drainage
PubMed: 37109647
DOI: 10.3390/medicina59040689 -
Pyometra in a sugar glider (Petaurus breviceps): surgical treatment and postoperative complications.The Journal of Veterinary Medical... Nov 2023A 7-year-old female sugar glider showed a well-defined, homogeneous, hypoechoic mass in the caudal abdominal cavity on ultrasound. Exploratory laparotomy revealed both...
A 7-year-old female sugar glider showed a well-defined, homogeneous, hypoechoic mass in the caudal abdominal cavity on ultrasound. Exploratory laparotomy revealed both uteri were severely dilated by viscous, purulent exudate. The patient underwent ovariohysterectomy with removal of bilateral vaginal canals. Antibiotic therapy was initiated postoperatively. Histopathological findings were consistent with suppurative metritis, leading to a clinical diagnosis of pyometra. Despite abscess formation in the uterine stump or central vaginal canal and bilateral renal pelvic/ureter dilations postoperatively, the sugar glider survived more than 270 days. Unfortunately, surgical and medical treatments performed in this case did not prove curative. The outcome of this case highlights the importance of further accumulation of cases to define more appropriate therapies for pyometra in sugar gliders.
Topics: Animals; Female; Pyometra; Postoperative Complications; Uterus; Suppuration; Sugars
PubMed: 37793836
DOI: 10.1292/jvms.23-0117