castration complications

• list the three delayed onset complications

  • champignon
  • scirrhous cord
  • hydrocele
• what are the clinical signs of a champignon?

  proud granulation tissue (mushroom shaped) +/- purulent discharge
• what causes a champignon?

  stump abscessation of streptococcus spp. Due to contaminated suture material used for ligation
• how do you treat a champignon?

  surgical removal of the diseased tissues, drainage and antibiotics
• what are the clinical signs of a scirrhous cord?

  scrotal swelling (hard but painless) and discharging tract
• what causes a scirrhous cord?

  contamination at the time of surgery. Non-absorbable sutures. Other material left behind (swabs / forceps)

  • (staphylococcus)
• how do you treat a scirrhous cord?

  surgical removal of the disease tissues under GA
• what are the clinical signs of a hydrocoele?

  a non-painful fluid scrotal swelling which may be reducible
• what causes a hydrocele?

  this is often idiopathic but this is more common following an open castration in the mule (vaginal tunic is not removed)
• what are the treatment options for a hydrocele?

  • benign neglect if no increase in size or problems
  • drainage for a temporary fix
  • surgical removal of the redundant vaginal tunic under GA
• what drug can be used in the horse to reduce anxiety prior to premedication for castration?

  ACP
• some cases of iatrogenic penile damage are self-limiting, but you can also suture the laceration or amputate
• minor bleeds during a castration are very common but major bleeds can be life-threatening
• how do you treat a mild haemorrhage?

  locate the source in relation to the tunic and if superficial then ligate. OR pack scrotum.
• how do you treat a severe haemorrhage?

  clamp  the spermatic cord stump and leave for 24 hours or ligate (may need GA)
•  If you cannot find the bleeder your only option is to pack and bandage the abdomen and pelvis - made need to anaesthetise fully to open up the horse more to find the bleeder
• the occasional blood drip acter castration is self-limiting.
• post-operative swelling / oedema is very common after castration and occurs due to trauma to the tissues and insufficient exercise. Mild cases can be treated with walking or riding exercises for 30 minutes twice daily.

  • If the animal is sore and doesn’t want to walk, then NSAIDs can be given.

  While more severe cases may require drainage and checking for infection.
• A scrotal abscess or post-op infection is common after castration due to failure to maintain asepsis in the field. this can be treated with digital drainage and lavage with dilute antiseptics. parenteral antibiotics are only given if there are systemic signs.
• A scrotal abscess or post-op infection may be open and draining or closed – hot, swollen and painful.

  • Rarely extend into the peritoneal cavity or present as peritonitis

  The horse will likely be depressed, not be eating and have a temperature
• Herniation of omentum is uncommon but can have severe consequences. This can be asymptomatic but the owner may see omentum, fat and fascia prolapsing out of the wound. These occur due to large scrotal rings (breed predisposition and adult stallions), an undetected inguinal hernia or an increase in abdominal pressure. To prevent these, castrate when young, close the tunic and skin as well as keeping the hind end elevated during healing.
• Herniation of omentum is treated under GA and in dorsal recumbency, cut the edges of the vaginal sac and fix them with allis tissue forceps. Apply traction to the omentum until a healthy omentum is exposed, place a ligature here and remove the distal omentum. Twist the vaginal tunic into a pedicle and anchor with ligatures to the margin of the inguinal canal.

  • The vaginal tunic distal to this is emasculated (contaminated) and left open
• Herniation of intestinal contents (eventration) is uncommon but life-threatening. this only occurs following open castration due to increased abdominal pressure, large scrotal rings or an undetected inguinal hernia. On visual inspection of these cases you will see the intestines and the horse may colic.
• to prevent further damage in a case of eventration, use a drape/sheet to retain viscera and administer systemic antibiotics, anti-endotoxin therapy and fluids.
• There are two treatment options for eventration

  • if potentially undamaged and uncontaminated sutures can be placed into the scrotum and kept in place via towel clamps or scrotal sutures. Under GA you can then lavage the viscera and replace/resect using a midline laparotomy if needed.
  • May need to euthanatize if the intestines have been long on the ground and have been trodden
• what is the correct way to position the emasculators and how long should you leave them in place to clamp the vessels?

  at a right angle to the spermatic cord at the level of the mesorchium. they should remain in place for 1 minute
• A skin bleeder will be a steady drip of blood (can count the drips). Anything more is likely to be a major vessel (inguinal artery, or more commonly testicular artery) and requires intervention
• Donkeys and mature horses are supposed to have an increased risk of bleeding, so general anaesthesia and a closed technique (or open with ligation) are recommended for these cases.

  • Make sure you always place emasculators ‘nuts to nuts’ or you will cut proximally and crush distally, and therefore achieve no hemostasis.
  • Keep emasculators on for at least 3 minutes
• what are the advantages and disadvantages of open and closed techniques?

  A) better drainage

  B) swelling

  C) longer

  D) prevents

  E) swelling

  F) drainage

  G) slower

  H) GA risk

  
• it has been traditional in the UK to castrate colts during the spring and autumn to prevent the presence of flies, contamination by winter mud and the disruption of hemostasis by hard frosts
• standing castration can be done in colts larger than 14.2 hands as full access to the inguinal area may be harder in smaller animals
• name the drug

  A) xylazine

  B) detomidine

  C) butorphanol

  
• detomidine and butorphanol should not be used together in horses with a history of liver disease or cardiac irregularities
• sedation for standing surgical castration includes an alpha 2 agonist which can be used with an opioid if necessary. This can also be preceded by ACP
• what local anaesthetics are licensed for the horse?

  lidocaine, mepivacaine and procaine (but procaine is not commonly used in castrates)
• below is an example protocol for castration under GA. fill in the drugs

  A) ACP

  B) midazolam

  C) detomidine

  
• what 3 sites are used for local anaesthesia?

  the visceral vaginal tunic, the testis or the scrotal skin
• Metabolism and clearance of NSAIDs by donkeys differ compared to horses so check your dosages! More frequent dosing is required of phenylbutazone, flunixin, and ketoprofen.

  • Carprofen is metabolised slower than in horses and meloxicam has a 1/10th half-life compared to horses