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Pyometra in a Cat: A Clinical Case Report

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DOI: 10.26717/BJSTR.2021.37.006068

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Research Article

ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.37.006068

Pyometra in a Cat: A Clinical Case Report

Tanjila Hasan1, Md. Monir Hossan2, Nazifa Tahsin3, Md. Afzal Hossain4 and AHM Musleh Uddin5*
1
Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University,
Bangladesh
2
Upazilla Livestock Officer, Department of Livestock Services, Bangladesh
3
Veterinary Officer, Palli Karma Shohayok Foundation (PKSF), Bangladesh
4
Veterinary Surgeon, Teaching and Training Pet Hospital, Bangladesh
5
Department of Surgery and Theriogenology, Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University,
Bangladesh
*Corresponding author: AHM Musleh Uddin, Assistant Professor, Department of Surgery and Theriogenology, Faculty of Veterinary,
Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet 3100, Bangladesh

ARTICLE INFO ABSTRACT

Received: July 28, 2021 Pyometra is one of the most common reproductive problem in cat. An eleven-year-
old native cat was admitted to Teaching and Training Pet Hospital and Research Centre,
Published: August 06, 2021 Chittagong Veterinary and Animal Sciences University, Bangladesh, with history of
anorexia and chronic emaciation. At first, general physical examination was done then
special examination was performed. On abdominal ballottement, uterus felt harder and
Citation: Tanjila Hasan, Md. Monir Hos- enlarged than normal. Then ultrasonography examination was done where found multiple
san, Nazifa Tahsin, Md. Afzal Hossain, tubulars, radio-opaque fluid filled structures from caudal to mid abdomen. Blood analysis
AHM Musleh Uddin. Pyometra in a Cat: A showed that the level of AST, ALT, urea, creatinin increased, and PCV and Hb% decreased.
Clinical Case Report. A Review of Litera- All the findings confirmed that cat had suffering from pyometra. After confirmation, it was
ture. Biomed J Sci & Tech Res 37(5)-2021. decided to do ovariohysterectomy under general anesthesia. The suture was removed
BJSTR. MS.ID.006068. after fourteen days. The cat had a complete recovery without any complication.
Keywords: Cat; Pyometra; Ultrasonography; Blood Analysis; Ovariohysterectomy

Introduction
show any vaginal discharge and are more commonly systemically
Pyometra is an acute or chronic suppurative inflammation
ill because resorption of bacterial toxins from the uterine lumen
of the uterus. It is characterized by endometrial hyperplasia
into the circulation can result in endotoxaemia. Bacteremia may
with cystic dilation of endometrial glands and accumulation of
also occur. Non-specific clinical signs such as anorexia, vomiting,
a neutrophil-rich exudate in the uterine lumen. The incidence of
lethargy, loss of weight and unkempt appearance can also be
feline pyometra is still not well documented and probably under-
observed [3]. Polyuria and polydypsia do not occur as often as in
estimated because queens often don’t present with clinical signs
dogs. They were reported only in 9% of the cases [4].
[1]. No prevalence data for pyometra have so far been described in
cats, but observations of most veterinarians are that the disease is Abdominal ultrasound is the most important diagnostic tool
observed less commonly than in dogs. The most common clinical in a pyometra case. The uterine horns typically appear distended
finding in case of 75% of pyometra cases is mucopurrulent to with hypo-/ to hyperechoic fluid with or without flocculation. The
hemorrhagic vaginal discharge [2]. The clinical presentation of uterine wall often appears thickened with irregular edges and small
pyometra is similar in cats and dogs. In ‘open-cervix pyometra’ hypoechoic areas consistent with cystic changes of the endometrial
a blood stained; purulent vaginal discharge may be the only glands. The pyometra can be diffuse or segmental. Cytology of
clinical sign. Animals with ‘closed-cervix pyometra’ may not the uterine or vaginal discharge is likely to reveal degenerative

Copyright@ AHM Musleh Uddin | Biomed J Sci & Tech Res | BJSTR. MS.ID.006068. 29851
Volume 37- Issue 5 DOI: 10.26717/BJSTR.2021.37.006068

neutrophils and phagocytized bacteria. Leukopenia can be present opaque fluid filled structures from caudal to mid abdomen (Figure
in around 5% of the cases [4]. Treatment includes correction 1). The structures appeared distinct and separate from the intestinal
of fluid deficits, proper administration of antibiotics against loops. Ultrasonography was performed using a B mode real-time
bacterial organisms and removal of infected uterine contents. The 5MHz linear transducer. The finding of abdominal ultrasound was
other management includes surgical removal of ovary and uterus found multiple anechoic fluid filled area without foculation (Figure
(ovariohysterectomy) or use of by PGF2α [3]. The decision to try 2). Then blood sample was collected for doing routine examination
medical or surgical therapy is based on the physical status and and serum analysis.
breeding capacity of the queen.

However, some complications may develop after

ovariohysterectomy (OHE), such as ovarian remnant syndrome
(ORS). This syndrome may develop because of the failure to totally
remove both ovaries (most commonly the right ovary) at OHE, or
the presence of a partial or complete separation of a portion of
normal ovary (the fragment may be located near the ovary or in
the broad ligament) that is not detected at OHE. In some cases,
uterine stump pyometra may occur because of ovarian remnants
and this situation may be fatal in affected queens. Worldwide, fatal
complications occur as a result of surgical errors in routine OHE. In
this article, we report and discuss the procedure and importance of
ORS in a queen.
Figure 2: Multiple anechoic fluid filled pocket.
Materials and Methods
History and Clinical Examination Surgical Management
An eleven years old local breed cat was admitted to Teaching Restraining and Anesthesia: Firstly, the cat was being held on
and Training Pet Hospital and Research Centre, Chittagong its side with its back against the handler, while the handler grasps
Veterinary and Animal Sciences University, Bangladesh, with the front and back legs, with a forearm across the cat neck. As
history of anorexia, chronic emaciation. At first, general physical premedication agent atropine sulphate was administered (Injection
examination was done, then special examination was done. On Atropine®, Techno drug, Bangladesh, 0.04mg/kg body weight
physical examination, body temperature found 1010C, heart rate intramuscularly) and as muscle relaxant xylazine hydrochloride
174 beats per minute and respiratory rate 42 breaths per minute. (Injection xylazine®, Indian Immunologicals Ltd, India, 1mg/
kg BW intramuscularly) administered. Again, as a general
anesthesia ketamine hydrochloride (G-ketamine®, Gonoshasthaya
Pharmaceuticals Ltd., Bangladesh, 15 mg/Kg body weight
intravenously) was administered. The maintenance anesthetic dose
was given half of the initial dose during the surgery. Preparation
of surgical area was carried out after shaving and removing hairs.
70% alcohol scrubbed onto the skin around the surgery area, the
area is then covered until surgery, since nothing must touch it once
it is cleaned.

Surgical Procedure: The cat was being laid on her back (Figure
3) and a sterile drapper was placed over her. Close monitoring of
temperature, blood pressure, heart rate, gum color, pulse strength
and depth of anesthesia was done. An incision was made in the
middle of the underside along the length of the abdomen. After
exposing the abdomen by laparotomy, the uterine and ovarian
Figure 1: Multiple tubular, radio-opaque fluid filled
blood vessels were properly secured and the ovaries, uterine
structures
horns and uterus were completely removed. The abdominal wall
was closed with catgut (size: 1-0). The skin was then closed with
On abdominal ballottement the uterus felt harder and enlarged
cross-mattress suture pattern using silk. The sutured wound was
than normal. Lateral radiograph revealed multiple tubular, radio-

Copyright@ AHM Musleh Uddin | Biomed J Sci & Tech Res | BJSTR. MS.ID.006068. 29852
Volume 37- Issue 5 DOI: 10.26717/BJSTR.2021.37.006068

covered with the benzoin seal. During the entire operative period, Post-Operative Care: After surgery, antibiotic ceftriaxone
5% dextrose saline was intravenously infused. @20 mg/Kg body weight (Injection Triject vet 1gm®, SK+F
Pharmaceuticals, Bangladesh) was administered intramuscularly
daily for 7 days. Antihistaminic chlorpheneramine maleate
@1mg/ Kg body weight (Injection Astavet®, Acme Laboratories
Ltd., Bangladesh) was administered intramuscularly daily for 7
days. Analgesic (Injection meloxicam @40 mg/Kg body weight
and Injection Melvet®, Acme Laboratories Ltd., Bangladesh) was
administered subcutaneously daily for 5 days for pain management.
The patient was kept in clean squeeze cage and observed for 7 days.
No complication was noted, and the bitch recovered uneventfully.
On the 14th day, the suture was removed, and it was noticed that the
surgical site was healed completely (Figures 4-9).

Figure 3: Lying the cat at dorsal recumbent position.

Figure 6: Removal of uterus.

Figure 4: Ligating the uterus at the base of the uterine
body.

Figure 7: Release of pus from uterus.

Figure 5: Removal of ovaries.

Copyright@ AHM Musleh Uddin | Biomed J Sci & Tech Res | BJSTR. MS.ID.006068. 29853
Volume 37- Issue 5 DOI: 10.26717/BJSTR.2021.37.006068

for developing pyometra. But it has been described also in younger

cats [9-11].
Table 1: Hematological and biochemical analysis of pyometric
cat.

Hematological
Results Reference value
parameters
Total RBC 4 5-10
Total WBC 3.5 5.5-19.5
PCV (%) 19 29-45
Hb (%) 4.5 9.8-15.4
MCV (fl) 59 41-54
MCH (pg) 18 13-17
MCHC (%) 37 31-36
Neutrophil (%) 80 35-75
Figure 8: Application of benzoin seal.
Lymphocyte (%) 20 27-36
Monocyte (%) 2 0-5
Basophil 0 0-1
Eosinophil (%) 1 0-4
Biochemical Parameters
AST 36 7-38
ALT 99 25-97
Urea 41 19-34
Creatinine 3.8 0.9–2.2

Present study before treatment the hemoglobin level of cat

was decreased indicating anemia which agrees with the previous
reports [12,13]. This might be due to loss of red blood cells by
diapedesis into uterine lumen apart from depressed feed intake
and impaired erythropoiesis under toxemic condition in severely
affected cases [14]. The PCV level was decreased in the bitches
Figure 9: Cat after surgery. indicating a mild normocytic, normochromic philia might be due
to and regenerative type of anemia [15]. According to Greene et al.
[16] total erythrocyte count before treatment was decreased in the
Results and Discussion bitches affected with pyometra indicating anemia which is similar
Pyometra is a uterine inflammatory disorder characterized to this study. It might be associated with the toxic depression of
by cystic endometrial hyperplasia [5]. Potter et al. Potter et al. [6] the bone marrow whereas severe non-regenerative, microcytic,
concluded that the prevalence of pyometra in cats increases with hypochromic anemia accompanied by extremely high white blood
age in sexually intact female cats and mainly after parturition, while cell levels might be indicative of a concurrent blood loss possibly
Agudelo, [7] suggested that the disease is common in queens older by diapedesis into luminal pus and due to shortened life span of
than three years and in other queens older than five years with no circulating erythrocytes associated with iron deficiency [17].
relationship to the number of parturitions, these close to findings Different degree of leucocytosis was observed in bitches affected
were reported in this case. Hagman et al. [8] found comparatively with pyometra which is consistent to this study. It might be due to
higher prevalence of pyometra in Bengal cat which is almost similar severity of the inflammation varying between animals.
to this study. Pyometra is a disease of the middle-aged or older In the present study, absolute neutrophilia, lymphopenia,
animal which was also stated by Brady et al. It could be speculated monocytosis with normal eosinophil count was the most consistent
whether this increase is related to degenerative changes in the finding among the bitches affected with pyometra. Neutrophilia
uterus or other conditions such as ovarian pathologies or uterine with regenerative shift to the left might be due to retention of
neoplasia that more often affect older animals and may predispose purulent exudates in the uterus which exerts a chemotactic

Copyright@ AHM Musleh Uddin | Biomed J Sci & Tech Res | BJSTR. MS.ID.006068. 29854
Volume 37- Issue 5 DOI: 10.26717/BJSTR.2021.37.006068

effect on neutrophils resulting into accelerated granulopoiesis 3. Nak D, Misirlioglu D, Nak Y, Keskin A (2005) Clinical laboratory findings,
vaginal cytology and pathology in a controlled study of pyometra in cats.
and lymphopenia might be due to severe stress and elevated
Australian Veterinary Practitioner 35(1): 10-14.
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cats with pyometra Kenney et al. [28]. (2003) Uterine neoplasia in 13 cats. Journal of Veterinary Diagnostic
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13. Sontas H, Erdogan Ö, Apaydin Enginler SÖ, Yilmaz ÖT, Sennazli G, et al.
general anesthesia using xylazine hydrochloride and ketamine (2013) Endometrial adenocarcinoma in two young queens. Journal of
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The causes of postoperative wound dehiscence include rough 14. Payan-Carreira R, Saraiva A, Santos T, Vilhena H, Sousa A, et al. (2013)
handling and tearing of tissues during surgery, improper selection Feline endometrial adenocarcinoma in females < 1 year old: a description
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Funding 736.

No funding. 17. Dabhi DM, Dhami AJ, Parikh PV, Patil DB (2009) Comparative evaluation
of haematological parameters in healthy and pyometra affected bitches,
Indian Journal of Animal Reproduction 30:70-72.
Conflict of Interests
18. Nelson RW, Feldman EC (1986) Pyometra. Veterinary Clinics of North
The authors declare that they have no conflict of interest. America: Small Animal Practice 16: 561-576.
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