Endometriosis and pyometra

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Post   » Sat Mar 16, 2002 8:49 pm

Choco was born in January 2001 to a rescue sow I had taken in. There were two babies and from the start, she was a lot bigger that her sister. When they were 6 weeks old, the two babies were placed in foster care with a friend of mine and they returned to my house this last November. Choco had always been the dominant of the two, but my friend informed me that it was getting worse. Choco was chasing, biting and mounting her sister and always acted like she was in heat, doing the butt swinging and everything.

One day, I noticed that Choco's shape was changing. Her weight was pretty stable (slight gain), but her belly seemed bigger. Then, one night, when I picked her up, I noticed her genitals were swollen, red, inflammed and were covered with a slimy substance. Of course, it was on the weekend, so I couldn't see my vet, but since these are often signs of urinary tract infections, I started her on Baytril. When I looked into the cage, I found one pine shaving with pink on it. I put her on white towels to monitor the pee, but I couldn't see more traces of blood. Then I brought her to the vet on Monday, but by that time, I knew something was not right. In the last week before that vet visit, her belly had gotten bigger and she now looked like she was pregnant (impossible, since she had never been in contact with a boar).

My vet palpated her and agreed something was wrong, so we made some x-rays (of Choco and of her sister for comparison). The x-ray showed a large mass on the right side of her abdomen. It was hard to see what it was, but my vet concluded that it could be either large ovarian cysts or a swollen kidney. She decided to send the x-rays to the vet school to see what the specialists thought of it, so I brought Choco home.

Later in the evening, Choco started having a serious amount of blood in her urine. It was like diluted blood, not just pinkish, so the next morning, I called my vet and we decided we didn't have enough time to wait for results. We decided that she would be performing a spay that very day.

She prepared, read everything she could, called the specialists at vet school. We agreed that if it was ovarian cysts, she was do a spay. If it was the kidney, she wouldn't do anything since removing a kidney is a major procedure she was not ready for. When she opened the abdomen, a huge thing popped out. She tried pushing it aside and started looking for the uterus before realizing THAT WAS the uterus! That thing was huge, and there were hundreds of blood vessels attached to it, some extremely large. She managed to remove the uterus and ovaries, but Chco's heart stopped while she was stitching her up.

We took pictures of the tumor (I'll post them when I get them) and documented it. It was about four inches long and weighted 4oz. It was filled with liquid. At my request, it was sent to the lab. Here is the lab report in vet-talk.

The uterine mucosa is extensively invaginated, forming many large cystic cavities which are lined by
a single layer of cuboidal epithelial cells or a double layer of cuboidal to columnar epithelial cells. Some epithelial segments exibit prominent apical blebbing. The underlying submucosa is
hypercellular due to the presence of a monomorphic population of densely packed mesenchymal
cells with a indistinct eosinophilic cytoplasm and enormous single round to oval to fusiform nucleus
with a vesicular or strippled chromatin pattern. Anisokaryosis is mareked. Four mitolic figures
are present per 10 random 40 X fields. This population of cells blends into the underlying smooth
muscle layer of the uterine wall in many areas. Polymorphonuclear leukocytes are scattered
throughout the submucosa, especially around congested blood vessels and sometimes form
aggregates just beneath the basement membrane zone of the mucosa.

Final Diagnosis
Marked cystic endometrial hyperplasia, with suppurative endometritis

The changes in the submitted uterus were dramatic and resemble those seen in other species seen
with cyctic endometrial hyperplasia. A litterature search regarding the pathogenesis of this
condition in guinea pigs suggested an association between cyctic endometrial hyperplasia and
cyctic ovaries, however no information on the microscopic appearance of this condition is found.

I asked my vet to explain this to me in normal-people-talk and she said it was probably ovarian cycts that had spread to the uterus, leading to endometriosis and it was turning into pyometra at the time we did the spay. The uterus wall was filled with dozens of small cysts and pus pockets. The inside of the uterus had started to fill with pus as well.

I could kick myself for not figuring it out sooner. If I has asked for a spay earlier, we might have been able to save her, but this mass was so big, there was little we could do at that time. My vet had to make a very long incision to take the uterus out, and Choco probably would have had an extremely difficult recovery. The thing with this condition is that you want to do something before the pigs is sick, so please, please, palpate your sows often. Because I had never dealt with ovarian cysts before, I wasn't able to recognize the problem until it was too late. Her horny/bitchy behavior was a sign, but she didn't have the enlarged nipples or hair loss that often are seen with Ovarian cysts.

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