Surgeon's Corner: Pyometra

Presentation

A 3 year-old intact female Husky presented with a 4-day history of lethargy. Physical examination revealed a mid-abdominal mass and a purulent vulvar discharge. A diagnosis of pyometra was made and the patient was prepared for aseptic surgery.

Surgery

A xiphoid to pubis incision was made ensuring appropriate exposure of abdominal contents. The falciform ligament was removed and self-retaining Balfour abdominal retractors were placed to facilitate adequate exposure as well as atraumatic manipulation of the puss filled uterus. After careful exploration of all abdominal contents the only abnormality found was the enlarged uterus. An ovariohysterectomy was planned. A LigaSure device was used to ‘seal and transect’ blood vessels in both ovarian pedicles as well as the mesometrium. The uterine arteries were identified and ligated by transfixing them to the sero-muscular layer of the uterine wall. A similar technique as used to encircle and ligate the uterine body. Carmalt forceps were used on the uterine body to help prevent backflow of pus into the peritoneal cavity as the uterine body was transected and removed. Prior to closure the peritoneal cavity was lavaged with 2 liters of body temperature sterile physiologic saline solution. The linea alba was closed with a synthetic monofilament absorbable suture material using a simple continuous appositional suture pattern ensuring that 5-7mm bites were taken in the collagen dense rectus sheath. The subcutaneous tissues and skin were closed using a simple continuous suture pattern.

Outcome

The patient was discharged one day post-operatively without complication.

This video was authored by Howard B Seim III, DVM, DACVS. Other surgical videos are available through VideoVet.

Surgeon’s Corner is intended as a forum for those with specialized expertise to share their approaches to various techniques and procedures. As such, the content reflects one expert’s approach and is not subject to peer review.