Clinical Exposures: Uterine rupture in an 18-month-old toy poodle

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Jun 01, 2009

An 18-month-old 8.1-lb (3.7-kg) intact female toy poodle was presented for evaluation of inappetence and lethargy of 48 hours' duration. The owners reported one episode of vomiting and multiple bouts of diarrhea.

Four days before presentation, the patient had whelped four live puppies with no apparent complications. The owners reported that the dog had delivered two previous litters of three puppies each without complications, and that a veterinarian had not examined the dog before any of the breedings or deliveries. The owners stated that they had not purposefully bred the dog and were not certain when the breedings had occurred. However, an intact male toy poodle lived in their household and was presumed to have sired the puppies.

With the most recent litter, there had been no reported complications during parturition, and each puppy had been delivered within 30 minutes. The puppies had thrived initially, but in the 24 hours before presentation, the puppies had started crying continuously. The owners were concerned that the bitch was not producing sufficient milk, so they had begun to bottle-feed the pups commercial milk replacer.

INITIAL FINDINGS

The bitch was lethargic on physical examination and showed no interest in eating. It was thin (body condition score of 1.5/5) and febrile with a rectal temperature of 103.5 F (39.7 C). Foul smelling yellow diarrhea covered the dog's perineum, making identification of vulvar discharge difficult. Mammae development was minimal to absent, with bloody crusts on the ends of the dog's nipples. The dog's heart and respiratory rates were normal. Its mucous membranes were slightly gray and tacky. Abdominal palpation elicited signs of pain.

An in-house complete blood count (CBC) and serum chemistry profile showed anemia (hematocrit 23%; reference range = 27% to 55%) and an amylase activity that was suspected to be too high to be readable, although dilution was not done at this time. Sodium (141 mEq/L; reference range = 144 to 160 mEq/L), potassium (3.4 mEq/L; reference range = 3.5 to 5.8 mEq/L), and chloride (106 mEq/L; reference range = 109 to 122 mEq/L) concentrations were low. Albumin, calcium, and glucose concentrations were normal. Radiographs revealed a soft tissue opacity in the mid to caudal abdomen.

The differential diagnoses included a retained fetus, a gastrointestinal foreign body, postpartum mucometra or pyometra, enterocolitis that was stress-induced or infectious in origin, and pancreatitis.

The patient was given intravenous lactated Ringer's solution (22 ml/hr) supplemented with 20 mEq/L potassium chloride and vitamin B complex. Intravenous sodium ampicillin (20 mg/kg) was given every eight hours. Medical treatment after an abdominal ultrasonographic examination and an exploratory laparotomy were discussed with the owners, and they chose surgery.

EXPLORATORY LAPAROTOMY

The dog was given buprenorphine intramuscularly, and anesthesia was induced with propofol and diazepam intravenously. The dog was intubated, and anesthesia was maintained with isoflurane.


1. The dog's uterus immediately after ovariohysterectomy. The proximal aspect of the left uterine horn contains a large, complete uterine wall rupture, and two smaller complete ruptures of uterine wall are noted at the junction of the right horn and uterine body. An incomplete rupture of the uterine wall can be seen in the proximal aspect of the right uterine horn.
The exploratory laparotomy revealed a moderate amount of burgundy-colored fluid within the abdomen. The uterus showed brown discoloration and had four distinct full-thickness perforations. The ovarian pedicles and uterus were ligated by using a Miller's suture tie with 2-0 polydioxanone suture. The uterus was oversewn by using a Parker-Kerr suture pattern, and the uterus and ovaries were removed (Figure 1). The abdomen was copiously and repeatedly flushed with about 100 ml of warm 0.9% sodium chloride solution and suctioned. Further exploration of the abdomen revealed brown discoloration of the entire omentum. The abdomen was closed in three layers with 3-0 polydioxanone suture.

A sample of uterine tissue was submitted to Antech Diagnostics for aerobic bacterial and Mycoplasma species culture. The remaining uterus was submitted to Stanford University's Department of Comparative Medicine for histologic examination.