Abscess in pets - Case Study: closed pyometra

Two interns from RI.  Abscess is their project.
Abscess can occur in any part of the body and system. Closed pyometra is an example of abscess in the reproductive system


They saw two cases

Open pyometra in a young female Boxer. Pus in vagina.
Closed pyometra in a 15-year-old. No pus in vagina.
   "I thought she was putting on weight," the elderly owner said.
   "The left abdomen has a large bulge, while the right is swollen but not bulging," I said to the interns. "Observation can tell a vet many things. This is not a case of ascites, a video done by the 2 interns recently.
  The dog has closed pyometra," I said. "When was her last heat?"
  "No more since last year," the woman said.
   "To save on medical costs, no blood test and X-rays."

I checked the history.

History
Maltese, Female, not spayed, Born July 1998

7 Sep 2005 I saw the dog in 2005.  Ear flap infections. "False pregnancy," I advised spay.
11 Sep 2006  Vaccination. Breast tumour MG5 left advised surgery.
11 Aug 2008. Vaccination. False pregnancy. Heat 2 months ago.
14 May  2009      Vacc
8 Oct 2010            Vacc
22 Sep 2011   Vacc & dental
20 Sep 2012   Vacc
11 Dec 2012  Vacc
17 Dec 2012  Tooth extraction
16 Jan 2013   False pregnancy Milk seen
18 Aug2013  Swollen abdomen, left side much bigger bulge. 15 years old.

BLOOD TEST
No abnormal total white cell count, but neutrophils high at 84.9% (60-70%)
Kidney's Creatinine 26 low (89-177)

X-RAYS
Radio dense womb seen

As dog is said to have swollen abdomen seen only in the past 2 days, it is possible that there is no increase in total WCC.

The dog came in on Aug 19, 2012 and the owner was worried about anaesthetic deaths. This was a 15-year-old Maltese. So, she had taken the dog back to think whether to do surgery or not. I gave the dog antibiotic injections and medication home. 

I spoke to the owner yesterday Tuesday, Aug 20, 21 as regards the X-rays showing swollen uterine bodies.
The left abdomen had such a large bulge as if there was a big hot dog bulging from the skin.

"I gave the dog the oral antibiotics. She vomited but now is eating and looks active."
"This is only temporary improvement in health," I said. "If you delay the surgery, the toxins will spread and it will be too late. It is urgent that you get the dog operated today before the uterine body rupture leaking pus into the inside and killing the dog, but there is the possibility of death on the operating table. You have to make the decision to operate."

"What is the chance of survival?" the slim elderly lady asked.

"Not good as the dog is very old and the kidney function is not normal."
"What are the chances of the dog dying during surgery?"
"Less than 50%," I said.
"How am I to decide?" she asked.
"The owner has to decide. Actually you have no choice," I said. "If you don't operate now, it will be too late as the dog gets sicker every day." 
The owner decided to get the dog operated today, Wednesday.