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Pyometra surgery in a dog | VETgirl Veterinary Continuing Education Videos

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In this VETgirl online veterinary continuing education video, we discuss surgical treatment of a dog with pyometra. Pyometra, which is often due to E. coli, is a common disorder in female intact dogs, with a reported occurrence in 15.2% of dogs by 4 years of age, and in almost 25% of dogs by 10 years of age (1-3). Morbidity ranges from 0-17% in dogs (4), due to secondary sepsis, shock and endotoxemia. That said, ovariohysterectomy (OVH) is typically curative. Surgery should only be initiated once the patient has been stabilized for clinical signs of shock and/or dehydration. Initial stabilization should include intravenous fluid therapy, clinicopathologic monitoring (including CBC, chemistry, electrolytes, blood glucose), dextrose and electrolyte supplementation as needed, parenteral antibiotic therapy, blood pressure monitoring, and symptomatic supportive care. Once the patient is more stable, anesthesia and emergency OVH is warranted (especially with a closed pyometra!). While medical management can be considered, VETgirl’s general recommendation is surgical management.

With OVH in the pyometra patient, it shouldn’t be considered a “routine” spay, as potential complications include anesthetic risks, hypotension, aspiration pneumonia, arrhythmias, sepsis, and spillage of infected uterine contents into the abdomen (secondary to friable uterine tissue). Approach to the abdomen should include a large incision to allow for better exteriorization and exposure of the uterus without excessive traction. The use of Balfours can be considered to help with exposure, although this may be patient dependent. The horns of the uterus and ovaries should be be carefully identified. The suspensory ligament is often loose in pyometra patients; otherwise, one can use cautery or “strum” it with the finger to free up the ovary for exteriorization. As in a routine spay, a window should be made into the broad ligament. Either using a 3-clamp or 2-clamp technique, the patient should be spayed traditionally. Appropriately sized ligatures should be placed initially around the first clamp and tightened down as the clamp is gently removed. Either a second encircling ligature or a transfixing ligature should be placed on each ovarian pedicle. The ovarian pedicle should be cut and released and monitored for hemorrhage. The same procedure should occur on the alternative side. The broad ligament should be cauterized or torn at the level of the cervix to allow for some hemostasis. Alternatively, ligatures can be used if there is significant hemorrhage from the broad ligament. The area just proximal to the cervix should be carefully clamped using 2 carmalts, taking care as this tissue can be friable and rupture with clamping. The area behind/dorsal to the cervix area should be packed off well with lap sponges prior to clamping in case of rupture. The uterine body should again be double ligated using either two encircling or one encircling and one transfixing ligature. The uterine stump should be lavaged well to remove any additional purulent material present. Ideally, a culture should be performed later from the excised uterus contents to confirm appropriate antimicrobial use. The abdomen should be lavaged and closed traditionally using a clean set of instruments (5).

References:
1. Root Kustritz MV. Small Animal Pediatrics and Theriogenology. University of Minnesota, Proceedings.
2. Egenvall A, Hagman R, Bonnett BN, et al: Breed risk of pyometra in insured dogs in Sweden. J Vet Intern Med 2001;15:530-538.
3. Fukuda S: Incidence of pyometra in colony-raised beagle dogs. Exp Anim 2001;50:325-329.
4. Johnston SD, Root Kustritz MV, Olson PN: Disorders of the canine uterus and uterine tubes (oviducts). In: Johnston SD, Root Kustritz MV, Olson PN, editors. Canine and feline theriogenology. Philadelphia PA: WB Saunders Co.; 2001. p. 216.
5. https://wcvm.usask.ca/vsac205/Lab6/ovariohysterectomy.php#Ovarianpedicles

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