Changes

=Introduction=

Complications following equine [[Castration - Horse|castration]] are rare, however owners should be warned of all the possible complications before the procedure to allow them to make an informed decision about the operation. This also ensured that they are able to observe and recognise any potential complications post operatively.

==Introduction==

Complications following [[Castration - Horse|equine castration]] are rare, however owners should be warned of all the possible complications before the procedure to allow them to make an informed decision about the operation. This also ensures that they are able to observe and recognise any potential complications post operatively. Complications can occur within hours or take many days to develop, and owners should be advised to monitor the patient closely over this period of time.

If presented with a patient post castration, a full history should be obtained both from the owner and the vet who undertook the surgery if it was not yourself.

=Haemorrhage=

 

==Haemorrhage==

This is the most immediate and common complication and can be '''life-threatening''' depending on the '''extent''' and '''duration''' of bleeding.  

This is the most immediate and common complication and can be '''life-threatening''' depending on the '''extent''' and '''duration''' of bleeding.  

==Prevention==

===Prevention===

* Early morning surgery - to allow observation throughout the day

* Early morning surgery - to allow observation throughout the day

* Appropriate haemostatic technique for the animal - additional haemostasis in older animals

* Appropriate haemostatic technique for the animal - additional haemostasis in older animals

* High quality emasculator

* High quality emasculator

==Treatment==

===Treatment===

If pressure from '''sterile packing''' is not controlling the flow, the horse may need to be '''rapidly re-anaesthetised''' to '''locate the source''' of the haemorrhage. The blood may be from the '''large scrotal vessels''', '''external pudendal vessels''' or from the '''testicular artery'''. The scrotal wound must be '''cleaned''' and the cut ends of the testicular artery located and '''re-ligated''' if necessary. The risk of '''infection''' occurring after such an emergency is '''high''', and '''antibiotics''' will be needed. The horse must be assessed for '''blood loss''' and '''haemorrhagic shock''', and treated accordingly.

If pressure from '''sterile packing''' is not controlling the flow, the horse may need to be '''rapidly re-anaesthetised''' to '''locate the source''' of the haemorrhage. The blood may be from the '''large scrotal vessels''', '''external pudendal vessels''' or from the '''testicular artery'''. The scrotal wound must be '''cleaned''' and the cut ends of the testicular artery located and '''re-ligated''' if necessary. The risk of '''infection''' occurring after such an emergency is '''high''', and '''antibiotics''' will be needed. The horse must be assessed for '''blood loss''' and '''haemorrhagic shock''', and treated accordingly.

=Eventration=

==Eventration==

==Omental Eventration==

===Omental Eventration===

Small pieces of '''omentum''', '''fat''' and '''fascia''' may prolapse out of the wound. Every effort should be made to '''trim''' excessive this omentum, fat and fascia away during surgery; if they are found hanging from the wound, they can act as a '''route of infection''' into the wound.  

Small pieces of '''omentum''', '''fat''' and '''fascia''' may prolapse out of the wound. Every effort should be made to '''trim''' the excessive omentum, fat and fascia away during surgery; if they are found hanging from the wound, they can act as a '''route of infection''' into the wound.  

===Treatment===

====Treatment====

'''Small''' pieces of tissue may be cut away under '''sedation''' if they are '''fresh'''; '''larger''' pieces may require removal under '''anaesthetic''' to ensure asepsis. In these cases the '''omentum''' and '''scrotum''' should be cleaned thoroughly and then the protruding omentum should be '''pulled further out of the wound''', then '''ligated''' and '''transected'''. Rectal manipulation can then be used to return the proximal stump into the abdomen.

'''Small''' pieces of tissue may be cut away under '''sedation''' if they are '''fresh'''; '''larger''' pieces may require removal under '''anaesthetic''' to ensure asepsis. In these cases the '''omentum''' and '''scrotum''' should be cleaned thoroughly and then the protruding omentum should be '''pulled further out of the wound''', then '''ligated''' and '''transected'''. Rectal manipulation can then be used to return the proximal stump into the abdomen.

===Prevention of recurrence===

====Prevention of recurrence====

'''Non-surgical''': the horse should be stood on a sloped plank, with the hind quarters raised higher than the front quarters for several days.

'''Non-surgical''': the horse should be stood on a sloped plank, with the hind quarters raised higher than the front quarters for several days.

'''Surgical''': the edges of the incised vaginal tunic at the site of the scrotal wound are grasped using haemostatic forceps. Then, the vaginal tunic should be separated from the surrounding skin and dartos fascia, then crushed proximally and ligated and transected distally.

'''Surgical''': the edges of the incised vaginal tunic at the site of the scrotal wound are grasped using haemostatic forceps. Then, the vaginal tunic should be separated from the surrounding skin and dartos fascia, then crushed proximally and ligated and transected distally.

==Intestinal Eventration==

===Intestinal Eventration===

This complication is '''rare''' and generally only occurs following an '''open''' castration, however it is lifethreatening and immediate action is required. It may occur either as a result of '''straining post-operatively''' in the presence of '''large inguinal rings''', or '''secondary to a hernia''' present prior to castration. It will normally occur in the first 24 hours post-op, but can occur up to one week following surgery.  

This complication is '''rare''' and generally only occurs following an '''open''' castration, however it is lifethreatening and immediate action is required. It may occur either as a result of '''straining post-operatively''' in the presence of '''large inguinal rings''', or '''secondary to a hernia''' present prior to castration. It will normally occur in the first 24 hours post-op, but can occur up to one week following surgery.  

===Treatment===

====Treatment====

'''1) If extended to the level of the thighs''':

'''1) If extended to the level of the thighs''':

* Wrap in a moist clean sheet and rubbish bag to prevent further contamination

* Wrap in a moist clean sheet and rubbish bag to prevent further contamination

* Euthanasia the only appropriate treatment

* Euthanasia the only appropriate treatment

=Oedema=

==Oedema==

This is clinically '''normal''' in uncomplicated cases. It can be marked and may extend to the '''front legs'''.

This is clinically '''normal''' in uncomplicated cases. It can be marked and may extend to the '''front legs'''.

==Treatment==

===Treatment===

* Cold hose the area for 10 minutes twice a day

* Cold hose the area for 10 minutes twice a day

* Walk the horse for 10 minutes three times a day

* Walk the horse for 10 minutes three times a day

* Breakdown of the wound edges with sterile gloved hands if severe as this allows the fluid to drain.

* Breakdown of the wound edges with sterile gloved hands if severe as this allows the fluid to drain.

=Infection=

==Infection==

Infection can be '''superficial''' and easily dealt with, or '''deeper''', leading to involvement of the '''vaginal tunic''' and '''scirrhous cord'''. Any suspicion of infection should be promptly investigated under sedation using a gloved hand. The owners may report a '''reduction in appetite''' and the horse have a '''stiff gait'''. The wound itself may be swollen and discharge may be present. Clinical signs include an '''increase heart rate''', '''respiratory rate''' and '''temperature''' if the infection is severe.   

Infection can be '''superficial''' and easily dealt with, or '''deeper''', leading to involvement of the '''vaginal tunic''' and '''scirrhous cord'''. Any suspicion of infection should be promptly investigated under sedation using a gloved hand. The owners may report a '''reduction in appetite''' and the horse have a '''stiff gait'''. The wound itself may be swollen and discharge may be present. Clinical signs include an '''increase heart rate''', '''respiratory rate''' and '''temperature''' if the infection is severe.   

'''Champignon''' is a specific infection that is normally caused by ''Strep zooepidemicus''. It produces mushroom-like growths of granulation tissue from the wound. It is associated with the use of ligatures. Drainage and surgical removal of diseased tissue is necessary to treat this condition.  

'''Champignon''' is a specific infection that is normally caused by ''[[Streptococcus zooepidemicus]]''. It produces mushroom-like growths of granulation tissue from the wound. It is associated with the use of ligatures. Drainage and surgical removal of diseased tissue is necessary to treat this condition.  

==Treatment==

===Treatment===

Local superficial infection is best dealt with by '''enlarging the incision''' sites to '''improve drainage''', '''cold hosing''' and '''walking''' as for oedema and a course of '''antibiotic''' treatment. If infection is within the vaginal tunic or spermatic cord ('''scirrhous cord'''), '''repeat surgery''' is required to '''resect all affected tissue''' and this may need to be combined with '''scrotal ablation''' if the scrotal tissue is also oedematous and infected.

Local superficial infection is best dealt with by '''enlarging the incision''' sites to '''improve drainage''', '''cold hosing''' and '''walking''' as for oedema and a course of '''antibiotic''' treatment. If infection is within the vaginal tunic or spermatic cord ('''scirrhous cord'''), '''repeat surgery''' is required to '''resect all affected tissue''' and this may need to be combined with '''scrotal ablation''' if the scrotal tissue is also oedematous and infected.

=Hydrocoele=

==Hydrocoele==

This presents as a '''circumscribed''',''' painless swelling''' which is filled with a '''sterile''', '''clear''', '''straw-coloured fluid'''. Fluid gradually builds up slowly, so may not be noticed until several weeks or months after castration. It is more common with open castration.   

This presents as a '''circumscribed''',''' painless swelling''' which is filled with a '''sterile''', '''clear''', '''straw-coloured fluid'''. Fluid gradually builds up, so may not be noticed until several weeks or months after castration. It is more common with open castration.   

==Treatment==

===Treatment===

'''Removal''' of the vaginal tunic under general anaesthesia

'''Removal''' of the vaginal tunic under general anaesthesia

=Persistent Stallion-like Behavior=

==Persistent Stallion-like Behavior==

This is a common problem but is rarely due to retained testicular tissue. Instead it is attributed to '''learned behaviour'''.

This is a common problem but is rarely due to retained testicular tissue. Instead it is attributed to '''learned behaviour'''.

=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''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

Railton, D (1999) '''Complications associated with castration in the horse''' ''In Practise 1999 21: 298-30''

Railton, D (1999) '''Complications associated with castration in the horse''' ''In Practice 1999 21: 298-30''

 

 

 

 

 

[[Category: To Do - Siobhan Brade]]

[[Category:Reproductive Diseases - Horse]]

[[Category:To Do - Manson review]]

[[Category:Expert Review - Horse]]