Post-spay complications in a rabbit

3 Post-spay complications in a rabbit




INITIAL PRESENTATION


Inappetence and lethargy after ovariohysterectomy in a rabbit.



Introduction


Surgical procedures involving the abdominal cavity of rabbits are historically associated with many potential complications, including wound breakdown and gastrointestinal ileus (Box 3.1). While the benefits of ovariohysterectomy (spaying) (Box 3.2) in the general population far outweigh these risks, they should nonetheless be discussed with clients before the procedure is performed on their pet. This case outlines the strong interplay between medical therapy and nursing care, and surgical treatment of complications after spaying in one individual.



BOX 3.2 Reasons for spaying female rabbits



• Prevent unwanted pregnancies (permitting neutered does to live with uncastrated bucks)

• Prevent pseudopregnancy

• Reduce territorial aggression

• Reduce incidence of or treat uterine neoplasia (commonly adenocarcinoma)

• Prevent or treat other uterine pathologies such as pyometra, uterine aneurysm and hydrometra.


BOX 3.1 Potential complications after abdominal surgery in rabbits



• Wound dehiscence, e.g. after self-trauma or excessive activity, resulting in herniation if linea alba closure dehisces

• Seroma formation

• Haemorrhage – with haematoma formation or bruising

• Infection: of wound, peritonitis

• Gastrointestinal ileus (particularly if gastrointestinal tract is handled roughly or excessively)

• Adhesions

• Reaction to suture material (particularly if catgut is utilized)

• Hepatic lipidosis (associated with fasting of obese individuals during the procedure and recovery period).


CASE PRESENTING SIGNS


A 10-month-old female English rabbit (Oryctolagus cuniculus) was presented with inappetance, lethargy, and reduced faecal output 3 days after ovariohysterectomy.



Husbandry


The rabbit was obtained from a local rescue centre 2 months prior to being presented for neutering. The patient’s sibling was obtained and spayed at the same time (with no problems noted). The rabbits were fed on a diet of hay, commercial extruded concentrate pellets for rabbits, and mixed fresh vegetables. They had been housed indoors initially, but had access to the owners’ garden after being vaccinated against myxomatosis and viral haemorrhagic disease.



Case History


The ovariohysterectomy was routine, using poliglecaprone 25 (Monocryl®, Ethicon, Livingstone, UK) suture material for ligatures, polydioxanone (PDS®, Ethicon) for the muscle layer, and poliglecaprone 25 for the subcutaneous and intradermal layers. The rabbit was overweight (body condition score 3/5), with excessive intra-abdominal fat, making the procedure technically more difficult. (Dietary advice was given to the owner at discharge, advising a reduction in the quantity of concentrate pellets being offered.) She was discharged 2 days after surgery, by which point she was eating and passing normal faeces, and the wound had a normal appearance. Analgesia was continued (meloxicam at 0.3 mg/kg PO q24hr, off-label use) for 3 days.


A day later (3 days after surgery), the rabbit re-presented at the clinic (Box 3.3). She had not eaten and had been quiet at home. Faecal output was reduced and the rabbit appeared to have abdominal discomfort.



BOX 3.3 Signs of pain in rabbits


Clinical signs of pain are usually vague in rabbits, often being a subtle change from normal behaviour. Normal grooming ceases and some individuals show aggression. Signs may include reluctance to move, anorexia and changes in physiological parameters (heart rate, respiratory rate and body temperature). Abdominal pain may be evidenced by a crouched posture and tooth grinding. Some rabbits may be restless, intermittently jumping and circling. Those with urinary tract pain may show signs of dysuria.



Clinical Examination


The rabbit’s weight had reduced slightly (from 2.93 kg pre-surgery to 2.6 kg 3 days after surgery). Auscultation of the abdomen showed reduced gut sounds on the left-hand side, and a large mass was palpated in the caudal abdomen. The rabbit was reluctant to move, but did not appear to have locomotor dysfunction (Box 3.3). A moderate tachypnoea was present (respiratory rate 100 breaths/minute, normal range 32–60).



DIFFERENTIAL DIAGNOSES


The differentials for reduced appetite and faecal output were:


• Gastrointestinal ileus post-surgery, associated with rough handling of intra-abdominal organs

• Pain/discomfort after surgery

• Peritonitis (infectious or sterile)

• Wound infection

• Other gastrointestinal disease: including infection, intussusception, foreign body (uncommon)

• Metabolic dysfunction, e.g. hepatic lipidosis

• Wound dehiscence, possibly with herniation of abdominal contents. (Remember that the linea alba may be compromised with or without loss of integrity of the skin wound.)


Case Work-Up



Trial with supportive care


Gastrointestinal ileus is extremely common after a stressor such as surgery. Prevention is preferable to cure, and it is advisable to administer prokinetics and assist feed rabbits after surgery until appetite and faecal output return to normal (as was done in this case). Re-instigation or continuance of prokinetics, assist feeding, and fluid therapy (see Nursing aspects box below) are indicated in a rabbit with reduced appetite and/or faecal output. An improvement should be seen within 24–48 hours. In the case of this patient, fluids were administered intravenously (Fig. 3.1).


image

Figure 3.1 Rabbit receiving intravenous fluids. The catheter is placed in the marginal auricular vein.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Post-spay complications in a rabbit
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