A síndrome do ovário remanescente é definida como a persistência da atividade ovariana em fêmeas castradas. É decorrente da presença de tecido ovariano acessório no ligamento largo uterino ou por erro na técnica cirúrgica de ovariosalpingohisterectomia ou ovariectomia. O presente trabalho descreve o diagnóstico e tratamento videolaparoscópico de um caso de síndrome de ovário remanescente em uma gata. No acesso, foram utilizados três portais de 5mm nas paredes abdominais direita, esquerda e na linha média ventral. Constatou-se a presença de massa com aspecto de tecido ovariano junto à fossa paralombar esquerda e aumento de volume na fossa paralombar direita, removidos com tesoura de Metzenbaum e cauterização monopolar. O exame histológico da massa extirpada do lado esquerdo confirmou a presença de tecido ovariano. Não se observaram complicações perioperatórias, e a paciente evoluiu sem sinais de recidiva de estro pelo período de pelo menos 24 meses. Conclui-se que a síndrome do ovário remanescente em gatas pode ser diagnosticada e tratada com sucesso por cirurgia laparoscópica.
"A falha em remover todo o ovário pode resultar da colocação inadequada das pinças hemostáticas, ligaduras ou da reduzida visualização do campo cirúrgico (Santos et al., 2009). Atualmente, alguns centros de excelência têm utilizado o procedimento cirúrgico de videolaparoscopia em gatas e cadelas portadoras de ovário residual, com obtenção de bons resultados (Finger et al., 2009; Luz et al., 2009). "
[Show abstract][Hide abstract] ABSTRACT: Background: The ovarian remnant syndrome (ORS) is the persistence of ovarian activity in spayed bitches or queens, which results from failure in complete gonadal removal or due to the presence of accessory ovaries on the uterine broad ligament. In most of cases, surgical approach may be required in order to both diagnose and treat the syndrome. The current case report describes the usefulness of video-assisted surgery as an alternative to diagnosis and treatment of an unusual case of ORS and stump piometra in a bitch. Case: The purpose of the current study was to report the case of a 4-year-old Dachshund bitch, bearing paraplegia due to intervertebral disk disease (IVDD), showing estrus and pseudo pregnancy regularly for two years. This report describes the use of alternative exploratory video-assisted laparoscopy followed by ovariectomy as a safe and effective method for both diagnosing and treating the ORS and stump pyometra uterine horn held in HV-UPF. Following complementary exams , the patient was submitted to ultrasonography, which revealed the presence of masses resembling ovaries caudally to the respective renal caudal pole. A two-portal laparoscopic-assisted approach was chosen for the surgical treatment. The intact ovary and a remnant uterine horn stump were present on the right side. On the left side, there was the intact ovary. The overall surgical time was 115 min and the postoperative was uneventful. The patient was discharged following 10 days of the surgery, right after removal of the skin sutures. The excised specimen was referred to the Laboratory of Animal Pathology of the UPF for both macroscopic and histological assessment. The macroscopic exam revealed the presence of both complete ovaries and the remnant uterine horn stump presented remnants of purulent content. The histologic assessment revealed several follicles and corpus luteum, besides mild perifollicular multifocal hemorrhage. On the second ovary, there were ovarian follicles and the remnant uterine horn presented discrete multifocal cystic endometrial hyperplasia. Discussion: The treatment of choice to ORS is surgical removal of the remnant tissue, especially due to the risk of development of neoplastic disease. The occurrence of ORS, as observed in the current case report, can be attributed to improper surgical technique during elective OVH. In our case, there was incomplete removal of both ovaries and incomplete resec-tion of the right uterine horn. In face of the advantages associated to the laparoscopic access, we opted for a two-portal approach. In this special case, regarding a patient bearing paraplegia and consequent fecal and urinary incontinence, we chose the endosurgical approach due to the reduced incision length, which could have resulted in decreased risk of wound fecal and urine contamination or infection. During laparoscopy, it was seen that the right ovary was intact, without rupture of the suspensory ligament and the presence of a segment of the right uterine horn. In these cases, the remnant tissue is most frequently found on the right side, fairly probably due its deep and cranial anatomical topography. Such condition could lead to poor exposition/viewing of the right pedicle and ovary. In cases of both impaired access and visualization of the mesovarium in patients positioned in dorsal decumbency, it is recommended to slightly rotate the patient in the lateromedial direction to the opposite side. In conclusion, the two-port laparoscopic approach is effective for the surgical management of ovarian remnants associated to stump piometra in the bitch.
Acta Scientiae Veterinari 01/2015; 43. · 0.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The ovariosalpingohisterectomy (OSH) is the treatment of choice for the remaining ovary syndrome and canine pyometra, which can be performed by conventional or laparoscopic approach. In recent years, have developed new techniques for laparoscopic treatment of uterine and ovarian diseases in dogs. However, there are few reports of laparoscopic OSH for treatment of ovarian remnant syndrome and stump pyometra. Thus, the present report aims to describe the use of laparoscopy for the treatment of pyometra uterine horns and ovaries in a bitch remaining. Case: A bitch, mixed breed, with two years of age, was answered with a history of heat after being submitted to OSH was five months. Against clinical and ultrasonographic findings, the diagnosis was the remaining ovary syndrome pyometra and uterine horns, the animal being referred for laparoscopic surgery to remove the remaining uterine and ovarian tissue. After placing two laparoscopic portals, the animal was placed in right lateral recumbency. After the seizure of the ovarian ligament itself with the Kelly forceps, was held dual temporary transparietal suture for better exposure of the left arteriovenous ovarian complex. Was continued with bipolar cautery and Metzenbaum scissors with section. The animal was repositioned in the left lateral decubitus position, and the procedure was repeated on the right ovarian arterial-venous complex. The animal was positioned in dorsal recumbency again. Was held to apply temporary transparietal suture involving the urinary bladder for inspection of the uterine stump, without this change. There was exposure of the ovaries and uterine segments from the removal of the cannula and aspiration of uterine contents with the aid of a catheter 18. Verifying the absence of hemorrhage, the cavity was deflated, and the wounds sutured into muscle level access quilter cross pattern with 2-0 polyglactin 910. Subcutaneous suture was performed with the same wire a simple continuous pattern. The skin was occluded with a 3-0 monofilament nylon in standard default horizontal quilter stopped. Discussion: Patient in this report, when it was found the remaining ovaries and uterine horns increased in volume, remained the proposal OSH by laparoscopy, once the laparoscopic surgery is associated with better and faster postoperative recovery, as well as lower production of painful stimuli, magnification of images, the possibility of wide-ranging exploration of the peritoneal cavity, decreases the length of hospitalization and intensive care at that stage. Despite the success of previous reports of therapeutic video-assisted OSH in dogs and cats, the use of laparoscopic OSH with two portals for the treatment of ovarian remnant syndrome is still scarce in the small animal clinic. The minimally invasive procedure has disadvantages as a steep learning curve, with consequent initial prolonged surgical time and high operating costs. On the other hand, laparoscopy has less adhesion formation and better preservation of lung function. This may have contributed to the rapid postoperative recovery this dog. It is concluded therefore that laparoscopic OSH with two portals proved effective and beneficial in the treatment of ovarian remnant stump pyometra and uterine horn can be used in dogs as an alternative to conventional surgery.
Acta Scientiae Veterinari 01/2015; 43. · 0.22 Impact Factor
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