In this VETgirl online veterinary continuing education blog, Dr. Garret Pachtinger discusses one of the leading reproductive emergencies seen in our veterinary patients: the pyometra. A pyometra is an infection of the uterus and life threatening surgical emergency in the intact bitch (One of the reasons why we advocate for spaying earlier!).
Middle-aged to older bitches (6+ years) are most commonly affected by pyometra due to a combination of cystic endometrial hyperplasia (CEH), ascending bacterial infection (E. coli), and hormonal influences. Clinical signs include lethargy, fever, inappetance, anorexia, dehydration, vaginal discharge, malodor, PU/PD (due to E. coli), and collapse.
This begs the question, what does this life-threatening infection have in common with the magical Walt Disney creation, Mickey Mouse?
Believe it or not, a pyometra patient and Mickey Mouse have a lot in common!
1) The old saying goes, “Never let the sun set on a pyo.” What that really means is that a pyometra is a surgical emergency. A pyometra, once diagnosed, should not be scheduled for surgery at a later date (ideally… this is definitely the case on a CLOSED vs. open pyometra!). Rather, the patient should be stabilized for surgery and in the operating room as soon as possible to limit morbidity and mortality. If you have ever been to Disney World, you certainly don’t want the sun to set on Mickey…that means the day is almost over…vacations always end too soon!
2) The first two Mickey Mouse films that Walt Disney made cost the studio $2,500 each. If you are lucky, that is the cost for a pyometra these days!
3) Finally, the image of Mickey Mouse, and more specifically the classic “Mickey Mouse hat” is the upside down version of the ultrasound diagnosis of a pyometra.
While x-rays often show a tubular, fluid filled structure in the caudal abdomen, an ultrasound shows a classic upside-down mickey mouse hat with the bladder and uterine horns.
Make sure to be able to diagnosis pyometra based on history, signalment, clinical signs, and diagnostic workup (e.g., radiographs and rapid ultrasound). Treatment includes aggressive IV fluid resuscitation, IV antibiotic therapy, supportive care, anti-emetics (if needed), and surgical stabilization (e.g., spay). VETgirl is not an advocate of medical management of pyometra, as the pyometra typically will develop again at the next heat cycle.
Dr. Garret Pachtinger, DACVECC