Arvind Sharma

Assistant Professor
Deptt. Of Surgery & Radiology
DGCN COVAS, CSK HPKV, Palampur
Canine Pyometra Complex
 accumulation of purulent material within the uterus.
 cystic endometrial hyperplasia-pyometra complex.
 Potentially a life threatening condition
 Develops during diestrus.
 Diagnosis gets delayed and unrecognized until
anestrous.
Pathophysiology of CPC
 develops during diestrus
 high and prolonged ovarian production of
progesterone
 Fluid accumulates in the endometrial glands
 Uterine drainage is hindered by progesterone
inhibition of myometrial contractility.
 Abnormal uterine environment allows bacterial
colonization to cause Pyometra.
 Administration of estrogen increases the risk of
Pyometra during diestrus.
CPC- Pathophysiology contd…
 Estrogen increases the number of uterine progesterone
receptors
 Leukocyte response to bacteria is inhibited in
progesterone – primed uterus- E. coli
 Open or close d cervix pyometra
 dehydration and toxemia ensues.
 Compression and over distension of the uterus -
peritonitis
 Torsion of the distended uterus may also occur.
CPC- Concurrent abnormalities
 Hypoglycemia
 Prerenal azotemia
 Hepatocellular injury
 Anemia
 Coagulation deficits
 Cardiac arrhythmias
Diagnosis of CPC
 Signalment: older intact bitches (6 to 11 years) , Nullipara bitches
 History: several weeks (4-8 weeks) after estrus
 purulent or bloody vaginal discharge.
 abdominal distention, fever, partial to complete anorexia, lethargy,
polyuria, polydipsia, vomiting, diarrhea and weight loss.
 Closed Pyometra - vomiting and diarrhea.
 Physical examination findings
 Dehydration ,endotoxaemia or septicemia may be in shock,
hypothermic and moribund. Fever is infrequent.
 Diagnostic imaging:
 Ultrasonography - uterine contents; determine uterine wall thickness
and irregularities.
 Radiographic confirmation of Pyometra may not be possible until 41 to
43 days after ovulation.
Caution…..
 Never perform a transabdominal percutaneous
puncture to aspirate the uterine contents.
 Leakage of the pus in the abdominal cavity usually
occurs leading to a usually fatal peritonitis.
 Treatment of CPC
 Medical treatment:
 prostaglandin therapy (PGF2α) - inappropriate for critically
ill patients ,evacuation is neither immediate nor
incomplete.
 Medical therapy with antibiotics for 2-3 weeks and with
PGF2α or preferably Aglepristone combined with
Cloprostenol should be considered only for metabolically
stable, valuable, breeding animals.
 Medical therapy is most appropriate for animals with an
open Pyometra.
 Expect Pyometra to recur in 20% cases during subsequent
estrus cycles.
 Doses: PGF2α 0.1-0.25mg/kg SC, qd or bid for 3-5 days
 Aglepristone 10mg/kg SC on days 1,3,8 and 15
 Cloprostenol 1µg/kg SC, days 3 and 8.
Surgical treatment of CPC
 Ovariohysterectomy should not be delayed
 Morbidity and mortality are associated with concurrent
metabolic abnormalities and organ dysfunction.
 Hydration, electrolyte and acid base imbalances should be
corrected before surgery.
 Ovariohysterectomy should be performed invariably
by mid ventral approach of the abdomen. Flank
approach must be avoided due to chances of rupture
of the already friable pus filled uterus during
manipulation and evacuation between the flank
muscles. Do not use spay hook to locate or exteriorize the
uterus as it may tear the uterus.
 Do not correct uterine torsion because this will release
bacteria and toxins.
Exteriorized pus filled uterus
Post- operative follow up
 Closely monitor the patients for 24-48 hours for sepsis
and shock, dehydration and electrolyte/acid-base
imbalances.
 Fluid therapy should be continued post operatively
until the animal is drinking and feeding normally.
 Stump Pyometra may occur.
 Prognosis following surgery is good
 - if abdominal contamination is avoided
 - shock and sepsis are controlled
 - renal damage reversed by fluid therapy and bacterial
antigen elimination.
Thank You