Pyometra with sepsis in the bitch: stabilise and operate

Question

9-year-old entire female Rottweiler, in season 6 weeks ago. Polyuria-polydipsia, vomiting and lethargy for 3 days. Tachycardia, injected mucous membranes, temperature 39.9 °C and no vulvar discharge. Ultrasound confirms a markedly distended uterus with contents.

What is the most appropriate management?

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A. Aglepristone and antibiotics for 2 weeks, then decide whether to operate

Medical treatment takes days to empty the uterus and is unsuitable in an older, septic bitch with a closed cervix, which is also at risk of uterine rupture.

B. Anaesthetise and operate immediately, without prior fluid therapy, so as not to lose time

Anaesthetising a hypovolaemic septic patient without resuscitation greatly increases the risk of hypotension and perioperative death; a few hours of stabilisation improve the outcome.

C. Stabilise over a few hours (fluids, intravenous antibiotics, correction of glucose and electrolytes) and perform ovariohysterectomy as soon as she is stable

Correct. The uterus is the septic source and its removal is the definitive treatment; antibiotics alone are not enough. Stabilisation should take hours, not days.

D. Drain the uterus by ultrasound-guided puncture and continue antibiotics, avoiding surgery

Puncturing a friable, pus-filled uterus can cause septic peritonitis, and it neither removes the source nor the endometrial hyperplasia that causes recurrence.

lightbulb Key takeaway

Pyometra, especially closed, is a common cause of E. coli sepsis in entire bitches. Handle the uterus gently to avoid rupture and, if there is pus in the abdomen, lavage thoroughly. Afterwards monitor for hypoglycaemia, kidney injury and hypotension.

What is the most appropriate management?

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