Changes

==Introduction==

==Introduction==

A recto-vaginal fistula can be caused during foaling by the '''foot-nape posture'''.

A recto-vaginal fistula in mares can be caused during foaling by the '''foot-nape posture'''.

This occurs when the '''foal''' is presented with the '''legs forward''' '''without the head'''. This posture is possible in the mare due to  the long limbs and slim head of the foal. The foot of the foal is directed dorsally by the transverse fold between vagina and vestibule. The presence of the foot-nape posture coupled with severe non-productive straining by the mare may cause the formation of a  '''rectovaginal fistula''' or eventually a '''third degree perineal laceration'''. In these cases both the dorsal vaginal wall and rectum are penetrated.

This occurs when the '''foal''' is presented with the '''legs forward''' '''without the head'''. This posture is possible in the mare due to  the long limbs and slim head of the foal.  

 

The presence of the foot-nape posture coupled with severe non-productive straining by the mare may cause the formation of a  '''rectovaginal fistula''' or eventually a '''third degree [[Perineal Laceration - Horse|perineal laceration]]'''. In these cases both the dorsal vaginal wall and rectum are penetrated by the foal's foot directed dorsally by the transverse fold between vagina and vestibule.

Recto-Vaginal fistulae can also be congenital.

Recto-Vaginal fistulae can also be congenital.

==Signalment==

==Signalment==

It is most common in '''primiparous''' mares. It is generally caused by a combination of '''poor alignment''' of the foal and '''excessive straining''' by the mare.

Recto-vaginal fistulae are most common in '''primiparous''' mares. They are generally caused by a combination of '''poor alignment''' of the foal and '''excessive straining''' by the mare.

==Treatment==

==Treatment==

The horse should be kept on her '''feet''' and walked around as this can decrease straining efforts. An epidural should be administered as this prevents straining. The foal should then be repositioned by '''forcefully repelling it''' and if possible '''lifting the foreleg(s)''' and '''placing them under the head'''. '''Lubricant''' and '''snares''' may be required to achieve this. If repositioning is unsuccessful but the foal is still alive an '''incision into the perineum''' can be made prior to any further attempts to remove the fetus. If the foal is dead this procedure is not necessary and instead partial '''fetotomy''' should be performed. This is achieved by sectioning the feet at the radius before removing the remainder of the foal. The damaged tissue should be assessed for '''bleeding''', and any '''devitalised tissue''' cut away. As for [[Perineal Laceration - Horse|perineal lacerations]] there is usually extensive bruising and laceration of the tissue, therefore repair should be delayed until bruising has subsided and '''granulation tissue''' has formed, usually a minimum of '''6–8 weeks''' after foaling or when the foal is '''weaned'''.

The mare should be kept on her '''feet''' and walked around as this can decrease straining efforts. An epidural should be administered to prevent straining. The foal should then be repositioned by '''forcefully repelling it''' and if possible '''lifting the foreleg(s)''' and '''placing them under the head'''. '''Lubricant''' and '''snares''' may be required to achieve this. If repositioning is unsuccessful but the foal is still alive an '''incision into the perineum''' can be made prior to any further attempts to remove the fetus. If the foal is dead this procedure is not necessary and instead partial '''fetotomy''' should be performed. This is achieved by sectioning the feet at the radius before removing the remainder of the foal. The damaged tissue should be assessed for '''bleeding''', and any '''devitalised tissue''' cut away. As for [[Perineal Laceration - Horse|perineal lacerations]], there is usually extensive bruising and laceration of the tissue, therefore repair should be delayed until bruising has subsided and '''granulation tissue''' has formed, usually a minimum of '''6–8 weeks''' after foaling or when the foal is '''weaned'''.

==Prognosis==

==Prognosis==

Prognosis is '''good''' as the normal anatomy of both the rectal and vaginal wall is restored following surgical repair. It should be noted that the function of the anal sphincter may not be completely return.

Prognosis is '''good''' as the normal anatomy of both the rectal and vaginal wall is restored following surgical repair. It should be noted that the function of the anal sphincter may not completely return to normal.

 

==References==

==References==

Pycock, JF (1997) '''Self-Assessment Colour Review Equine Reproduction and Stud Medicine''' ''Manson''

Pycock, JF (1997) '''Self-Assessment Colour Review Equine Reproduction and Stud Medicine''' ''Manson''

[[Category:To Do - Siobhan Brade]]

 

[[Category:To Do - Manson review]]

[[Category:Reproductive Diseases - Horse]]

[[Category:Expert Review - Horse]]