CASE SERIES Veterinary Surgery 28:113-116, 1999 Standing Surgical Repair of Cystorrhexis in Two Mares DWAYNE H. RODGERSON, DVM, MICHAEL A. SPIRITO, DVM, PAUL E. THORPE, DVM, and R. REID HANSON, DVM, Diplomate ACVS Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares. ©Copyright 1999 by The American College of Veterinary Surgeons A LTHOUGH UNCOMMON, rupture of the urinary bladder can occur in adult horses as a result of urolithiasis, 1 trauma, 2 or during parturition. 3-5 Systemic deterioration can occur if the defect is large or is not repaired. In mares, surgical repair of bladder rupture has traditionally been accomplished by using general anes- thesia with a caudal ventral median approach, however, exteriorization of the bladder and observation of tears involving the neck of the bladder can be difficult. 4 Repair by a vaginal approach has been described in anesthetized and standing mares. 3,5 In previously reported vaginal approaches, the defect was closed by passing a hand through the urethra and into the bladder to guide suture placement with long-handled instruments. The purpose of this report is to describe two different techniques that use a vaginal approach in the standing mare, and to observe and surgically repair defects of the bladder. CASE REPORTS Mare 1 A 16-year-old, multiparous, 11-month pregnant, Thor- oughbred mare was admitted for signs of abdominal dis- comfort. The mare was mildly uncomfortable with a heart rate of 54 beats/min and respiratory rate of 48 breaths/min. Rectal temperature, borborygmi, rectal examination find- ings, hematocrit, and total serum protein concentration were normal. The abdominal discomfort resolved after the ad- ministration of flunixin meglumine (1 mg/kg intravenously [IV]). The next day, the mare had occasional signs of mild abdominal discomfort and total serum protein (8 g/dL), potassium (5 mEq/L), and creatinine (3.9 mg/dL) concen- trations were elevated. Flunixin meglumine (1 mg/kg IV) and 20 L of lactated Ringer’s solution were administered. A total of 36 hours later, signs of parturition occurred. Difficulty occurred in the second stage of parturition and on rectal examination, the foal was not within the pelvic cavity. On vaginal examination, the foal was in a cranial presenta- tion with both front feet and head angled cranially. Under general anesthesia with the mare’s hind quarters elevated, the foal was repositioned and pulled without difficulty, but attempts to resuscitate the foal were unsuccessful. After recovery from anesthesia, mild signs of abdominal discom- fort were observed. Hematocrit (50.2%) and total serum protein concentration (7.1 g/dL) remained elevated; serum potassium (5.4 mEq/L), blood urea nitrogen (54 mg/dL), creatinine (3.9 mg/dL), and blood glucose (270 mg/dL) From the Department of Veterinary Medicine and Surgery, Clydesdale Hall, Columbia, MD; Hagyard-Davidson-McGee and Associates, PSC, Lexington, KY; and the Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, Auburn, AL. Address reprint requests to Dwayne H. Rodgerson, DVM, Department of Veterinary Medicine and Surgery, Clydesdale Hall, Columbia, MD 65211. ©Copyright 1999 by The American College of Veterinary Surgeons 0161-3499/99/2802-0005$3.00/0 113