Castration Complications

Question 1

Why is castration the easiest most difficulty surgery you will do?

Answer 1

Most common cause of malpractice claims

Question 2

What is the complication rate of castrating a horse?

Answer 2

Up to 38%

Question 3

Are castration complications usually very severe?

Answer 3

No, most are mild or self-limiting

Question 4

What is the best way to avoid complications and treat them well when they occur?

Answer 4

Know your anatomy

Question 5

When does the worst swelling occur after castration?

Answer 5

3-5d post-op

Question 6

When should swelling post-castration resolve?

Answer 6

10-12d post-op

Question 7

What are additional clinical signs that might indicate the excessive swelling is more complicated than just swelling?

Answer 7

Stiff gait reluctance to urinate or move

Question 8

What demographic of horses are at higher risk of having an excessive swelling complication?

Answer 8

Older horses

Question 9

Not enough scrotal skin removed, infection, lack of exercise or skin/SQ stretch

Answer 9

Excessive swelling

Question 10

How do you treat excessive swelling?

Answer 10

Establish drainage, NSAIDs, forced exercise to get lymphatics moving

Question 11

How will the swelling migrate over time if it persists?

Answer 11

Moves forward to the prepuce

Question 12

What can excessive swelling lead to?

Answer 12

Infection, dysuria, paraphimosis

Question 13

What are sources of hemorrhage assoc. w/castration?

Answer 13

Testicular a. cremaster m. SQ vessels

Question 14

What causes hemorrhage?

Answer 14

Faulty emasculators or improper use of emasculators

Question 15

How can you determine if hemorrhage is normal or excessive?

Answer 15

Should drip, not flow, but drip should not persist for more than a couple days

Question 16

How do you treat hemorrhage?

Answer 16

ID and ligate source or pack w/sterile gauze and suture

Question 17

What meds can you give to help stop hemorrhage?

Answer 17

Aminocaproic acid

Question 18

When should you refer a hemorrhage complication?

Answer 18

Hypovolemic shock, intra-abdominal hemorrhage

Question 19

How often should you check bloodwork for changes assoc. w/intra-abdominal hemorrhage?

Answer 19

Every 6h

Question 20

Why won’t bloodwork demonstrate PCV drop w/intra-abdominal hemorrhage immediately?

Answer 20

Splenic contraction

Question 21

Presents as swelling, fever, lameness, discharge anywhere from days to years after castration

Answer 21

Septic funiculitis

Question 22

How do you dx septic funciculitis?

Answer 22

Decreased serum amyloid A response

Question 23

What is septic funiculitis?

Answer 23

Chronic infection of the spermiatic cord

Question 24

What is the most common bacteria cultured from septic funiculitis cases?

Answer 24

Staphylococcus

Question 25

How do you correct septic funiculitis?

Answer 25

Strip back to unaffected region and emasculate (remove infected tissue)

Question 26

When should you refer a septic funiculitis case?

Answer 26

Non-responsive to tx, CS present months post-op, sepsis/endotoxemia

Question 27

How can you prevent clostridial infections when castrating?

Answer 27

Booster w/tetanus toxoid peri-operatively

Question 28

Treat this uncommon complication by IDing, ligating, and transecting tissue and confirming anatomic normalcy via rectal palpation

Answer 28

Omental eventration

Question 29

What complication is an inherent risk that happens within 4h of castration and is often life-threatening?

Answer 29

Intestinal eventration

Question 30

How do you treat an intestinal eventration?

Answer 30

Lavage and replace through scrotum and suture/sling closed - REFER

Question 31

How do you refer an intestinal eventration?

Answer 31

Sedation, IV abx, banamine

Question 32

Uncommon complication of an open castration that is not an infectious process - treatment is cosmetic

Answer 32

Hydrocele

Question 33

How do you treat a hydrocele?

Answer 33

Remove the rest of the parietal tunic

Question 34

Presents with colic, fever, depression, and anorexia

Answer 34

Peritonitis

Question 35

How do you dx peritonitis?

Answer 35

MDB and abdominocentesis

Question 36

Why should abdominocentesis not be the sole method used to dx peritonitis?

Answer 36

WBC should be >100k for 3-4d after castration anywah

Question 37

What parameters of abdominocentesis other than WBC can indicate peritonitis?

Answer 37

Intracellular bacteria, degenerate PMNs, glucose

Question 38

How do you treat peritonitis?

Answer 38

Intensive ICU care

Question 39

Occurs when the surgeon is inexperienced and doesn't know basic anatomy

Answer 39

Penile damage

Question 40

How do you treat penile/urethral transection?

Answer 40

Refer for sx intervention

Question 41

How do you treat nerve damage and subsequent paraphimosis assoc. w/penile damage?

Answer 41

Sling, hydrotherapy, NSAIDs

Question 42

Inadvertent removal of epididymal tail but not testes

Answer 42

Incomplete castration

Question 43

Why might an incomplete castration occur?

Answer 43

Cryptorchid epididymis looks like hypoplastic testis to an inexperienced clinician

Question 44

What % of horses demonstrate aggressive behavior toward other horses post-castration?

Answer 44

20-30%

Question 45

What % of horses demonstrate aggressive behavior toward humans post-castration?

Answer 45

5%