Chapter 6: Table of Contents
Pyometra
Ovariohysterectomy for pyometra is performed using the technique described in the ovariohysterectomy section. However, depending on the severity of the pyometra (open or closed), the uterus is likely to be enlarged and more friable than usual. A larger incision is recommended and the uterus should be handled with care to prevent rupture and abdominal contamination. Gently lift the distended uterus and isolate it from the remainder of the abdominal cavity with moist laparotomy sponges. Avoid the use of a spay hook.
Then proceed with the ovariohysterectomy procedure. Use absorbable, monofilament suture for all ligatures. Braided suture is more likely to harbour bacteria in the crevasses of the suture material. Ensure that you remove the uterus at the level of the uterine body (close to the cervix). Do not leave excessive space between your ligatures around the uterine body as you may create a pocket filled with purulent material that could lead to abscess formation. Do not oversew the uterine edges at the level of transection as this creates a closed, contaminated pocket that can also lead to abscess formation. Instead, gently wipe the uterine stump with a moistened gauze sponge to reduce potential contamination. Abdominal closure is routine. Bacterial culture swabs of the purulent material should be collected once the abdominal cavity is closed. When uterine rupture was present preoperatively or occurs during surgery, contain the contamination as much as possible, collect samples for bacterial culture, perform thorough abdominal lavage and if available, insert a closed-suction to provide postoperative drainage.
