Uterine Torsion in Mares: Diagnostic Challenges and Surgical Management

Uterine torsion is an uncommon but life-threatening reproductive emergency in mares, often associated with high mortality rates for both the mare and the foal ¹. Although relatively rare in equine practice, delayed diagnosis or improper management can lead to devastating consequences including uterine rupture, fetal death, severe vascular compromise, and maternal shock. 

Unlike cattle, where uterine torsion is more frequently encountered, uterine torsion in mares is often considered a “once-in-a-lifetime” diagnosis for many veterinarians. However, every equine practitioner dealing with pregnant mares should remain alert to this condition, especially when examining mares in late gestation presenting with signs of colic. 

When to Suspect Uterine Torsion 

Uterine torsion should always be included in the differential diagnosis when a pregnant mare in advanced gestation shows persistent or recurrent abdominal discomfort². Clinical signs are often nonspecific and may mimic gastrointestinal colic. 

Common Clinical Signs^1,2 

• Frequent getting up and lying down 

• Excessive rolling 

• Pawing the ground 

• Kicking at the abdomen 

• Mild to moderate abdominal pain 

• Restlessness 

• Reduced appetite 

In the reported case, a full-term Kathiawari mare in her third foaling was presented with a history of severe restlessness, rolling, and abdominal pain for one week after being bred approximately 11 months earlier. 

Clinical Examination and Diagnosis 

Accurate diagnosis relies heavily on thorough obstetrical examination. 

Vaginal Examination Findings 

The vaginal canal was found twisted approximately 270° towards the right side, and the cervix could not be palpated. 

Rectal Examination Findings 

Rectal palpation revealed: 

• Tight stretching of the left broad ligament 

• Displacement across the dorsal abdomen towards the right lower abdomen 

These findings confirmed a diagnosis of right-sided post-cervical uterine torsion. 

Rectal palpation remains one of the most reliable methods for diagnosis because the broad ligaments can often be traced in the direction of torsion^1,3. 

Why Does Uterine Torsion Occur? 

The exact cause of uterine torsion in mares remains unclear. However, several contributing factors have been proposed¹: 

• Sudden fetal movement 

• Violent maternal movement 

• Instability caused by unilateral pregnancy 

• Increased uterine mobility during late gestation 

Initial Management Attempt 

The mare was initially managed conservatively using the modified Schaffer’s rolling method. Two attempts at detorsion were unsuccessful. 

Although nonsurgical correction methods are occasionally attempted, they carry significant risks in near-term mares, including: 

• Uterine rupture 

• Premature placental separation 

• Fetal death 

• Severe maternal trauma 

These complications have been documented particularly in advanced pregnancies^1,4. 

Surgical Intervention: Right Oblique Laparohysterotomy 

Due to failed nonsurgical correction, emergency caesarean section through right lower oblique laparohysterotomy was performed. 

Anaesthetic Protocol 

The mare was restrained on a sand bed and sedated using¹: 

• Xylazine: 1.1 mg/kg 

• Ketamine: 2.2 mg/kg 

Anaesthesia was maintained with intravenous ketamine, while the surgical site was infiltrated locally with 2% lignocaine hydrochloride. 

Surgical Technique 

The procedure involved¹: 

1. Incision through the right paralumbar fossa 

2. Separation of abdominal muscle layers 

3. Identification of the gravid uterine horn 

4. Incision over the greater curvature of the uterus 

5. Removal of the dead male fetus using caudal and lateral traction 

Following fetal removal, uterine detorsion was carefully achieved by manually elevating and rotating the uterus dorsally to the left. 

The uterus was subsequently flushed with normal saline followed by metronidazole infusion as recommended by Barber (1979). 

Surgical Approach: Flank vs Ventral Midline 

The choice of surgical approach in equine uterine torsion remains debated. 

Flank Approach^1,5 

Advantages: 

• Easier field access in standing animals 

• Reduced contamination risk 

Limitations: 

• Limited exposure 

• Risk of severe muscle trauma 

• Difficult manipulation in advanced pregnancies 

Ventral Midline Approach^1,5 

Many authors recommend ventral midline celiotomy in specialized surgical facilities because it offers: 

• Better exposure 

• Easier uterine manipulation 

• Improved access to abdominal organs 

• Greater versatility during complications (Martens et al., 2008; Saini et al., 2015) 

However, in field conditions or resource-limited settings, modified flank or oblique approaches may still provide satisfactory outcomes when performed carefully. 

Prognosis and Outcome 

Studies suggest that the degree of torsion alone does not necessarily determine mare survival, although torsions greater than 180° are generally associated with¹: 

• Greater tissue damage 

• Vascular compromise 

• More severe clinical signs 

• Reduced fetal viability  

In this case, despite fetal death, the mare recovered successfully following surgery. 

The report highlights that timely surgical intervention can significantly improve maternal survival even in advanced torsion cases. 

Practical Takeaways for Equine Practitioners 

Key Clinical Pearls 

• Always evaluate reproductive structures in late-gestation mares with colic 

• Rectal palpation of broad ligaments is critical for diagnosis 

• Delayed diagnosis worsens prognosis dramatically 

• Rolling techniques should be attempted cautiously near term 

• Surgical correction is often the safest option in severe torsions 

• Adequate surgical infrastructure greatly improves outcomes 

Conclusion 

Uterine torsion in mares is a rare but extremely serious obstetrical emergency requiring rapid diagnosis and decisive intervention. The reported Kathiawari mare case demonstrates that right lateral oblique laparohysterotomy can serve as an effective surgical option in resource-limited settings when nonsurgical correction fails. 

Although fetal survival remains poor in advanced cases, prompt caesarean section and careful uterine detorsion can result in successful maternal recovery and future breeding potential. Early recognition of clinical signs and thorough rectal examination remain the cornerstones of successful management. 

References  

1. Murugan, M., Senthil Kumar, K., Ezakial Napolean, R., Gopikrishnan, D., Selvaraju, M., Ravikumar, K., Palanisamy, M. and Dharmaceelan, S. (2023). An unusual case of uterine torsion and its management by laparohysterotomy in a Kathiawari mare. The Haryana Veterinarian, 62(2), 148–149.  https://www.luvas.edu.in/haryana-veterinarian/download/dec-2023/32.pdf  

2. Martens KA, Govaere J, Hoogewijs M, Lefevre L, Nollet H, Vlaminck L, Chiers K, de Kruif A. Uterine torsion in the mare: a review and three case reports. Vlaams Diergeneeskundig Tijdschrift. 2008;77(6):397-405. https://backoffice.biblio.ugent.be/download/671562/706856  

3. Yorke EH, Caldwell FJ, Johnson AK. Uterine torsion in mares. Compend Contin Educ Vet. 2012 Dec 1;34(12):E2. http://vetfolio-vetstreet.s3.amazonaws.com/  

4. Palmieri V, Catone G, Conte A, Di Palma T, Liguori P, Izzo I, Vullo C. Near-Term Extrauterine Pregnancy Secondary To Uterine Rupture In A Mare. Journal of Equine Veterinary Science. 2026 May 22:105943. https://www.sciencedirect.com/science/article/pii/S0737080626001784   

5. Samsel J, Gündemir O, Szara T, Witkowski M. Midline vs. flank laparotomy-criteria for choosing the optimal surgical technique for uterine torsion correction in the mare. BMC Veterinary Research. 2025 Sep 24;21(1):542. https://doi.org/10.1186/s12917-025-04883-w