Equine Clinic – Castration Complication

Turville Hanover survives rare medical situation after being gelded

story by Kimberly French

The day commenced like any other at Jeff Gregory’s barn at Gaitway Farm in Manalapan, N.J. The horses received their usual amount of attention and other routine chores were completed with normal due diligence. In fact, one of the tasks on Gregory’s agenda, the gelding of 2-year-old Turville Hanover, was hardly unconventional. Within 48 hours, however, Gregory and his staff were immersed in one of the most peculiar and terrifying medical situations they had ever encountered after a castration.

“It was a Tuesday morning (June 26) and Dr. Linke from Colts Neck Equine came to the farm to castrate Turville Hanover,” Gregory said. “The procedure was performed right in his stall and everything seemed to be fine that day. On Wednesday, we had to wash his legs up because he was dripping some blood, and figured if he wasn’t perfectly OK on Thursday, we would have him checked.

“On Thursday morning, all his medication was delivered as scheduled, and he was bright and alert, but he had two feet of omentum, which is fatty abdominal tissue, hanging from his castration  incision. Obviously, we panicked, so we put a harness with a stud support on him for safe travel to the clinic and made arrangements for Dr. Patty Hogan to examine him and trim off the protruding omentum. It took us only 15 minutes to get to Dr. Hogan’s, as it could have taken us an hour to get to Mid-Atlantic Equine Emergency Center with the traffic on the Thruway. Thank God we did that, and Patty was nice enough to take us in, because by the time we arrived, it was very painful for the horse. He was sweating profusely and had three to four feet of his small intestines coming out through this castration incision and into the stud support; he would not have made it if it would have meant traveling any longer.”

Purchased by Gregory, Stuart Morgan and Steven Finkelstein for $25,000 at the 2017 Standardbred Horse Sale, Turville Hanover is a son of Cantab Hall – Thistle Dhu. His dam earned $168,233 during her racing career and is a half-sibling to Yursa Hanover (Windsong’s Legacy, $910,567), He’s Spooky (Cantab Hall, $410,494) and Scary Good (Cantab Hall, $245,205).

When he began his training, Turville Hanover progressed as his connections hoped, but, like many youngsters, experienced some body soreness. Therefore, it was determined to provide him with the opportunity to overcome his growing pains, and look to the future.

Gregory, like the majority of horsemen and horsewomen, never imagined gelding the then-colt could terminate his life.

“I have never seen anything like it and probably never will again,” he said. “When we first came to him Thursday morning, he was given his bute and was eating his breakfast; he was bright-eyed and alert. Even after we put the stud support and harness on him, to load him on the van, he just acted like nothing was wrong and continued to eat his hay. But the ride is what really shook things up. The stud support protected the protruding intestines from further injury and contamination and was a huge factor in being able to save this horse’s life.

“They tell you to drive a horse around that is showing symptoms of colic, because with colic everything is shifted around and the movement of the van or trailer can shift things the opposite way to help them. In this case, that sure proved true, as shortly after we started driving, he showed signs of obvious discomfort. He was sweating, and started shifting around because he was in pain. We think even that short of a trip is what caused his intestines to start coming out because it stirred everything up inside.”

As castration is such an integrated component of harness racing, the procedure is often viewed as low risk with minimal side effects. Research, however, proves otherwise.

“Castration is the most common surgical procedure performed by equine veterinarians in the field,” wrote Dr. Liberty Getman in a 2009 American Association of Equine Practitioners (AAEP) presentation. “Although the surgery is technically easy to perform, the complication rate associated with it is relatively high, with 20–38 percent of horses experiencing a complication. Additionally, equine castration complications are the most common cause of malpractice claims against veterinarians in North America.”

A review of the medical records of 159 horses castrated over a seven-year period was published in the May 2017 Canadian Veterinary Journal. The results revealed certain complications were more prevalent.

“Main short-term complications were: scrotal hematoma in 12 horses (7.6 percent), signs of colic in six horses (3.8 percent), fever in four horses (2.5 percent), and peri-incisional edema in three horses (1.9 percent),” wrote Mickael Robert, lead researcher on the study. “As for long-term complications, 24 out of 105 (23 percent) horses sustained some form of edema (swelling). One horse was euthanized because of a suspected inguinal abscess. Among tested parameters, horses aged 3- to 6-years-old and French trotters appeared to be more at risk of developing complications.”

Although post-operative issues can transpire, Turville Hanover’s set of circumstances remains extremely rare. His condition is referred to as post-operative castration evisceration, and often results in death.

“Evisceration through the vaginal ring and open scrotal incision is uncommon and potentially fatal,” wrote Dr. R. Reid Hanson in a 2005 presentation for the North American Veterinary Conference (NAVC). “Evisceration generally occurs within four hours, but may occur up to six days after castration. Evisceration of the small intestine makes up 67 percent of cases while omental prolapse comprises the remainder. A survival rate of 85 to 100 percent can be expected where appropriate treatment is carried out.

“Post-castration evisceration is always a risk following open castrations, but the risk is increased in certain breeds with large inguinal rings, or after castration of an adult stallion. Standardbreds, Tennessee Walking Horses and Belgians are at greater risk because they have larger inguinal rings. Other predisposing factors include a pre-existing, undetected inguinal hernia, presence of visceral structures adjacent to the internal inguinal ring, and increased abdominal pressure after surgery.”

Another situation that can impact the risk of complications from gelding a horse is the method selected to close the incision site. Veterinarians can use sutures or can employ an “open” procedure in which the wound closes naturally of its own accord. This approach allows the wound to drain from gravity, and prevents swelling beneath the skin.

“It seems reasonable to recommend primary closure castration to prevent postoperative evisceration, particularly for high-risk individuals or breeds,” Robert wrote, but that method of castration requires care in a hospital environment and can be a significant expense.

In Turville Hanover’s case, his life was saved due to the swift response from Gregory and his team.

“After intestinal eventration (castration evisceration) occurs, initial therapy is aimed at keeping the bowel safe from damage and further contamination and preparing the horse for transport to a referral center,” Getman wrote. “The protruding portion of bowel should be cleaned of all gross contamination with sterile saline and then replaced into the scrotum, which is sutured closed or closed with several towel clamps. If this is not possible because of the amount of bowel that is prolapsed, then a moist towel or drape should be made into a sling and used to support the bowel during transport.”

Turville Hanover was taken to surgery immediately upon arriving at Dr. Hogan’s. The correction of his evisceration took almost two hours in order to free the four feet of swollen and contaminated small intestine that had become tightly bound inside the left inguinal ring.

The gelding recovered well from anesthesia, but required some intense round-the-clock postoperative care to manage the severe bowl inflammation, ileus (shutdown of bowel motility), and subsequent peritonitis that occurs after this kind of open intestinal hernia. He had some low-grade colic and fever (up to 103.6 degrees), but responded to the aggressive treatment (IV fluids, IV antibiotics, anti-inflammatory drugs) and progressed as expected.

He was gradually reintroduced to feed over the course of five days and finally left Dr. Hogan’s clinic after a week of intensive care. He healed uneventfully and has not endured any other problems from the castration.

“He was in his stall for about a month after he came from the hospital,” Gregory said. “We were jogging him a month or two later, and he never had any sign of infection, so he had a full recovery. We even trained him down to 2:04 before deciding to turn him out, and there is no reason to think it will impact his racing career.

“We were very lucky we got him there in time and that Patty was available to do the surgery. We know she does not do these types of emergency surgeries due to her orthopedic caseload, but not only did she take him right in, she personally kept a close eye on him the whole time he was there and took great care of him. She went the extra mile for us, and that is why he is here. We are more than grateful for that.” HB

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