Treatment of haemoperitoneum secondary to ruptured granulosa cell tumours in two mares

Abstract

SummaryThis report describes two cases of successful surgical management of granulosa cell tumours (GCT) in mares presenting with haemoperitoneum (HP). Controlled abdominal drainage was initially attempted in Case 1 but was not successful. A ventral midline exploratory laparotomy allowed removal of a haemorrhaging 13 kg GCT. The mare made a full recovery and returned to normal work as a driving pony 11 months post-operatively. In Case 2 controlled abdominal drainage was followed by standing left flank laparoscopic visualisation of the bleeding ovary and transection of the ovarian pedicle by electrocautery. The GCT was then removed via a ventral midline incision due to its large size. Haemoperitoneum can be associated with GCTs and in some cases is severe enough to prompt emergency treatment. Stabilisation of the patient and removal of the haemorrhaging GCT can lead to a successful outcome.

Haemoperitoneum associated with bilateral granulosa cell tumours in a pregnant mare treated by standing ovariectomy

“…Worsman et al. (2018) hypothesised that this rupture was due to rapid growth of the tumour and the rapid expansion of both ovaries in this case would support this theory.…”

“…GCTs have been reported to cause HP as a result of rupture prior to or during surgery (Alexander et al., 2004; Harper et al., 2010; Sherlock et al., 2016; Worsman et al., 2018). Worsman et al.…”

“…It also facilitated the removal of a large volume of the intra‐peritoneal blood from the ventral abdomen which in turn improved laparoscopic visualisation. This approach also negated the need for pre‐operative controlled drainage as has been advised prior to performing general anaesthesia and exploratory laparotomy (Conwell et al., 2010; Finding et al., 2011; Harper et al., 2010; Worsman et al., 2018). The larger portal also allowed removal of the enlarged ovaries without the need for general anaesthesia as previously described by Worsman et al.…”

“…The larger portal also allowed removal of the enlarged ovaries without the need for general anaesthesia as previously described by Worsman et al. (2018). Bilateral ovariectomy performed with the mare in dorsal recumbency would have been challenging due to the degree of HP and ongoing haemorrhage from the ovaries and would have added to the surgical and anaesthetic time.…”

“…A unilateral GCT has previously been reported in a pregnant mare (Crabtree et al., 2013; Gee et al., 2012) and in a juvenile foal (Harper et al., 2010). Additionally GCTs may infrequently result in development of HP (Alexander et al., 2004; Worsman et al., 2018). This case report describes the surgical management of severe HP caused by bilateral GCTs in a pregnant mare, with bilateral ovariectomy at 70 days, followed by normal parturition of a healthy foal.…”