Page 513 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

488 CHAPTER 2

VetBooks.ir this confirms that the vestibulovaginal seal is also (Figs. 2.97–2.100). It is best to check the confor-
mation following breeding and ovulation before
compromised. There may also be a history of aspi-
ration of air during normal exercise (vaginal wind
is removed from either side of the vulval lips under
sucking). performing the procedure. A thin piece of mucosa
local anaesthetic and then the two edges are sutured
Differential diagnosis together down to the level of the pelvic brim. The
Other causes of infertility and endometritis. repair must ensure that the dorsal commissure is
closed and kept closed. Once the procedure is car-
Diagnosis ried out the mare will require a Caslick’s operation
History and clinical examination of the external for the rest of her reproductive life (Fig. 2.101). The
genitalia are usually enough to achieve a provisional Caslick will require opening for breeding and foal-
diagnosis. The perineal and pelvic conformation ing, and rapid repair thereafter to prevent reinfec-
will need careful consideration. The vulva is ide- tion. Endometritis/cervicitis/vaginitis secondary to
ally evaluated during oestrus. The integrity of the the pneumovagina often resolve spontaneously after
perineal body is best assessed by placement of one the Caslick’s operation due to the natural defence
finger into the rectum and the thumb in the vesti- mechanisms. In older or heavily contaminated mares,
bule (there should be at least 3 cm of muscular tissue specific endometritis therapy may be necessary.
between the two). Calculation of the Caslick index Where a Caslick’s operation is ineffective, and
will help define if this procedure is necessary. On especially if there is vestibular insufficiency, it may
vaginoscopic examination, there may be air in the be necessary to undertake additional surgical pro-
vagina and a vaginitis/cervicitis with congestion and cedures. Where there is cranial migration of the
mucus/discharge (sometimes frothy and foamy due anus and rectum, Pouret’s procedure may be used
to air). Samples can be taken to confirm the presence to realign the vulval labia. Where there is vestibular
of an endometritis (swabs for bacterial culture/cytol- and perineal insufficiency, perineal reconstruction
ogy). Rectal palpation and ultrasound examination is indicated. Both are more technical procedures
may reveal an air-filled vagina/uterus (Fig. 2.96) and than the Caslick’s operation and are best carried out
cranial migration of the uterus into the abdomen. in stocks under epidural anaesthesia. Occasionally,
mares/fillies in racing or competition may draw
Management air into the vagina during exercise leading to poor
Caslick’s vulvoplasty operation is the most important hindlimb action and poor performance. These
treatment for vulval insufficiency and pneumovagina animals are frequently treated with a Caslick’s

2.96

Fig. 2.96 Transrectal
transverse ultrasonogram of
the right uterine horn showing
air within the lumen (note the
bright white hyperechoic foci).
This mare had abnormalities
of the vulva and vestibule
leading to aspiration of air
into the proximal reproductive
tract. (Photo courtesy
Tracey Chenier)