Iranian Journal of Veterinary
Science and Technology
CASE REPORT
Received: 2023- Jan- 24
Accepted after revision: 2023- Apr-05
Published online: 2023- Apr-08
DOI: 10.22067/ijvst.2023.80548.1224
Uterine Horn Intussusception in a Chihuahua Bitch
Samaneh Ghasemi , Mohammad Reza Emami , Ali Mirshahi, Pouria Khanzadeh, Sina
Yal Beyranvand, Mohammad Mahdi Zarezadeh
Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran.
ABSTRACT
Uterine horn intussusception has rarely been reported in bitches. However, the pathogenesis is not
entirely clear and the incidence of uterine intussusception in bitches is unknown. This disorder occurs during the postpartum period and is a challenging clinical condition in terms of presentation,
diagnosis, and management. In this report, a case of uterine horn intussusception is described in a
four-year-old female Chihuahua bitch, which presented with abdominal pain, lethargy, anorexia,
tremors, recumbency, and ongoing reddish vaginal discharge 20 days after whelping two pups. All
the hematological and biochemical test results were within normal ranges except for a decreased
calcium level. Ultrasonographic examination revealed the multilayered appearance of the uterine
wall. The midline laparotomy confirmed the invagination of a proximal segment of the uterine
horn into its distal segment near the uterine body. Ovariohysterectomy was performed as the recommended treatment. This case highlights the importance of assessing abdominal pain to avoid
delay in diagnosis and management. Moreover, uterine intussusception should be considered as
a differential diagnosis in bitches with the symptoms of abdominal pain during the postpartum
period.
Keywords
Bitch, Intussusception, Postpartum period,
Uterine horn
Number of Figures:
2
Number of Tables:
0
Number of References:: .20
Number of Pages:
.. 4
Abbreviations
https://IJVST.um.ac.ir
Corresponding author:
Samaneh Ghasemi
Email: : s.ghasemi@um.ac.ir
Tel: +98(91)5581-4581
IRANIAN JOURNAL OF VETERINARY SCIENCE AND TECHNOLOGY
Introduction
D
ifferent acquired disorders can affect the canine uterus during the postpartum period.
Some of them include hemorrhage, retained placenta,
sub-involution of placental sites, metritis, uterine prolapse, and rupture [1, 2]. Uterine intussusception is a
rare acquired disorder in bitches [3]. Therefore, its incidence cannot be estimated exactly. The pathogenesis
of uterine intussusception is not very clear. Physiological changes of the uterus during the postpartum period, such as uterus involution and hormonal changes or some pathological conditions, namely dystocia
and retention of fetal membranes, may lead to uterine intussusception [3-7]. Diagnosis of this problem
is a challenge because of the nonspecific clinical signs
and symptoms. This report describes a case of uterine
horn intussusception in a Chihuahua Bitch.
Case Presentation
A four-year-old female Chihuahua was referred
with a 24-hour history of lethargy, anorexia, tremors,
and recumbency. The patient had a delivery 20 days
before with an ongoing reddish vaginal discharge
post-parturition. Her two previous pregnancies had
been uncomplicated. She had no known trauma
history. The bitch was nursing her puppies. On the
physical examinations, although panting was initially observed, heart rate and rectal temperature were
CASE REPORT
normal. In addition, some stiffness in her limbs and
inability to stand was observed, and the palpation of
the abdominal region was painful.
For hematological and biochemical assessment,
blood samples were collected by venipuncture of the
cephalic vein. The results of routine hematological
and biochemical tests were within the normal range,
except for a decreased calcium level (5.99 mg/dl, reference value: 9-10.8). In caudal abdominal ultrasonography, the multilayered appearance of the uterine wall
(concentric rings) was obvious which represented
the superimposed wall layers of intussusceptum and
intussuscipiens. Furthermore, echogenic mesenteric fat was noticed in this view. The ultrasonographic
findings were suggestive of uterine intussusception
(Figure 1a). The surgeons advised a laparotomy, and
the dog underwent surgery after her condition was
stabilized by fluid therapy, perioperative pain management, oxygen therapy, and intravenous antibiotics.
Confirmed surgical findings revealed the invagination
of a proximal segment of the right uterine horn into its
distal segment near the uterine body which confirmed
uterine horn intussusception (Figure 1b). The manual reduction of intussusception was successfully performed by gentle pulling and the retrograde milking
of the intussusceptum out of the intussuscipiens (Figure 2a). The intussuscipiens segment was distended
without any significant abnormalities in the appearance of the affected uterine horn, and no adherence
areas were observed (Figure 2b). An ovariohysterec-
Figure 1.
a) Transverse ultrasonographic image of uterine intussusception, the inner uterine wall is identified within the outer uterine wall
surrounded by echogenic mesenteric fat; b) Right uterine horn intussusception (arrow) near the uterine body
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Uterine horn intussusception in a bitch
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IRANIAN JOURNAL OF VETERINARY SCIENCE AND TECHNOLOGY
Figure 2.
a) Manual reduction of the invaginated uterine horn segment by a combination of milking and pulling; b) Uterine horn after the
manual reduction of intussusception presenting a slight distention (arrow)
tomy was performed following obtaining the owner's
consent.
Discussion
Uterine intussusception is a rare condition in
small animals, which has only been described in a
few cases. To date, only less than ten case reports of
bitches with this condition were published in the literature. Among these cases, only three were described
in the English literature [3, 8, 9], while Brazilian veterinarians have reported three cases in Portuguese [3,
4, 8, 10, 11] and one case in Spanish [12]. The female
dogs affected by uterine intussusception have been of
various breeds, including Chow Chow [8], Golden
Cocker [12], Yorkshire Terrier [10], crossbred [11],
American Bully [3], Shih Tzu [4], German Shepherd
[9], and Chihuahua. Uterine intussusception has also
been previously reported in a nulliparous sheep [13]
and a Thoroughbred broodmare [14].
The possible pathogenesis and complete clinical
manifestations are not very clear due to the rarity of
this condition. The tubular anatomical structure of
the uterus and its ability for contraction and expansion may predispose it to intussusception [3]. In the
cases of Chow Chow [8] and Yorkshire Terrier [10],
the bitches were in the proestrus phase and imminent delivery, respectively. In other case reports [3,
4, 12], uterine intussusception was described in the
postpartum period, as for a Chihuahua described in
this paper. Therefore, it seems that uterine intussusception predominantly occurs during the postpartum
period. This period is characterized by uterine involution which is completed when the uterus diameter reUterine horn intussusception in a bitch
turns to the original non-pregnant size. Furthermore,
it was suggested that the normal involution process
of the uterus is slow in the bitches and can last about
3 months [15]. During the postpartum period, physiological changes, involving the regeneration of the
uterine tract [5], distention of uterine ligaments [3],
and hormonal changes, including decreased or increased estrogen concentration [4], may be associated
with uterine intussusception in this period. Moreover,
uncoordinated peristalsis along the uterine tube may
contribute to this condition [13, 16]. Uterine horn
intussusception may be associated with prolonged
dystocia because of the more atonic condition of the
uterus [11]. Retained fetal membranes combined with
prolonged straining and injudicious traction on a retained fetal membrane are other predisposing factors
in this regard. The traction of a retained fetal membrane can invert the tip of the uterine horn, thereby
leading to the progression of prolapse [3, 7]. However,
in the reported case, parturition was normal.
In the Chihuahua Bitch presented in this paper,
abnormally low levels of calcium were observed. Calcium is an essential element for the proper contractions of muscles, including the uterine muscles [17].
Low blood calcium is the leading cause of the poor
contraction of the uterus, also known as uterine atony
or inertia [2, 18]. Therefore, it seems that hypocalcemia may be implicated in the development of uterine
intussusception via uterine inertia. Other hematological and biochemical values were normal in the case
presented here. In a previous case of uterine intussusception, decreased hematocrit, the total number of
red blood cells, and hemoglobin levels were found [3].
In contrast, in another case report, blood laboratory
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IRANIAN JOURNAL OF VETERINARY SCIENCE AND TECHNOLOGY
analysis showed no changes in the parameters [9].
Uterine intussusception associated with non-specific symptoms makes it challenging to diagnose. The
most commonly observed symptoms in previous cases
[3, 4, 8-12] and the present case report are weakness,
muscle tremors, dyspnea, abdominal pain, and vaginal discharge. Uterine prolapse was another concurrent clinical sign in a bitch [3]. Abdominal discomfort
related to uterine intussusception may be caused by
compromised circulation and pressure on nerve endings [7]. The uterine intussusception was detected in
the right horn of the current case. This condition may
develop either on the right horn or the left horn of
the uterus. Uterine intussusception was previously reported three times in the right [3, 10, 11] and left [4,
8, 12] uterine horn.
In some previous case reports, the ultrasonography of the abdominal cavity was not performed or was
not possible, and a definitive diagnosis was obtained
by laparotomy [4, 10]. No signs of uterine intussusception were observed in one case of uterine intussusception in ultrasonography examination [3]. Therefore, it
seems that pre-operative diagnosis is rather difficult
in such cases. In contrast, the abnormal view of the
uterus was visible in our case as the telescoping of
concentric rings in ultrasonography was confirmed at
surgery. A similar appearance in the abdominal cavity
was reported in a case of uterine body intussusception
in a bitch [9].
In large animals, such as horses, the manual reduction is often recommended for resolving uterine
horn intussusception in affected mares. If the cases
become nonresponsive, surgical intervention, including partial or total hysterectomy, is required [7, 19].
There is no defined non-surgical treatment for this
condition in bitches. Ovariohysterectomy is the treatment of choice in small animals [20].
In conclusion, uterine intussusception must be
considered as a differential diagnosis for abdominal
pain in bitches during the postpartum period. This
condition is quite rare, which limits the overall knowledge and understanding of this problem. Research on
uterine intussusception epidemiology, pathophysiology, and diagnosis is required for effective management.
Authors' Contributions
All authors have been involved in writing the article, and accept responsibility for its content.
Acknowledgments
The authors gratefully acknowledge the support
and facility provided by the Veterinary Teaching Hospital of Ferdowsi University of Mashhad, Iran.
Conflict of Interests
The authors declare that there is no conflict of interest.
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Ethical Approval
This case reports details the management of a
clinical case that was a part of clinical caseload. The
owner understood procedure and agrees that results
related to investigation or treatment and the high veterinary care has been performed with the consent of
the animal owner.
CASE REPORT
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How to cite this article
Ghasemi S, Emami MR, Mirshahi A, Khanzadeh P, Yal Beyranvand S, Zarezadeh MM. Uterine Horn Intussusception in a Chihuahua
Bitch . Iran J Vet Sci Technol.2023; 15(1): 63-67.
DOI: https://doi.org/10.22067/ijvst.2023.80548.1224
URL: https://ijvst.um.ac.ir/article_43706.html
9. Antonov A. A rare case of uterine body intussusception
in a bitch. EJ-VETMED. 2022;2(4):1-3. Doi: 10.24018/
ejvetmed.2022.2.4.41.
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uterina em uma cadela Yorkshire Terrier (Uterine intussus-
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Uterine horn intussusception in a bitch
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