A case report of a chronic vaginitis caused by a polyglycolic acid suture

Kód výsledku v IS VaVaI

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Výsledek na webu

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DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

A case report of a chronic vaginitis caused by a polyglycolic acid suture

Popis výsledku v původním jazyce

A ten-year-old Rhodesian Ridgeback was presented in consultation for a chronic vaginitis that appeared after an ovariohysterectomy. This bitch was spayed for a pyometra eight months ago in a private practice. The ovariohysterectomy was performed, PGA RESORBA? (polyglycolic acid with resolactone coating) was used for ligatures of ovarian pedicles and a uterine cervix. To ligate the uterus, PGA RESORBA? USP 2-0 (EP 3.0) was placed caudally of the uterine cervix and a circumferential ligature on the cranial part of vagina was performed. A second ligature was performed near the uterine body like a transfixing ligature. The PGA RESORBA? thread was suture throught the cranial part of vagina and a figure-eight suture was placed on the uterine cervix. A forceps were put on the uterus near the uterine cervix and a transection was performed between the forceps and ligatures throught the cervix. The uterus was removed and the ovariohysterectomy was completed by the standard surgical protocol. Several weeks after the surgery a clear mucous discharge from the vulva was observed by the owner. A few vaginal smears were done in the same private practice but no signs of an inflammation were found. The bitch was without medication. The vulvar discharge changed character to purulent two weeks before visiting of Small Animal Clinic. A suspicion of a stump pyometra was pronounced and a surgical revision of an abdominal cavity was recommended by the private practice. The owner asked us at Small Animal Clinic for a clinical examination of her bitch and our recommendation if the bitch should undergo the surgery. The bitch was presented with a yellowish purulent odorless vulvar discharge lasting two weeks. No specific or nonspecific symptoms of deterioration of a general health were observed. The bitch was active and in a good general health. An ultrasonographic examination was performed and neither the ovaries nor the uterus were found. A vaginoscopy with a rigid endoscope was performed. Hysteroscope/TCI Endoscope Karl Storz with fiberoptic system, direction of view 6°, 8 Fr. distal tip and length 43 cm was used. A vaginal mucosa was pink and clear. We visualized a dorsal median fold of vagina where a small amount of the purulent discharge was present. A source of the discharge had to be cranially from this place. An air insufflation was used for an opening of the vagina and a vaginal fornix was visualized. A remnant of the uterine cervix was present and a suture material was found between the cervix and a fornix bottom. The material was a polyfilament thread. We tried to remove the thread with an endoscopic forceps with double action jaws (forceps for grasping stone fragments, 5 Fr., length 60 cm) and third attempt was successful. We released and removed the suture which was very fragile. Than a lavage with a warm saline was performed. The fornix was inspected for suture residues and the examination was closed. No special care was required and the patient was released home. We contacted the owner three weeks later and no signs of any vaginitis were observed. Because the bitch was without any signs of disease, no examination was recommended. The PGA RESORBA? is a polyfilament absorbable suture material with complete absorption in approximately 90 days. Metabolization of the PGA suture material within the tissue occurs by the uptake of water, thus reversing the synthesis. The monomeric glycolic acid is split enzymatically into CO2 and H2O by normal metabolism (1). First circumferential ligature was probably absorbed by metabolism but second transfixing ligature persisted. In the canine vagina is probably a lower humidity than in soft tissue so the PGA was not split and behaved like a foreign body. Based on this case the authors recommend to use only double circumferential ligature without suture through the vagina. Over the years, various types of vaginal foreign bodies have been described in bitches like grass awns (2, 3) or a piece of retained calvarium from a macerated fetus (4). To the authors? knowledge, this is the first reported case of a PGA foreign body in the vaginal fornix of a dog.

Název v anglickém jazyce

A case report of a chronic vaginitis caused by a polyglycolic acid suture

Popis výsledku anglicky

A ten-year-old Rhodesian Ridgeback was presented in consultation for a chronic vaginitis that appeared after an ovariohysterectomy. This bitch was spayed for a pyometra eight months ago in a private practice. The ovariohysterectomy was performed, PGA RESORBA? (polyglycolic acid with resolactone coating) was used for ligatures of ovarian pedicles and a uterine cervix. To ligate the uterus, PGA RESORBA? USP 2-0 (EP 3.0) was placed caudally of the uterine cervix and a circumferential ligature on the cranial part of vagina was performed. A second ligature was performed near the uterine body like a transfixing ligature. The PGA RESORBA? thread was suture throught the cranial part of vagina and a figure-eight suture was placed on the uterine cervix. A forceps were put on the uterus near the uterine cervix and a transection was performed between the forceps and ligatures throught the cervix. The uterus was removed and the ovariohysterectomy was completed by the standard surgical protocol. Several weeks after the surgery a clear mucous discharge from the vulva was observed by the owner. A few vaginal smears were done in the same private practice but no signs of an inflammation were found. The bitch was without medication. The vulvar discharge changed character to purulent two weeks before visiting of Small Animal Clinic. A suspicion of a stump pyometra was pronounced and a surgical revision of an abdominal cavity was recommended by the private practice. The owner asked us at Small Animal Clinic for a clinical examination of her bitch and our recommendation if the bitch should undergo the surgery. The bitch was presented with a yellowish purulent odorless vulvar discharge lasting two weeks. No specific or nonspecific symptoms of deterioration of a general health were observed. The bitch was active and in a good general health. An ultrasonographic examination was performed and neither the ovaries nor the uterus were found. A vaginoscopy with a rigid endoscope was performed. Hysteroscope/TCI Endoscope Karl Storz with fiberoptic system, direction of view 6°, 8 Fr. distal tip and length 43 cm was used. A vaginal mucosa was pink and clear. We visualized a dorsal median fold of vagina where a small amount of the purulent discharge was present. A source of the discharge had to be cranially from this place. An air insufflation was used for an opening of the vagina and a vaginal fornix was visualized. A remnant of the uterine cervix was present and a suture material was found between the cervix and a fornix bottom. The material was a polyfilament thread. We tried to remove the thread with an endoscopic forceps with double action jaws (forceps for grasping stone fragments, 5 Fr., length 60 cm) and third attempt was successful. We released and removed the suture which was very fragile. Than a lavage with a warm saline was performed. The fornix was inspected for suture residues and the examination was closed. No special care was required and the patient was released home. We contacted the owner three weeks later and no signs of any vaginitis were observed. Because the bitch was without any signs of disease, no examination was recommended. The PGA RESORBA? is a polyfilament absorbable suture material with complete absorption in approximately 90 days. Metabolization of the PGA suture material within the tissue occurs by the uptake of water, thus reversing the synthesis. The monomeric glycolic acid is split enzymatically into CO2 and H2O by normal metabolism (1). First circumferential ligature was probably absorbed by metabolism but second transfixing ligature persisted. In the canine vagina is probably a lower humidity than in soft tissue so the PGA was not split and behaved like a foreign body. Based on this case the authors recommend to use only double circumferential ligature without suture through the vagina. Over the years, various types of vaginal foreign bodies have been described in bitches like grass awns (2, 3) or a piece of retained calvarium from a macerated fetus (4). To the authors? knowledge, this is the first reported case of a PGA foreign body in the vaginal fornix of a dog.

Druh

O - Ostatní výsledky

CEP obor

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OECD FORD obor

40301 - Veterinary science

Projekt

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Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2019

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů