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  Discussion on Rectal Tear from Ultrasound Exam
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Posted on Thursday, Jul 25, 2002 - 5:30 pm:

Hello. Recently I took my mare in for an ultrasound to check to see if she was in foal. The vet did a rectal exam and my mare strained and was very tense during the examination. When he removed his arm I noticed a significant amount of blood. I questioned the vet, who immediately said that he was going to sedate her and see what had happened.

He told me that there had been a rectal tear on the upper section, about 12 inches in and about 1.5 inches long. He said it did not appear to be all the way through. We put her on banamine and antibiotics and he told me her prognosis was guarded.

I brought her home, hoping for the best Thursday night. Saturday she started feeling better and I felt encouraged that she was walking around, grazing and drinking. She was still on the antibiotics and banamine.

Monday afternoon,I found her in distress. Temp 104, high respirations, drenched in sweat and thready pulse. I called the vet and he gave her more fluids, electrolytes and more antibiotics and said keep me posted.

She progressively got worse and the banamine was no longer controlling the pain, so I called the my local vet, as it became apparent to me, that she needed to be put down and end her suffering. It was truly horrible. My local vet-on examining her. Noted that she was in shock, and her abdomen was distended (probably filled with manure) High temperature, and in severe pain. There was no question of the decision to put her down.

My question is. I'm wondering why the tear couldn't be sutured? He never mentioned this, and I was not thinking clearly enough to ask if this was a possibility. I'm also wondering how this could have been prevented. The vet does extensive breeding/AI and I wonder how this happened, as he was very knowledgeable. She has been palpated many times and we have almost always sedated her. My local vet examined her one time without sedating her and when my mare strained she stopped what she was doing and waited for her to relax. This other vet, on the other hand, continued to push as she pushed. I know that he didn't do this on purpose, but I feel that she should have been sedated. What are your thoughts!

This was my best mare and my best friend and I am so devastated that she had to go through this. Does this occur very often? How can this be prevented in the future? I am afraid to have these exams done now.

Amber

Posted on Friday, Jul 26, 2002 - 7:29 am:

My condolences about your mare Amber.

I have a already completed article on rectal tears that I just need to have the HTML inserted and uploaded. I think I can get that up today and I will put it in the colic and reproductive disease sections. It should answer your questions and if you have more it will have its own forum to put your questions in.
DrO

Posted on Friday, Jul 26, 2002 - 11:37 am:

DrO
Thank you for your condolences. I will be interested to read this article. I haven't been able to find much on this topic.

Amber

Posted on Friday, Jul 26, 2002 - 1:03 pm:

We had a similar situation in my barn last year. A 26yo mare with colic was having a rectal exam, got a little excited during the exam, and ended up with a rectal tear. The mare then had colic surgery and surgery for the rectal tear. Initially her prognosis was not good at all.
The mare has now made a full recovery, although we've had problems with impactions due to the way everything healed up. (However, we are now quite expert in administering enemas!) Her diet has changed to grass only and very liquid feed. We've all been extremely careful with rectal exams ever since. When we had to ultrasound her, we were sure to use a twitch.

This mare is my barn owner's old champion show mare and her best friend. They've been together 20+ years. I am so sorry for your loss.

Posted on Friday, Jul 26, 2002 - 6:32 pm:

I didn't realize this occurred very often, but I will definitely take precautions in the future. My veterinarian said this was a 1 in 100,000 type occurance. I am surprised that my vet didn't put her on stool softeners or a liquid diet like your mare. His only recommendation was to keep her on pasture which we did. I think I would do things differently as I look back. I think she might have just pulled through if we could have kept her stool soft. Well, I can't look back now, but it is a terrible tragedy and one that I certainly hope to not have a repeat of.

I only hope that others might gain knowledge from my experience and take precaution when a rectal exam is given and understand the risks.

I am happy that your mare pulled through. God Bless!

Posted on Saturday, Jul 27, 2002 - 10:07 am:

Amber did you find the article at Equine Diseases: Colic and GI Diseases: Colic in Horses: Rectal Tears in Horses.
DrO

Posted on Monday, Jul 29, 2002 - 12:51 pm:

Oh, Amber! What a dreadful thing for you and your beloved mare to have to endure! Please accept my condolences for your loss.

All I can add is that my mare has had several exams - including ultrasound - and my vet has commented more than once about how careful she has to be because horses tear relatively easily.

Again, so sorry about your best friend.

Suzy

Posted on Friday, Aug 2, 2002 - 6:24 pm:

Thank You Suzy,
It has been a horrible loss and I just feel devastated. I am currently in the process of leasing another mare, so I don't lose the breeding. I am so nervous about the exam and all the palpations, but I realize I have to move on. I will definitely be more informed and involved in the future.

Posted on Thursday, Aug 8, 2002 - 7:29 am:

Amber, I am so sorry to hear about your mare. I can't even imagine how devastated I would feel if I were in your shoes.

Shortly after reading your original post, one of my vets was out to sonogram my mare for pregnancy & I told her about your case. She said that unfortunately it does happen - & at more unpleasant odds than your vet mentioned - & is why she halts the sonogram IMMEDIATELY & administers either a mild sedative &/or lidocaine (sp?) rectally at the very first feeling/sensation that the mare is uncomfortable &/or straining.

Not to add additional trauma to your grief, but she also mentioned that there have been a number of successful liability/negligence lawsuits against vets where this has occured, as there really is very little reason for this to happen if everything is done with care.

Bonnie

Posted on Friday, Aug 9, 2002 - 7:59 am:

Hello Bonnie,
I am not sure I agree completely with your veterinarians assessment that, "there is very little reason for these too occur". I have had 3 rectal tears in my career and each time there was little warning. Of course since we stand a stallion and run a breeding station I palpate more than my share of mares but in these 2 cases I do not know what I could have done differently and in the third a sudden movement by a sedated and twitched mare resulted in a tear.

Though successful litigation has occured, usually it was because owners were not informed of a risk and not because of anything the veterinarian did wrong. I have mixed feelings about this but do believe that veterinartians should do a better job of informing clients. It is true that improper or rough technique or sudden movements by the mare can result is tears but sometimes it is difficult to understand why a tear occured.
DrO

Posted on Sunday, Aug 11, 2002 - 8:41 am:

Well-said, Dr. O.

I must say that in the over 30 years that I have been involved with horses & the dozens (at least) of ultrasounds I have been a party to, I have NEVER - & I mean NEVER - had ANY of the different veterinarians performing the procedure over the years EVER even mention to me in passing any risk at all. In fact (& I am obviously sadly undereducated regarding this incidence), this is the very first time I had ever heard of "rectal tearing" during an ultrasound exam - & was quite shocked - which is why I brought it up to my vet after reading this thread. I got the impression from her remarks that she feels that ultrasound exams are more commonplace as a diagnostic tool than they used to be, & many vets are becoming rather indifferent/complacent while performing them.

That said, while I am certainly not a litigious person in the least, I do believe that if the same thing had happened to me, & as I mentioned, absolutely nothing had ever been said to me about the risk, my mare was obviously tense, straining, & hadn't been sedated, there is a good chance that I would strongly consider pursuing some sort of compensation (as inadequate as that would be emotionally) from the vet involved. To be blunt - I would be really PISSED OFF!!!

Bonnie

Posted on Tuesday, Aug 13, 2002 - 10:11 am:

Hi all,
This is exactly the reason that I feel this site is so important. We all need to be able to access as much information as possible and then make an 'educated' decision about our horses. We have had a few foals (and along with that quite a number of palpations) and never was it even mentioned in passing that this was a possibility. I know that it is a fine line that vets walk in regard to how much to tell an owner without unneccessarily alarming them (some are alarmed much easier than others), but this seems important enough that it should be made known. Thank you DrO for giving us access to this kind of information.
Kathleen
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