Severe constipation with concurrent cystic endometrial hyperplasia in a Kunekune sow: a case report on diagnostic and therapeutic management

Background Acute abdominal pain in pet pigs presents a diagnostic challenge, as severe constipation can present with a clinical picture similar to diseases that represent an abdominal surgical emergency. Case presentation This case report describes the diagnostic reasoning and therapeutic management of a 10-year-old pet Kunekune sow, in which the use of ultrasonography and radiography enabled the distinction between severe large bowel constipation accompanied by reduced intestinal motility and other potentially life-threatening abdominal conditions, whilst also identifying a concomitant uterine disorder. Clinical stabilisation through a multimodal approach, which included intravenous fluid therapy, continuous rectal irrigation and analgesia, led to rapid clinical improvement. Following stabilisation, a deferred ovariohysterectomy was performed and histopathological examination of the uterus confirmed cystic endometrial hyperplasia. The sow’s clinical condition improved considerably following medical treatment and surgical intervention, with a return to normal defecation. Conclusion This case highlights the importance of selecting diagnostic tests based on specific clinical hypotheses rather than within the framework of a pre-established diagnostic protocol and demonstrates that severe constipation should remain an important differential diagnosis for acute abdominal conditions in pet pigs, even in the presence of residual faecal expulsion. The concurrent diagnosis of cystic endometrial hyperplasia further emphasises the importance of considering reproductive disorders and reproductive status when assessing adult sows presenting with gastrointestinal and abdominal clinical signs.