Equine Health Update EHU Vol 20 Issue 02 | Page 16

EQUINE | CPD Article

EQUINE | CPD Article

in place long enough , or including scrotal skin when crushing the cords . 3 In horses with large testicles , the tunic and cremaster muscle can be emasculated separately from the spermatic cord . Bleeding should be regarded as being excessive if persisting in a streamlike fashion for more than 15 minutes and should be addressed . 10 If the castration was performed standing , the bleeding stump will be relatively long and may still be anaesthetized . If the stump can be grabbed with gloved fingers , it can be cut / crushed again with emasculators . If it is still bleeding , it should be clamped with large curved artery forceps . These are usually left on overnight ( 12 -24 hours ). Alternatively the scrotal incision can be packed with sterile gauze swabs and sutured closed . 3 , 10
If the source of bleeding cannot be identified and controlled or if intra-abdominal haemorrhage is suspected , the horse should be referred to a surgical facility . Anaesthetizing the horse to find the bleeder in the scrotum or even ligating the testicular artery intra-abdominally ( laparoscopically ) may be needed in extreme cases . 3 ( In the author ’ s experience , this is scenario is very unlikely .) After closed or semi-closed castration in which the skin was sutured , bleeding will present as a large haematoma or swelling of the scrotum , usually within a day after surgery . Separate ligation of the cremaster muscle and the use of electrocautery may reduce this complication . 8 If a scrotal haematoma is present , the incision ( s ) need to be opened to allow drainage , after which the horse should be treated as if it had an open castration .
Because of the invasive nature of addressing haemorrhage and the presence of blood clots , all these animal should receive antimicrobial coverage 3 ( usually oral trimethoprim sulphonamide at 25 mg / kg BID for 5 days ).
Herniation / Eventration Eventration after castration is a rare but life-threatening complication , occurring in 0.2 -2.6 % of castrations 3 . A report of intestinal herniation in draught colts after castration with a prevalence as high as 4.8 % has also been reported . 11
Unapparent congenital inguinal hernias may be present before castration and will predispose the animal to eventration after castration . Most unapparent congenital inguinal hernias will resolve spontaneously in the first 3-6 months of life , thus making it safer to perform castrations only after six months of age . Of the more commonly encountered breeds in South Africa , Draft horses and American Saddlebreds may have a higher incidence of congenital inguinal hernias and may therefore be predisposed to post-castration evisceration . These horses are good candidates for closed or semi-closed castrations under general anaesthesia , which should include ligation of the tunic . 10
Herniation of the greater omentum should not pose an immediate life-threatening condition to the horse . After aseptic preparation of the scrotum , the omentum can be abducted from the external inguinal opening until clean tissue is seen . The exteriorized omentum can then be trimmed as proximal as possible to the scrotum . 3 , 10 A rectal examination should be performed to confirm that no intestine have entered the inguinal canal and to evaluate the size of the inguinal canal . The horse should be strictly confined to a stable for 48 hours to prevent further omental herniation . The scrotal incision can also be packed with sterile swabs and sutured closed . The affected inguinal ring will be filled with omentum , which should prevent intestinal evisceration . 1 , 3 , 10 Additional antimicrobial coverage for a week is advised .
16 • Equine Health Update •