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Summary: Despite castration being one of the most frequently performed elective equine surgical procedures, complication rates are high and range from severe life‐threatening conditions to mild complications that are of no consequence to the horse. This article will briefly review strategies to prevent complications and surgical castration techniques before reviewing, in‐depth, the following complications: excessive scrotal swelling and seroma formation, scrotal infection, septic funiculitis, septic peritonitis, haemorrhage, evisceration, omental prolapse, pyrexia, tetanus, penile trauma, hydrocele, signs of colic and continued stallion‐like behaviour. Whilst this list of complications can be daunting, an understanding of male anatomy, castration techniques and an awareness of possible complications can reduce both the incidence and mortality of complications, should they occur. This article will consider castrations performed in both a hospital and field setting and will review complication prevention, surgical techniques of castration and the management of intraoperative and postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post‐operative complication. However, few AAD cases are described in the literature. Objectives: To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. Study design: Retrospective case series. Methods: Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10‐year period (2009‐2019) were reviewed. Data were collected for pre‐, intra‐ and post‐operative factors that were considered relevant. Descriptive statistical analysis was performed. Results: A total of 63 cases of AAD were identified. AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). AAD occurred at a median of 5 days (0.5‐70 days) post‐operatively and broodmares accounted for 25% of the cases (n = 16). Surgical site infection developed prior to AAD in 28 horses (44%); leakage of peritoneal fluid occurred in 5% of horses prior to AAD being identified. Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately. Repair was most frequently performed using suture (n = 14), wire (n = 5) or a combination (n = 5). Overall survival to hospital discharge was 39% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%) managed conservatively survived to hospital discharge. Main limitations: Follow‐up was not performed for all cases following hospital discharge and some data were incompletely recorded in hospital files. Conclusions: Previously stated causative factors for AAD were not consistent features in the present study. Surgical site infection following laparotomy and pregnant or early post‐partum mares may be important risk factors for AAD and warrant further investigation. [ABSTRACT FROM AUTHOR]

The respiratory trees present only in the class Holothuroidea and the rest of the echinoderms lack it. Only some holothurian species have the ability to regenerate their respiratory trees after autotomy. Therefore, respiratory trees could be considered as a suitable model to assess the regeneration mechanisms in animals. In the present study, the respiratory tree regeneration after posterior evisceration were examined in Holothuria parva during 75 days. Since autotomy reduces antioxidant defense in the organisms, in the present study alterations of antioxidant enzymes were also evaluated during the experiment. H. parva is the dominant intertidal species distributed in the north of the Persian Gulf. In the present study, H. parva ejected the left respiratory tree, the digestive tract and supportive mesenteries from the anus, about 1–2 min after potassium chloride injection. The closure of the opening at the posterior ends of the body was the first reaction to the injury. Seven days after evisceration, the small bud formed on the dorsal side of the cloaca which was covered with the coelomic epithelium of cloaca. The coelomic epithelium started to proliferate to undifferentiated cells on the apex of the buds. The primary respiratory tree consisted of the luminal cuboidal epithelium and thin connective tissue surrounded by the slender coelomic epithelium. This preliminary organ was observed at the apex of the buds, 13 days after evisceration. Gradually, myoepithelial cells arranged around a longitudinal axis and formed a circular muscle. The primitive branches of primary respiratory tree started to form 18 days after evisceration. Forty days after evisceration, the luminal epithelium of the respiratory tree had the same appearance as the intact luminal epithelium. The regenerated respiratory tree was histomorphologically very similar to an intact respiratory tree 56 days postevisceration, but unlike that, it was not yet wrapped around the intestine and was completely separate from it. Despite the development of the regenerating respiratory tree, no wrapping around the intestine was observed until the end of the experiment. According to the results, the activity of the catalase (CAT) and superoxide dismutase (SOD) in the muscle homogenate was significantly higher than the control 5 days after evisceration. The CAT and SOD levels gradually decreased in eviscerated animals. The lipid peroxidation level followed a decreasing trend in the eviscerated animals during the experiment. However, its value reduced to the control level at the end of the experiment. HIGHLIGHTS: Holothuria parva is posterior‐eviscerating sea cucumber.Only the left respiratory tree of Holothuria parva was eviscereted.The respiratory tree of Holothuria parva was only regenerated from cloacal end.56 dpe, the tissue structure of regenerated respiratory tree was similar to intact digestive tract.75 dpe, regenerated respiratory tree was not yet wrapped around the intestine.CAT and SOD in the regenerated respiratory tree was significantly higher than the control [ABSTRACT FROM AUTHOR]

A case of postmortem dismemberment and evisceration is presented. Over a 5‐year period, a serial killer murdered twelve men, with a necrophilic intent, so he could mimic relationship behaviors with the corpses of those he killed. Analysis of the methods he chose to dispose of his victims reveals a stark contrast to the motive for perpetrating the homicides, methods which are suggestive of anger toward the victim when they could no longer fulfill their role in the necrophile's fantasy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate causes, diagnostics and treatment modalities for persistent socket pain (PSP) after enucleation and evisceration. Methods: A systematic search was undertaken in accordance with the PRISMA Statement, in PubMed, Embase.com and Thomson Reuters/Web of Science. We searched for relevant papers until the 28th of July 2016. Inclusion criteria were (1) patients with a history of enucleation or evisceration, (2) PSP, (3) report of the cause and/or used diagnostics and/or treatment modality, (4) full text in English, Dutch or Spanish language. Excluded were (1) review articles, (2) comments, and publications concerning, (3) nonhumans, (4) exenterated patients, (5) acute postoperative pain, or (6) periorbital pain without pain in the socket. Given the lack of high quality evidence from randomized controlled trials, we examined all available evidence from primary observational studies and assessed quality within this lower level of evidence. Results: A total of 32 studies were included. Causes of PSP found were prosthesis‐related (n = 5), dry socket (n = 2), trochleitis (n = 3), compression of the trigeminal nerve (n = 2), implant‐related (n = unknown), inflammation (n = 5), surgery‐related (n = 4), neuromas (n = 8), malignant tumours (n = 3), psychiatric/psychosocial (n = 2), phantom pain (n = 149), rarer entities (n = 3) or unknown (n = 14). Nonsurgical treatments suffice for conditions as trochleitis, prosthesis‐related pain, dry socket and for phantom pain. Other causes of pain may require more invasive treatments such as implant removal. Conclusion: Careful history and examination can give some direction in the diagnostic procedure; however, PSP is probably multifactorial and the specific origin(s) may remain uncertain. Implant replacement can be an effective treatment. Studies to identifiy less invasive procedures are required. [ABSTRACT FROM AUTHOR]

Abstract: Background: Secondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion. Purpose: To evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients. Methods: Retrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital. Outcome parameters: implant exposure or extrusion. Other complications. Results: Sixty‐three patients underwent secondary orbital placement of scleral‐wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow‐up (<3 months). Mean age was 49 years (range: 1–84.5 years). The mean follow‐up was 4.1 years (range: 0.25–13, 6 years). Implant exposure or extrusion occurred in six of 18 (33%) patients in whom no muscle had been reattached during secondary orbital implantation and in five of 43 (12%) patients in whom the extraocular recti muscles had been attached, but the follow‐up time was shorter for the latter group. Surgical treatment for implant exposure/extrusion was required in eleven of 61 patients (18%). Other complications included postoperative volume deficiency despite optimal prosthesis (five of 61, 8%), inclusion cysts (four of 61, 7%) and conjunctivitis sicca (two of 61, 3%). Seven of 61 (11%) patients required fornix deepening and seven (11%) blepharoptosis correction. Conclusion: Secondary orbital implantation of sclera‐wrapped alloplastic implants was complicated by implant extrusion or exposure in 12% of cases in which the extraocular muscles were attached to the implant. [ABSTRACT FROM AUTHOR]

Enucleation is the removal of the entire globe of the eye and a portion of the optic nerve, while evisceration involves the removal of the contents of the globe leaving the sclera, extraocular muscles, and optic nerve. Following enucleation or evisceration, intraorbital implants are routinely placed to enhance the prosthetic outcome in addition to restoring the lost orbital volume. Current practice employs intraorbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Intraorbital implant selection and placement, being a highly demanding procedure in terms of knowledge, skill, and expertise, may be associated with a multiplicity of technical and surgical errors. Complications are usually minimal with these implants, but they do occur. The literature reveals many articles related to intraorbital implants, their benefits, and complications; however, the literature regarding the effect of various intraorbital implant situations on the subsequent prosthetic rehabilitation is markedly scarce. Moreover, the need for interdisciplinary surgical and prosthetic interventions required for successful rehabilitation in cases of compromised implant situations has been underemphasized. Hence, this review aimed to evaluate the effect of different intraorbital implant situations on ocular rehabilitation and the required interdisciplinary surgical and prosthetic treatment approach for rehabilitation of enucleated/eviscerated sockets with compromised implant situations, to provide a critical appraisal, and to present a simplified management strategy. [ABSTRACT FROM AUTHOR]

Objective To characterize the histopathological causes for failure of intrascleral prosthesis placement in dogs and cats. Procedures The Comparative Ocular Pathology Laboratory of Wisconsin database was searched to find canine and feline evisceration samples that were diagnosed with neoplasia. A second population included canine and feline scleral shells that were removed after an evisceration surgery had been performed. The causes for removal were divided into: neoplasia, corneal abnormalities, and other causes. Results In dogs, 163 of 1985 evisceration samples (8.21%) contained a neoplasm, whereas 17 of 88 (19.31%) evisceration samples in cats contained a neoplasm. In dogs, severe corneal disease was diagnosed in 38 of 80 scleral shells (46.25%) and neoplasia was diagnosed in 31 of 80 scleral shells (38.75%). Malignant melanoma was the most frequently diagnosed tumor, in 14 of 31 scleral shells. In cats, eight of 12 scleral shells contained a tumor (66.7%), with feline diffuse iris melanoma being diagnosed most commonly (six of eight shells). Two of 12 feline scleral shells had severe corneal disease (16.7%). Epithelial downgrowth, lining the inner aspect of the fibrous tunic, was seen in 14 of 38 canine scleral shells and in two of two feline scleral shells with severe corneal disease. Conclusions Severe corneal disease and neoplasia are the most common causes for intrascleral prosthesis failure in dogs, whereas neoplasia is the single most common cause for intrascleral prosthesis failure in cats. [ABSTRACT FROM AUTHOR]

This report describes the case of an 81-year-old woman with sudden evisceration of the small intestine through the vagina. It occurred one year after repair of a vaginal vault prolapse, which was initially treated by vaginal hysterectomy and colporrhaphy three years prior to the repair. On examination, we found a 70-80-cm loop of bowel prolapsing through a 3-cm oval defect in the vaginal vault. The patient underwent emergency exploratory laparotomy under general anesthesia. After careful reduction of the eviscerated small intestine, the hernia hiatus was closed and the widened cul-de-sac was obliterated by performing a Moschcowitz culdoplasty. Rapid intervention by abdominovaginal surgery may enable smooth repositioning of the eviscerated intestine, thus preventing subsequent morbidity. [ABSTRACT FROM AUTHOR]

. Purpose: To present long-term follow-up data on eviscerations carried out with scleral modification and placement of spherical porous polyethylene implants. Methods: We conducted a retrospective, interventional study on eviscerations performed with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330° and placement of porous polyethylene spherical implant, performed between March 2000 and August 2007 by a single surgeon. Patient age, sex, causative diagnosis, axial length, implant size, follow-up duration, complications and treatment were recorded. Results: In total, 92 patients were identified. The mean implant size was 19.46 mm. During the follow-up period (mean: 60 months, range: 19-107 months), there were no cases of implant exposure. In some patients, mild discharge, ptosis and conjunctival cysts developed. Conclusions: Primary evisceration with four anterior relaxing incisions and posterior sclerotomies made circumferentially behind the equator at approximately 330°, combined with porous polyethylene orbital implant placement, is a useful technique for treating a variety of end-stage eye diseases. [ABSTRACT FROM AUTHOR]

An interview study of 173 eye amputated patients [ABSTRACT FROM AUTHOR]

In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. To indentify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV). Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients. The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive ( n = 19); (ii) radiating, zapping or shooting ( n = 8); (iii) superficial burning or stinging ( n = 5); or a mixture of these different pain qualities ( n = 7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify the number of eye amputations, and the causative diagnoses, indications for surgery and surgical techniques applied, and to evaluate a possible change in surgical technique in a tertiary referral centre in Denmark. Methods: The hospital database was screened using surgery codes for patients who had undergone bulbar evisceration, enucleation or orbital exenteration in the period 1996–2003. Patient records were reviewed for gender, age, time since surgery, causative diagnosis (the disease process leading to the indication for amputation), indication for eye amputation, type of surgery and whether an implant was applied. Results: A total of 345 patients were identified as having undergone eye amputation during the 8-year period. Indications for eye amputation were: painful blind eye (127); neoplasm (119); infection (42); recent injury (25); disfiguring blind eye (25); prevention of sympathetic ophthalmia (5), and other reasons (2). Surgical procedures included 174 eviscerations, 154 enucleations and 17 orbital exenterations. The mean number of surgeries per year was 43.1. An orbital implant was applied in 168 patients. Conclusions: The most frequent indications for eye amputation were painful blind eye (37%) and neoplasm (34%). During the study period, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used in 33% of patients in 1996 and 67% in 2003. [ABSTRACT FROM AUTHOR]

Objective To evaluate motility of silicone orbital implants and corneoscleral prostheses, with and without use of a motility coupling post (MCP) in dogs. Animals studied Eighteen mixed-breed dogs. Procedures The motility of an orbital silicone implant and corneoscleral prosthesis after enucleation ( n = 6), evisceration ( n = 6), or use of a MCP with evisceration ( n = 6) in dogs were compared. One eye from each dog had surgery whereas the opposite eye was used as a control. Clinical evaluations were performed three times a week. Histopathology of the orbital tissues was performed 8 and 12 weeks after surgery. Results Implant motility in dogs with evisceration (vertical movement [VM] 8.04 ± 2.13; horizontal movement [HM] 11 ± 3.05) and evisceration with MCP (VM 9.61 ± 1.59); HM was significantly greater than the enucleation group (VM 0.51 ± 0.5; HM 1.22 ± 0.68) ( P < 0.01). Prosthetic motility in dogs with evisceration with MCP was significantly greater than in dogs with evisceration; dogs with evisceration had significantly greater motility than dogs with enucleation ( P < 0.01). No postoperative complications were observed in any of the groups. No significant abnormalities were noted on histopathology. Conclusions MCP placement in silicone orbital implants significantly enhanced the prosthetic motility in dogs. This study supports the use of MCP in silicone orbital implants to enhance corneoscleral prosthesis motility and cosmetics in dogs. [ABSTRACT FROM AUTHOR]

With timely recognition and surgical intervention along with administration of an antibiotic, antihistaminic, and anti‐inflammatory drugs, evisceration of umbilical content with extensive adhesion can be treated, and the outcome is also good. [ABSTRACT FROM AUTHOR]

The choice of enucleation and evisceration for removal of an eye remains controversial in certain circumstances. An international panel was asked to give their surgical management of two clinical cases that require either enucleation or evisceration. Case one follows multiple vitreoretinal procedures, and the risk of sympathetic ophthalmia is considered in the surgical management. Case two has had postoperative endophthalmitis, and the possibility of implant infection following insertion of an orbital implant with evisceration and enucleation is discussed. [ABSTRACT FROM AUTHOR]

Abstract Aim: To study the demographic pattern and indications for evisceration in north India and to evaluate the changing trends over the last decade. Methods: In a retrospective hospital-based study, case records of all patients who underwent evisceration at Rajendra Prasad Centre for Ophthalmic Sciences from January 1990 to December 1999 were reviewed. The parameters evaluated were the age and sex distribution, the place of residence (urban/rural) and the indications for evisceration. The aetiology responsible for evisceration was determined on the basis of history, clinical examination and investigations as determined from previous records. Results: One hundred and sixty-four patients had one eye eviscerated during the study period. The mean age of the patients was 51 ± 13.84 years (range 6 months to 90 years). Panophthalmitis was the most common indication for evisceration (78.6%, n = 129), followed by irreparable globe injury (21.3%, n = 35). There was a significant decrease in the eviscerations performed due to pano-phthalmitis from 104 cases during the period 1990-1994, to 25 cases in the period 1995-1999. Conclusion: Panophthalmitis and severe ocular injury are the major indications of evisceration in north India. There has been a significant decrease in the number of eviscerations related to panophthalmitis over the last decade. [ABSTRACT FROM AUTHOR]

Purpose: To determine the epidemiology and outcomes of penetrating eye injuries in a rural Australian setting. Methods: A retrospective study of an 11 year period to identify 77 cases of penetrating eye injury in Lismore, New South Wales. Results: The commonest cause of penetrating eye injury was fencing wire followed by hammering metal. The average age was 32.6 years, and males were involved in 88% of cases. A final visual acuity of 6/12 or better was achieved in 61% of cases. Enucleation was performed in 14%. Visual outcome was best for wounds involving the cornea only. Conclusions: Penetrating eye injuries are potentially devastating to vision, but with modern surgical techniques patients are likely to achieve reasonable vision. Prevention requires education to ensure adequate protective measures are taken in potentially hazardous settings. [ABSTRACT FROM AUTHOR]

Apostichopus japonicus is a useful model for studying organ regeneration, and the gut microbiota is important for host organ regeneration. However, the reconstruction process and the mechanisms of gut microbiota assembly during gut regeneration in sea cucumbers have not been well studied. In the present study, gut regeneration was induced (via evisceration) in A. japonicus, and gut immune responses and bacterial diversity were investigated to reveal gut microbiota assembly and its possible mechanisms during gut regeneration. The results revealed that bacterial community reconstruction involved two stages with distinct assembly mechanisms, where the reconstructed community was initiated from the bacterial consortium in the residual digestive tract and tended to form a novel microbiota in the later stage of reconstruction. Together, the results of immunoenzyme assays, community phylogenetic analysis, and source tracking suggested that the host deterministic process was stronger in the initial stage than in the later stage. The bacterial interactions that occurred were significantly different between the two stages. Positive interactions dominated in the initial stage, while more complex and competitive interactions developed in the later stage. Such a dynamic bacterial community could provide the host with energetic and immune benefits that promote gut regeneration and functional recovery. The results of the present study provide insights into the processes and mechanisms of gut microbiota assembly during intestinal regeneration that are valuable for understanding gut regeneration mechanisms mediated by the microbiota., (© 2021 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

This report describes a case of a 55-year old woman presenting with evisceration of small bowel through the vagina, five years after a Total abdominal hysterectomy and bilateral salpingoopherectomy for irregular bleeding and a benign ovarian cyst. Examination under anesthesia revealed a 70 cm loop of bowel prolapsing through a 5 cm defect in the vaginal vault. She underwent an exploratory laparotomy and repair of vaginal vault defect. Small bowel prolapse through vaginal vault defect is a rare complication after abdominal hysterectomy. Appropriate management includes prompt recognition, thorough assessment of the herniated viscus and surgical repair of the vaginal defect. Combining abdominal and vaginal approaches as in our case may facilitate repair and avoid further morbidity. [ABSTRACT FROM AUTHOR]

A 65-year-old woman presented with malignant melanoma of the right socket following evisceration of her right eye for ocular trauma 8 years previously. Computed tomography demonstrated a solid mass adjacent to the residual eviscerated eyeball without extraorbital extension. The tumour was removed by total exenteration of the orbit. The clinical and radiological features of this condition, and a review of the literature are presented. [ABSTRACT FROM AUTHOR]