Colopexy in broodmares: 44 cases (1986-1990).

Colopexies were performed in 44 broodmares requiring abdominal surgery for large colon volvulus or right dorsal displacement of the large colon. Colopexies were performed by suturing the lateral bands of the left and right ventral colon to the ventral abdominal wall. Forty-seven percent of the mares in which a colopexy was performed had previous surgery for a large colon volvulus or right dorsal displacement of the large colon. Postoperative complications considered directly associated with the colopexy procedure were intermittent abdominal pain in 7, reoperation in 5, subcutaneous fistulous tracts in 1, and catastrophic rupture of the left ventral colon in 2 horses. Thirty-six horses survived greater than 6 months after colopexy, 34 of which had complete follow-up examinations. Twenty-seven mares have foaled at least once subsequent to the colopexy procedure, totalling 40 foals. Colopexy was considered a viable technique to prevent recurrence of large colon displacement or volvulus in selected predisposed populations.     

Colopexy of the equine large colon: comparison of two techniques

A study was designed to evaluate 2 colopexy techniques (A and B) in 8 clinically normal horses to determine which technique would prevent recurrence of large-colon displacement and/or volvulus. For technique A, 35 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. For technique B, the medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon, and 8 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. One horse from each group was euthanatized at 6 months, and another at 12 months after surgery. The position of the large colon, the integrity of the colopexy, and other adhesions within the abdominal cavity were evaluated. At necropsy, attempts were made to manually create displacement and volvulus of the large colon. The remaining horses in each group were anesthetized 6 months or 12 months after surgery, and the integrity of the colopexy was evaluated. After a 60-day recovery period, these horses were exercised for 2 months. Although each horse initially lost weight, the weight of all but 2 was acceptable at the conclusion of the study. Two horses that had technique-B colopexies had progressive weight loss serious enough to warrant euthanasia. Both colopexy techniques prevented manual creation of large-colon displacement and large-colon volvulus centered at the sternal and diaphragmatic flexures. Technique-A colopexy also prevented manual creation of volvulus of the large colon centered at its base.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopic colopexy in a horse

An 11-year-old Trakehner gelding required 2 ventral midline celiotomies for correction of a large colon volvulus and a large colon displacement, respectively. Laparoscopic colopexy was performed 50 days following the 2nd celiotomy. Delayed laparoscopic colopexy is minimally invasive and does not disrupt the ventral midline incision following abdominal exploration.     

Partial gastrectomy and total splenectomy for the treatment of a gastric mass in a horse

A 9-year-old cob mare with a history of recurrent colic presented during an acute colic episode. Ultrasonography revealed a mass emanating from the greater curvature of the stomach and was tightly adhered to the cranial edge of the spleen. Partial gastrectomy and total splenectomy were performed via a midline celiotomy incision. The mass was subsequently confirmed to be granulomatous inflammation, postulated to be secondary to a penetrating injury to the stomach. Post-operatively, the mare had episodes of recurrent colic that were successfully managed with optimisation of the horse's diet and feeding regime. At 10 months’ post-operatively the mare was managed on full turn out, with no evidence of colic and had returned to the previous level of ridden work. The horse then presented 14 months post-operatively with severe colic due to a large colon impaction and displacement and was euthanased. This is the first report to describe successful partial gastrectomy as a treatment option for a gastric mass in the horse.     

Displacement of the large colon associated with nonsurgical correction of large-colon entrapment in the renosplenic space in a mare

Nonsurgical correction of a renosplenic entrapment of the large colon was attempted in a mare, using a rolling technique. After correction, the mare had initial improvement in clinical signs, but later developed signs of abdominal discomfort. A ventral midline celiotomy was performed, and a pelvic flexure impaction and large intestinal volvulus were found and corrected.     

Is a standardised approach to colopexy justified?

Equine colopexy techniques vary according to surgeon preference and there is no clear evidence of the superiority of any one technique. Complications secondary to colopexy are varied, but dehiscence of the colopexy site is rare, with less than 1% of horses reported to have a repeat large colon volvulus after dehiscence of the colopexy. Considerations of how and when to perform a surgical fixation of the colon to the body wall include position of the colon, length of the colopexy, and suture material and pattern. Little evidence exists regarding best practice outside of experimental studies and retrospective studies of Thoroughbred broodmares. Therefore, more work must be done to standardise a colopexy technique to apply to a broad spectrum of horses suffering from large colon volvulus and displacement.     

Treatment of haemoperitoneum secondary to ruptured granulosa cell tumours in two mares

This report describes two cases of successful surgical management of granulosa cell tumours (GCT) in mares presenting with haemoperitoneum (HP). Controlled abdominal drainage was initially attempted in Case 1 but was not successful. A ventral midline exploratory laparotomy allowed removal of a haemorrhaging 13 kg GCT. The mare made a full recovery and returned to normal work as a driving pony 11 months post-operatively. In Case 2 controlled abdominal drainage was followed by standing left flank laparoscopic visualisation of the bleeding ovary and transection of the ovarian pedicle by electrocautery. The GCT was then removed via a ventral midline incision due to its large size. Haemoperitoneum can be associated with GCTs and in some cases is severe enough to prompt emergency treatment. Stabilisation of the patient and removal of the haemorrhaging GCT can lead to a successful outcome.     

Colopexy of the Left Large Colon to the Right Large Colon in the Horse

Three colopexy techniques were examined in 11 normal horses to determine which would prevent recurrence of targe colon displacement and volvulus. The medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon (technique A). The free band of the left dorsal colon was sutured to the free band of the right dorsal colon (technique B). In technique C, both the ventral and dorsal colon were sutured as in techniques A and B, and the pelvic flexure was sutured to the mesocolon between the right dorsal and right ventral colon. Absorbable (surgical gut) and nonabsorbable (polypropylene) suture material were compared.
One horse from each group was euthanized 2 weeks and 6 months after surgery. The position of the colon and the integrity of the colopexy were examined. At necropsy, attempts were made to produce displacement and volvulus of the colon. In the remaining horses, exploratory celiotomy 1 year after surgery was used to examine the integrity of the colopexy.
Although all horses initially lost weight after surgery, all but one began gaining weight 2 to 4 weeks later and had attained their preoperative weight by 6 months. The horse that continued to lose weight was euthanized 2 months after surgery. Numerous small colon, omental, and large colon adhesions were found at necropsy.
For all colopexy techniques, the colopexy adhesion remained short and intact at polypropylene suture sites. At surgical gut sites, the adhesion had lengthened by 6 months and was absent at 1 year. At necropsy, all colopexies prevented manual displacement of the large colon and volvulus of the colon at the sternal and diaphragmatic flexures. The colopexies did not prevent manual creation of volvulus at the base of the colon. Technique A was the easiest to perform.     

Surgical correction of entrapment of the large colon and caecum through a mesoduodenal rent with standing laparoscopic repair in a mare

A 12-year-old Tennessee Walking Horse mare displaying signs of severe colic for 48 h was found during an exploratory celiotomy to have entrapment of a cranially displaced large colon and the caecum through a rent in the mesoduodenum. The entrapment was relieved, and 24 h later, the mesoduodenal rent was closed laparoscopically, with the mare standing. The owner reported 6 months later that the mare had displayed no signs of colic since being discharged from the hospital 11 days after surgery.     

Left dorsal displacement of the large colon in the horse

Left dorsal displacement of the large colon is a condition unique to the horse that results in an obstruction of the colon and signs of colic. This condition may be successfully treated medically with analgesia, i.v. or oral fluids and feed restriction, exercise with or without administration of phenylephrine, or rolling under general anaesthesia with or without administration of phenylephrine, or a combination of these conservative options. Surgical correction via standing left flank laparotomy or, more commonly, ventral midline laparotomy under general anaesthesia, is required in cases where conservative therapy is unsuccessful. Recurrence rates range from 3.2% to 21%. Surgical attempts to prevent recurrence of this condition include large colon resection, colopexy, and ablation of the nephrosplenic space.     

Volvulus of the colon in a horse associated with a mesocolic-umbilical band

A 7-years-old Clydesdale mare was presented with severe abdominal distension and acute colic. Dilated large intestine was palpated per rectum and a ventral midline exploratory laparotomy was performed. A 180 degrees volvulus of the pelvic flexure was present, associated with an inelastic band of tissue connecting the mesocolon to the umbilicus. The band was ligated and transected, and the volvulus reduced. Postoperative complications included hyponatraemia, metabolic acidosis and laminitis. The possible aetiology of the mesocolic-umbilical band is discussed.     

Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18‐year‐old mare

An 18‐year‐old Arabian‐mix mare was presented with a history of severe colic. Emergency exploratory celiotomy revealed diaphragmatic hernia, with a large rent in the left dorsal aspect of the diaphragm and large colon volvulus. Attempts to close the defect in the diaphragm in dorsal recumbency were unsuccessful. Therefore, a thoracic approach through lateral thoracotomy was elected, and a mesh was attached to the diaphragm using skin staples. While in dorsal recumbency, the mare suffered from significant respiratory acidosis. Thus, the mare was tilted into reverse Trendelenburg (30° head upward) and ventilation improved markedly. The mare recovered uneventfully, and was doing well 5 years after surgery.     

Surgical Correction of Uterine Torsion and Mare–Foal Survival in Advance Pregnant Equine Patients

This article describes the surgical management of uterine torsion by midline celiotomy and cesarean section on 12 mares presented with signs of colic to a teaching veterinary hospital. The mares were either in full term of gestation (n = 7) or in advanced stage of pregnancy (n = 5). Six mares were in first parity. Uterine torsion was diagnosed by per rectal and per vaginal examinations. For surgical intervention, mares were anesthetized using a combination of xylazine (1.1 mg/kg) and ketamine (2.2 mg/kg), intravenously. After intubation, the animals were maintained on halothane (n = 4) or isoflurane (n = 8) inhalation anesthesia. Midline celiotomy was performed, and foals were delivered by cesarean section. In 11 mares, before closing the abdominal wound, the uterus was detorted manually and confirmed for its normal position. Both anesthetic protocols using halothane and isoflurane were found satisfactory for surgical correction of uterine torsion. After long-term follow-up, the study reported 75.0% (9/12) survival rate for mares. One mare was euthanized because of devitalized, necrosed, and adhered uterus to the abdominal wall. Of the nine surviving mares, seven were successfully bred. Three foals were born alive, and only one could survive on long-term basis. Of the nine dead foals, two had umbilical cord torsion.     

Hand-assisted laparoscopic reattachment of a mesoduodenojejunal defect in a broodmare

In this report, a jejunal entrapment through a presumptive chronic mesenteric defect extending over approximately 20 cm of the duodenojejunal region was found as a cause of acute onset colic in a multiparous broodmare. Mesenteric reattachment during the initial exploratory laparotomy was deemed unsafe given the majority of the avulsion could only be palpated deep within the abdomen. Following recovery and an uneventful parturition 12 days later, the mare returned 18 days post-foaling for attempted, standing laparoscopic reattachment of the mesentery. The procedure was converted to a hand-assisted technique and reattachment completed using a mechanical suturing device and knotless, unidirectional barbed suture. The mare was discharged 3 days post-operatively, bred 28 days following discharge and a singleton pregnancy confirmed 15 days post-ovulation and 46 days following laparoscopy. There were no signs of abdominal discomfort noted in the first 8 months following surgery. In summary, a standing, right-sided hand-assisted laparoscopic approach provided effective visibility to the mesoduodenojejunal region.     

Volvulus of the cecum and large colon caused by multiple mesenteric defects in a horse.

A 2-year-old Standardbred colt was examined because of signs of abdominal pain of 12 hours' duration. Clinical signs of disease, including tachycardia and abdominal distention, and rectal palpation findings of distention and thickening of the ventral colon, were consistent with displacement or early strangulation obstruction of the large colon. Surgical exploration revealed volvulus of the large colon around an axis formed by the dorsal mesenteric attachment of the transverse colon. The cecum could be completely exteriorized and lacked the cecocolic ligament and dorsal mesenteric attachments. The dorsal mesenteric attachments of the right ventral and dorsal colons were also lacking. The viscera were repositioned, and the horse was discharged 13 days after surgery. The horse developed severe colic 6 months later and was euthanatized. Mesenteric volvulus and omental adhesions were found at necropsy.     

Chronic intermittent colic in a mare attributed to uterine marbles

A 13‐year‐old Quarter Horse mare presented for evaluation of chronic intermittent colic. Following extensive diagnostics, abdominal radiographs revealed two round, radiopaque objects in the caudal abdomen. Palpation per rectum and transrectal ultrasonography of the reproductive tract confirmed that the round objects were uterine marbles. Dinoprost tromethamine (Lutalyse, 5 mg i.m. q. 24 h for 2 days) was administered to bring the mare into oestrus, and both uterine marbles were manually removed from the uterus following digital dilation of the relaxed cervix. Follow‐up with the owner 12 months after discharge revealed that the mare had shown no further signs of abdominal discomfort since having the uterine marbles removed. To the authors' knowledge, this is the first published report of chronic intermittent colic attributed to uterine marbles in a mare.     

Surgical Treatment of an Abdominal Abscess Caused by a Migrating Iron Wire From the Ventral Colon,a Case Report

A 13-year-old mare presented for evaluation of recurrent colic episodes. The horse was diagnosed with a mass within the spleen at the ultrasound examination of the abdomen; the levels of Serum Amyloid A and the fibrinogen were high and so a presumptive diagnosis of an abscess involving the spleen was made base on clinical, ultrasonographic and laboratory findings and it was decided to perform n exploratory laparotomy for a definitive diagnosis and possible treatment. Upon abdominal exploration a mass involving the spleen, the lateral wall of the ventral colon adherent to the left abdominal wall was diagnosed and with an intraoperative ultrasound examination a linear hyperechoic foreign body was diagnosed within the mass. It was removed through an enterotomy of the left ventral colon that allowed the digital exploration of the mass without spilling of pus within the peritoneal cavity. The horse was discharged and the long term follow-up revealed no complications and no more signs of abdominal pain.     

Clinical and ultrasonographic evaluation of three suture techniques for closure of the equine linea alba

Surgical technique plays an important role in preventing ventral midline incisional complications. The aim of this study was to compare the clinical and ultrasonographic outcome of three suture techniques for closure of the linea alba. In this prospective case series (n = 43), horses operated for acute abdominal intestinal disease through a midline incision were randomised in three groups: closure with a conventional continuous technique (Group 1), a small stitches continuous technique (Group 2) and the UX-technique (shoe-lace configuration, Group 3). Age, sex, body weight, type and duration of surgery were recorded and the suture to wound length ratio was calculated. Clinical evaluation of the wound (wound discharge) was performed daily during hospitalisation. At 7 weeks post-operatively the linea alba was evaluated clinically and ultrasonographically. The linea alba width was measured halfway along the length of the incision. One horse in Group 1 had acute incisional dehiscence, but there were no further significant differences between the groups in the short term. Seven weeks post-operatively two horses had complete herniation in Group 1 and one horse had partial herniation in Group 2. In the UX group no herniation occurred. The incidence of herniation was not significantly different between the groups. On ultrasound at 7 weeks the linea alba width was significantly smaller in Group 2 (P = 0.00029) and Group 3 (P = 0.0018) compared with Group 1, even with exclusion of the acute incisional dehiscence and two herniated horses. Limitations were the small group size and relatively low incidence of incisional complications for statistical analysis. It was concluded that the use of small stitches and the UX-technique resulted in a smaller linea alba width compared with the conventional continuous suture technique and might therefore be preferred for closure of the linea alba in equine colic surgery.     

Surgical Removal of a Descending (Small) Colon Foreign Body through a Secondary Paramedian Approach

Intestinal obstruction due to foreign body ingestion is one cause of colic in horses. Although it occurs more frequently in juveniles, adult horses also may be affected. The small colon is a common location in which foreign bodies can be found. Depending on the location of the obstruction in the small colon, different techniques to dislodge the foreign body toward areas where it can be safely exteriorized and removed can be attempted. Alternatively, different approaches to the abdomen can be performed to facilitate exteriorization of the obstructed segment and removal of the foreign body. This paper describes a case of large and small colon obstruction in an adult horse caused by two distinct foreign bodies. The large colon obstruction was removed through a pelvic flexure enterotomy using the ventral midline approach, and the small colon obstruction was removed through a small colon enterotomy using a paramedian approach. Information regarding signalment, history, clinical signs, surgical treatment, and follow-up status of the horse are described.