EQUINE VETERINARY EDUCATION / AE / NOVEMBER 2013 563

Clinical Commentary
Post castration evisceration
L. M. Getman
Tennessee Equine Hospital, Tennessee, USA.
Corresponding author email: libertygetman@gmail.com

Although uncommon, unfortunately post castration Luckily post castration evisceration is a rare event,
evisceration of small intestine through the vaginal ring does occurring in only 0.2–2.6% of castrations, but since it is likely to
occur. However, herniation of the small intestine through the be fatal without proper treatment, referral to a surgical facility
femoral canal following castration as reported by Torre et al. is always indicated (Moll et al. 1995; Thomas et al. 1998; May
(2013) in the current issue is extremely rare. This is the first report and Moll 2002; Shoemaker et al. 2004; Schumacher 2006). Like
to describe such a herniation fully and it provides a good the case reported by Torre et al. (2013), evisceration typically
reference for the clinical presentation, treatment, and occurs within 4–6 h after castration, but there are reports of it
outcome of such a hernia. It is interesting to note that this case occurring as late as 12 days after surgery (Thomas et al. 1998;
occurred in a horse of a breed that is not considered to be ‘at May and Moll 2002; Shoemaker et al. 2004; Schumacher 2006).
risk’ of herniating and after having a closed castration Risk factors include breed (Standardbreds and draught horses
performed with a ligature placed – a technique that is are over represented, and anecdotally Saddlebreds and
generally thought to prevent inguinal herniation (Schumacher Tennessee Walking Horses are also at increased risk),
2006). However, as this case illustrates, this technique would pre-existing inguinal hernias, the presence of an inguinal
not be expected to prevent herniation through other hernia as a foal, and an internal inguinal ring that is 2 or more
anatomical structures such as the femoral canal. In fingers wide on rectal palpation (Schumacher 2006). If a horse
agreement with the authors’ theory, it seems likely that the has any of these risk factors, it is recommended that the
femoral canal herniation was present at the time of admission scrotum be palpated carefully prior to castration to identify
to the referral centre due to the degree of damage present possible pre-existing inguinal hernias. Some authors also
within the entrapped portion of the small intestine that was recommend performing a rectal examination on at-risk horses
found at the second surgery. Had a ventral midline approach prior to castration to determine the size of the inguinal rings;
been used initially, this would probably have been identified. however, this is not always practical or safe. In the current
In hindsight, the large amount of swelling noted in the medial author’s opinion, any horse with the above risk factors should
thigh area at presentation may have been an indication that at least have ligatures placed around the cremaster muscle
this was not a ‘routine’ evisceration; however, in the author’s and spermatic cord separately (as the cremaster muscle adds
experience it is not unusual to note a fair amount of unilateral considerable bulk in mature horses, and contraction of this
swelling in the inguinal area in horses with post castration muscle can cause the ligature to loosen). If there is reason to
evisceration. believe that the horse has an excessively large inguinal ring,
The nomenclature used to describe inguinal hernias can then either surgical closure of the superficial inguinal ring or
be somewhat confusing and is inconsistently used throughout packing of the ring with gauze overnight should also be
the literature. Hernias that occur when a portion of intestine considered. It may also be beneficial to hospitalise at-risk
goes through the vaginal ring into the inguinal canal and horses overnight for careful observation and immediate
exiting to the scrotum are called scrotal or inguinal hernias. The identification of post operative evisceration.
herniated portion of intestine is still confined within the vaginal If post castration evisceration does occur, prompt
tunic with inguinal hernias and these hernias can be emergency care is essential for a successful outcome. Initial
congenital or acquired. When they are congenital there may therapy is aimed at keeping the bowel safe from damage and
not be any obvious clinical signs associated with them (until further contamination and preparing the horse for transport to
the horse is castrated). Acquired inguinal hernias cause post a referral centre. The protruding portion of bowel should be
castration evisceration in recently gelded horses or colic in cleaned of all gross contamination with sterile saline and then
stallions and rarely geldings. Although they are correctly replaced into the scrotum, which is sutured closed or closed
classified as ‘indirect’ hernias, this nomenclature is taken from with several towel clamps. If this is not possible – either due to
the human literature and is somewhat confusing. the amount of bowel that is prolapsed or lack of enough
If a herniated portion of intestine goes through the vaginal scrotal skin to do so – then a moist towel or drape should be
ring and inguinal canal but then passes through a rent in the made into a sling and used to support the bowel during
vaginal tunic to lie subcutaneously in the inguinal or scrotal transport. Alternately a hand towel can be sutured to the
area this is referred to as a ruptured inguinal hernia. This inguinal region to keep the bowel in place. The horse should
condition occurs more commonly in foals and is typically only be given sedation (if systemically stable), broad-spectrum i.v.
seen in adults due to trauma. Finally, inguinal rupture refers to antimicrobials, and flunixin meglumine for analgesic and
when a portion of intestine passes through a rent adjacent to antiendotoxic therapy. In some cases the horse will be painful
the vaginal ring. This has also been called a ‘direct’ hernia enough to require i.v. anaesthesia during transport. Once at a
again with reference to the human literature but this does surgical facility exploration by both an inguinal and ventral
not accurately describe the condition in horses, which is fairly midline approach is warranted, since a better determination
rare. of the health of the entire small intestine can be made by fully

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564 EQUINE VETERINARY EDUCATION / AE / NOVEMBER 2013

exploring the intestinal tract. Survival rates following surgical Moll, H.D., Pelzer, K.D., Pleasant, R.S. and Modransky, P.D. (1995) A
treatment of intestinal evisceration range from 36–87%, with survey of equine castration complications. J. Equine Vet. Sci. 15,
522-526.
the lowest survival rates associated with an inguinal-only
surgical approach, increased length of prolapsed bowel, and Schumacher, J. (2006) Testis. In: Equine Surgery, Eds: J.A. Auer and J.A.
the need to perform a resection and anastomosis (Thomas Stick, Saunders Elsevier, St Louis. pp 775-810.
et al. 1998; Shoemaker et al. 2004). Shoemaker, R., Bailey, J., Zanzen, E. and Wilson, D.G. (2004) Routine
castration in 568 draught colts: incidence of evisceration and
Author’s declaration of interests omental herniation. Equine Vet. J. 36, 336-340.

No conflicts of interest have been declared. Thomas, H.L., Zaruby, J.F., Smith, C.L. and Livesey, M.A. (1998)
Postcastration eventration in 18 horses: the prognostic indicators for
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