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Post-neuter Haematoma?

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RosieMaia

Teenage Guinea Pig
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Hello everyone!

I have a 8-month old male guinea pig who was neutered 7 days ago (28 January). The vet who did the surgery is cavy savvy and has excellent reputation. The surgery went fine, and he was active, climbing his cage bars and wheeking for veggies less than 24 hours later. He has been feeling fine ever since, and is eating, pooping and acting normally.

The vet used intradermal stitches (not chromic gut) and then covered the two incisions with surgical glue. He has been on meloxicam (1.5 mg/ml concentration, 0.2 ml once daily) and a 5% enrofloxacin solution at 0.2 ml once daily since. I made sure to keep his cage and bedding very, very clean and purchased sterile hospital bedding (the one used to cover surgical beds), and changed that 4 times daily, microwaved his hay and pellets, and disinfected his water bottle and food bowls twice daily. The only thing that didn't come into his cage sterilized were his veggies. I'm mentioning all these details just to explain why I kind of agree with the vet that an infection is probably not very likely considering the antibiotic plus my obsessive cleaning (I'm usually nor crazy or an OCD cleaner, but was just worried these days).

A few days after the surgery, I noticed some swelling in his groin. The swelling wasn't localized, it looks like the whole area is filled with squishy liquid. He's chocolate brown, so it's a bit hard to tell, but as far as I can see, no redness is visible. I took him to the vet and they excluded a hernia, saying that the technique they used (I don't remember the technical details) make it extremely unlikely, and they did say they don't think it's an abscess, because it doesn't feel like one, and isn't warm nor red. They said they think it's a haematoma, that it should resolve on its own in a few days/weeks, that I shouldn't be concerned, but that I should take him back for a check-up if it hasn't cleared in a week just in case or if he appears to not feel OK. At that point, his stitches were healing very well.

Today, I noticed a bean-sized lump where his right testis had been. It is mobile (i.e. isn't attached either to the skin, or to the soft tissue underneath), isn't red, warm and doesn't appear painful to touch. There's another lump like that on his left side, slightly bigger, but more diffused. I took him to the vet straight away, and she again said it was haematoma. She said that there was some bleeding on the right testis when she removed it, so she had to cauterize a bit more and remove somewhat more from the fatty tissue there and this appears to be where the lump is now. She thinks it's an aseptic inflammation of the soft tissue, a reaction from the surgery with a haematoma, not an abscess, and I should just wait for it to resolve. She said it doesn't feel like there's pus inside, and doesn't want to lance it or aspirate with a needle, because it would cause him unnecessary stress. She did ask me to continue with the meloxicam for another week for its anti-inflammatory properties, and to use enrofloxacin for 10 instead of only 7 days just in case (he appears to tolerate both meds very well, hasn't lost weight, hasn't had any diarrhoea and happily takes his probiotics).

The question is: should I return tomorrow an insist on aspirating some fluid to check whether it really is a haematoma, or considering that the guinea pig is OK, should I just wait and see? What concerns me is that no one here or in the other large guinea pig forums ever mentioned heametoma after neutering, and I am worried that the vets may dismiss an abscess as a haematoma. Is it easy to differentiate between an abscess and a haematoma? If yes - how, are tests needed, or can one just palpate the lump and say for sure? I know there are really knowledgeable people here and I'd be so very grateful for any input.
 
Sorry to hear your little one is still recovering.

Heamatoma's are relatively common in all surgical procedures. My recent surgery on my sow Dill who had a thyroidectomy (removal of her thyroid) developed a large heamatoma post surgery. It became quite large under her chin and did take many weeks to resolve, but all fine now.

Sounds like your vet is clued up. Heamatoma's can take some time to go down due to the body having to process the fluid. It can be aspirated, the problem with this is the body may well just fill the space with more fluid and not really help with the healing process. I would personally leave it be unless it's causing undue pain or problems with walking. If you want to be certain it is a heamatoma then you can pull some of the fluid off and look under the microscope to see blood cells. If you trust your vet though I would leave it be. The bean sized lumps on both sides sounds like scar tissue forming around the stumps where the testicles were removed. If the vet said there is very little chance of herniation this means they had to have ligated and stitched closed the iguanal canals (this is where the testicles can move in and out of the abdominal cavity), the stitching is probably what your feeling. Sometimes they get a little bit of a reaction from it and it's perfectly normal.

Hope he feels better soon. I would keep on the antibiotics to cover him for sure.

x

Ps. On a side note, we have recently started trialling a new approach of Guinea pig castration by making a small incision into the abdomen near the belly button and castrating via this route. It doesn't reduce the risk of heamatoma but does reduce the risk of infection considerably due to the surgical wound not sitting right next to anus and prepuce which is the rather dirty end.
 
Thank you both for your help, your really prompt and detailed answer has indeed taken away some of my worries!

I do trust my vet and with this piggy and every other one I've ever brought to her she's always been just amazing. What worried me was actually that I hadn't ever seen a reference to haematomas in guinea pigs after neutering, and I was wondering if it's something that does happen at all. I am strangely relieved to hear it's a common complication, as it appears quite benign compared to an abscess. In that case, I will trust my vet, and just keep monitoring his behavior and the lumps and bring him in only if I see something worrying. And will keep the antibiotic until Monday for full 10 days (unless something changes) and the meloxicam until next Thursday, when is our next scheduled appointment.

I will be sending her a link to this thread, so she will be able to contact you for further info on your trial. It does sound interesting, and it's great that people are now doing research about helping guinea pigs, not just using them in the lab :)

I will keep you posted about how the swelling develops.
 
I have a 5 year old sow who has a lovely haematoma near her "lady Bits" - it has been aspirated twice over the last two months and just keeps filling up again - my vet (very cavy savy - gave my Boar bumble acupuncture yesterday ) says it was more than likely caused by an over excited nip from her huspig - it doesnt bother her,just looks like she is wearing a bum bag on her backside!
 
I've booked an appointment for tomorrow at lunch time for him, as I am still concerned. The lump on the right has grown a bit, though I am not sure, so I will just insist on having both lumps aspirated and checked. I will update you when we get home - hopefully with good news.

I've circled the two lumps. The lump where his right testis was is more pronounced and hard, with defined boundaries. The one on the left testis is more like general swelling. I've tried pushing the right lump up a bit, so that it becomes more visible in the picture, it doesn't protrude as much normally. But maybe it's still too large to be scar tissue?

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So, the guinea pig spent the night well, eats and drinks normally. We went back to the vet, and then their three exotic specialists palpated him carefully. They took his rectal temperature (38.2 degrees C), checked his eyes, listened to his chest, palpated the stomach. All three of them were of the opinion it was a haematoma. My own vet said the lump on the left was actually less hard and defined than yesterday, which she considered a good sign.

Regarding the harder lump on his right testis, she said the scar tissue appears to have moved down a bit, as it is mobile, but insisted there were no indications that it was an abscess. The bean-sized lump is right underneath the skin, isn't warm or pulsating. The guinea pig also doesn't seem to be in pain when the lump is palpated, although naturally he isn't happy about it.

Now, at that point, I still wasn't satisfied everything is normal and wanted to do further tests, so they did an ultrasound. Unfortunately, I wasn't able to obtain the footage to post it here, as the ultrasound wasn't scheduled for us and the next patient was waiting. However, the right lump appears to be made of clear fluid, surrounded by scar tissue. The vet said that guinea pigs' puss is very dense, and doesn't look at all like that on an ultrasound.

I did ask about aspirating some fluid, but she refused, saying that while it's the only way to 100% exclude an abscess, it wasn't in the best interest of the piggy to be prodded just for the sake of it. She also advised me to double his meloxicam dose to 0.2 ml twice daily to help reduce the inflammation, and to supplement with Vitamin C to help with the haematoma resorption.

Finally,the vet suggested that if I would feel more comfortable, we could change the enrofloxacin with thrimetoprim/sulfamethoxazole, and she feels both would be equally effective in keeping the haematoma from getting infected. I've got both at home, do you have any thoughts re. which would be better? And would a combination of enrofloxacin with thrimetoprim/sulfamethoxazole be a good idea to consider?
 
Hi! I know it's difficult to give opinions based on images/descriptions, but I'm writing just to give you a quick update on how Rosie's doing.

In short: he's been fine. The lumps are still there, and still look mostly the same, maybe they have shrunk a bit and become less hard, but I'm not really sure. I'm checking him at least a couple of times daily, so it's difficult to detect subtle changes. The lumps aren't warm, pulsating or foul-smelling. I've scheduled another check-up for Friday morning, and the plan is to repeat the ultrasound, so that we can compare the images to the ones from last week. Fingers crossed that there will be some improvement.

Otherwise, he's eating, active and behaving normally. I've decided to switch to thrimetoprim/sulfamethoxazole, which he also seems to tolerate nicely. He's put on some weight actually. He was 900 grams before the surgery and his weight stayed the same. Today, he was 920 grams, though it's probably due to still being in the smaller "hospital" cage and not having as much space to run around.

I will post here any updates, if any, and then on Friday I will try to upload the ultrasound images from this and last week. I hope someone may find this useful at some point.

Thanks for reading, and have a lovely evening! :)
 
Sorry to hear your little one is still recovering.

Heamatoma's are relatively common in all surgical procedures. My recent surgery on my sow Dill who had a thyroidectomy (removal of her thyroid) developed a large heamatoma post surgery. It became quite large under her chin and did take many weeks to resolve, but all fine now.

Sounds like your vet is clued up. Heamatoma's can take some time to go down due to the body having to process the fluid. It can be aspirated, the problem with this is the body may well just fill the space with more fluid and not really help with the healing process. I would personally leave it be unless it's causing undue pain or problems with walking. If you want to be certain it is a heamatoma then you can pull some of the fluid off and look under the microscope to see blood cells. If you trust your vet though I would leave it be. The bean sized lumps on both sides sounds like scar tissue forming around the stumps where the testicles were removed. If the vet said there is very little chance of herniation this means they had to have ligated and stitched closed the iguanal canals (this is where the testicles can move in and out of the abdominal cavity), the stitching is probably what your feeling. Sometimes they get a little bit of a reaction from it and it's perfectly normal.

Hope he feels better soon. I would keep on the antibiotics to cover him for sure.

x

Ps. On a side note, we have recently started trialling a new approach of Guinea pig castration by making a small incision into the abdomen near the belly button and castrating via this route. It doesn't reduce the risk of heamatoma but does reduce the risk of infection considerably due to the surgical wound not sitting right next to anus and prepuce which is the rather dirty end.
That's interesting as l saw a friends piggy today that had been recently neutered, l noticed he only had one wound. I will have a chat with my vet as it seems a very good idea.
 
I am glad that your piggy is doing well. I had a piggy with a haematoma post castrate once (done by a vet with limited experience). He ended up getting an abscess but the vet didn't give preventative antibiotics. Needless to say l didn't use that vet again!
 
Yes, I read that haematomas could get infected. I gave enrofloxacin for 12 days, and then switched to thrimetoprim/sulfamethoxazole, so that the piggy doesn't become resistant to enrofloxacin, in case he ever needs to get it. But I do suck at waiting for the haematomas to resolve on their own, and keep wishing there was something I could do to speed up the process or at least ensure they don't evolve into something nasty. At lest Rosie doesn't seem to notice them, which is a relief.
 
Hi there :) I haven't written for a while, because after the time off I took to care for Rosie post-op, I had a lot of catching up to do at the office. My news are good: Rosie's fine, the lumps disappeared over time, we had no infections and everything went smoothly. I shouldn't have worried as much.

He's now been finally united with Maia and they are very happy and sweet to each other. And they sleep snuggled together, which is unbelievably cute :P

Thank you all for the support during Rosie's post-op!
 
Hi there :) I haven't written for a while, because after the time off I took to care for Rosie post-op, I had a lot of catching up to do at the office. My news are good: Rosie's fine, the lumps disappeared over time, we had no infections and everything went smoothly. I shouldn't have worried as much.

He's now been finally united with Maia and they are very happy and sweet to each other. And they sleep snuggled together, which is unbelievably cute :P

Thank you all for the support during Rosie's post-op!
That's great news !
 
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