Background: Vaginal and rectal prolapse are clinically relevant reproductive disorders in female livestock, typically associated with dystocia, abnormal uterine contractions, late gestation, nutritional imbalances, or pelvic floor dysfunction.
Vaginal prolapse is relatively common in multiparous small ruminants; however, the concurrent occurrence of both vaginal and rectal prolapse in the same animal is rare and poses significant therapeutic challenges. This report describes an ewe that initially presented with vaginal prolapse and subsequently developed secondary rectal prolapse, highlighting the complexities of management and the potential for recurrence and complications. Methods: On November ۲۹, ۲۰۲۴, a two-year-old ewe with a recent history of dystocia was presented to the Veterinary Hospital of Shahid Bahonar University of Kerman due to vaginal prolapse. Clinical examination included assessment of vital parameters, hydration status, mucous membrane color, and gastrointestinal motility, all of which were within normal limits. After administering caudal epidural anesthesia using ۲% lidocaine, the prolapsed vaginal tissue was gently cleansed with sterile warm saline and a mild antiseptic solution. Manual reduction was performed using uniform, controlled pressure. To prevent recurrence, a Buhner retention suture was applied by passing No. ۲ non-absorbable nylon tape subcutaneously on both sides of the vulva with a Buhner needle, leaving an opening sufficient for normal urination. Approximately ۲۰ days later, the ewe was readmitted with recurrent vaginal prolapse, this time accompanied by rectal prolapse. The prolapsed tissues were viable but congested. Following cleansing and reduction, a new Buhner suture was placed to stabilize the vaginal prolapse, and a topical mammary ointment containing prednisolone was applied to reduce local inflammation and edema. The ewe was subsequently monitored for straining and general health status. Results: Following the second presentation, the ewe demonstrated stabilization after reduction of both prolapsed structures; however, the recurrence of vaginal prolapse combined with the new onset of rectal prolapse reflected a progressive weakening of pelvic support structures. The pattern suggested that persistent abdominal straining after dystocia likely contributed to the simultaneous occurrence of both disorders. The final clinical assessment indicated that although both prolapses were manually reducible and the tissues remained viable, the ewe showed a continued predisposition to recurrent prolapse episodes. This outcome emphasized the role of underlying pelvic floor insufficiency and sustained tenesmus as key etiological factors in the development of concurrent vaginal and rectal prolapse. Conclusion: This case underscores the importance of rigorous postoperative monitoring in animals with vaginal prolapse, especially those with a history of dystocia. Early identification of straining, appropriate retention suture selection, and diligent postoperative care are essential to prevent recurrence and secondary complications such as rectal prolapse. The findings emphasize the need for practitioners to remain vigilant for the potential development of dual prolapse in predisposed small ruminants and to implement comprehensive follow-up protocols to ensure successful clinical outcomes.