The patient, a fifteen-year-old Holsteiner mare, presented to the Equine Park at Cornell for breeding management with cooled-transported semen. The mare had produced one live foal successfully as a 3-year-old, however no other breeding history was known. Physical examination revealed poor perineal conformation with a sunken anus, tipped vulva, and a second degree perineal laceration. The remainder of the physical examination was within normal limits. A breeding soundness examination was performed upon initial presentation and the results were normal with a negative culture, normal cytology, and Grade I biopsy. The following week, repeated transrectal ultrasounds showed air and fluid in the uterus. Treatments included uterine lavages, repeated cytology and culture, oral antibiotics, Caslick’s procedures, and oxytocin. Due to persistent air and fluid in the uterus, a perineal body reconstruction was performed.