EMPHYSEMATOUS PYOMETRA IN A DOG

EMPHYSEMATOUS PYOMETRA IN A DOG J.L. HERNANDEZ, J.G. BESSO,D.N. RAULT,A.H. COHEN,A. GUIONNET, D. BEGON,Y. RUEL

An 8-year-old intact female West Highland White Terrier was examined for anorexia, vomiting, abdominal distension, and mild purulent vulvar discharge. The results of physical examination, laboratory testing, and radiography are presented. Emphysematous pyometra was suspected and confirmed at surgery. Clostridium perfringens was isolated from the uterine lumen. A brief discussion of emphysematous pyometra is presented. Veterinary Radiology & Ultrasound, Vol. 44, No. 2, 2003 p p 196-1 98. Key words: emphysematous pyometra, dog, radiography, gas dilation, intestinal ileus.

Case History Report Signulmerzt

Eight-year-old, female, West Highland White Terrier, 6.7 kg. History

The dog had a history of anorexia, weight loss, and vomiting of 1 week duration. She had been in estrous 2 months earlier. No mating was reported.

view (five times the dorsoventral diameter of the fifth vertebral body) and more than 15 centimeters long, was present in mid- to caudal abdomen (Figs. 1,2), To further determine the origin of this structure (bowel vs. uterus), a barium enema was performed. The colon was normal and unrelated to the gas-filled tubular organ (Figs. 3,4). Ruled out for this tubular structure, therefore, included small intestinal ileus’ or emphysematous pyometra. Because of the position of this gas-filled structure, the lack of abnormal appearance to small intestine, emphysematous pyometra was suspected, and a laparotomy was performed.

Physical Examination and Laboratory Test Results

On physical examination, the dog was dehydrated, its abdomen was enlarged, and the contents felt doughy on abdominal palpation. A mild purulent vulvar discharge was noted. There was no sign of abdominal pain or palpable peritoneal fluid wave suggestive of abdominal effusion. There was elevated serum urea nitrogen (35.7 mmol/l, reference range 4.2-8.3 mmol/l), and creatinine (200 kmol/l, reference range 45 to 130 kmmol/l), low serum potassium (2.5 mmol/l, reference range 3.7-5.2 mmol/l), and high serum bicarbonate (30 mmol/l, reference range 17-24 mmol/ 1). Liver enzymes were within normal limits. Urine specific gravity was 1 .O 15 (reference range 1 .O 18-1.060). These results were suggestive of renal failure. Hypokalemia and metabolic alkalosis were probably related to vomiting. Survey abdominal radiographs were performed to assess the suspected organomegaly.

Treatment and Outcome

Before surgery, dehydration, metabolic alkalosis, hypokalemia were corrected with isotonic, potassium supplemented, saline fluid therapy. An intravenous antibiotic* treatment was initiated. A dilated uterus containing gas and exudate was found at laparotomy. An ovariohysterectomy was performed, and exudate was collected from the lumen of the excised uterus for aerobic and anaerobic culture. The gastrointestinal tract and the remainder of abdominal structures were grossly unremarkable. Clostridium perfringens was isolated from the anaerobic culture of the exudate. The aerobic culture was negative. Two days postoperatively, serum urea and creatinine were within the normal range. The patient recovered normally from surgery and was discharged from the hospital.

Discussion

Radiographic Findings

On survey abdominal radiographs, a gas-filled, thinwalled tubular structure of 5-cm diameter on the lateral

Survey abdominal radiographic signs of pyometra are a fluid-filled convoluted or tubular structure located between the colon and urinary bladder.24 This patient is unusual because of the gas-producing organism and consequently the gas distension of the uterus. Escherichia coli is isolated

From the Department of Medical Imaging, Ecnle Nationale VCtCrinaire d’ Alfort. 94 700 Maisons-Alfort, France. Address correspondence and reprint request to D. Begon, 7 avenue du general de Gaulle 94 700 Maisons-Alfnrt FRANCE. Received March 21, 2002; accepted for publication June 1 I , 2002

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FIG. I . Lateral abdominal plain radiograph

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FIG.3. Lateral abdominal radiograph of the barium enema.

from 90% of patients with p y ~ m e t r a .Clostridium ~.~ perfringens, a rare gas-producing bacterial agent, is rarely isolated from the uterus. Local gas distension of the uterus is reported as a sign of fetal death, fetal mummification, and after p a t ~ r i t i o n . ~In- ~ this patient, no mating was reported, and the gas dilation was tubular, regular, and homogeneous. Considerations for the gas-filled tubular structure on survey abdominal radiographs were normal large intestine, distended small intestine, and emphysematous pyometra. We

elected to do a barium enema, a quick and easy contrast procedure, to rule out the colon as the origin of the gas-filled tubular structure seen on survey abdominal radiographs. An upper gastrointestinal contrast study may have been more specific to determine the nature of this tubular structure, but was more time-consuming and may not have been well tolerated by the patient. An ultrasonographic examination would have been difficult in this patient in light of the large amount of air in the structure to be evaluated. The differential diagnosis of a gas-filled tubular structure in the abdomen of a vomiting dog should include emphysematous pyometra.

FIG. 2. Ventrodorsal abdominal plain radiograph. There is a dilated gaseous tubular structure suggestive of colon, small intestine ileus, or gaseous pyometra.

FIG.4. Ventrodorsal abdominal radiograph of the barium enema. The large intestine is unrelated to the dilated gaseous tubular structure identified in Fig. 1 and Fig. 2.

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