Nonstrangulated colonic displacement in horses

Nonstrangulated colonic displacement was diagnosed by exploratory celiotomy in 32 horses with acute abdominal pain. Clinical signs progressed slowly and included evidence of mild to moderate abdominal pain, good cardiovascular status, reduced intestinal sounds, and normal peritoneal fluid, and resembled those of colonic impaction. In most horses, rectal palpation supported a diagnosis of colonic obstruction but not a diagnosis of colonic impaction.     

Caecal impactions: Diagnosis,management and prognosis

A caecal impaction can be caused by an accumulation of dry ingesta (type I) or abnormal caecal motility resulting in a feed impaction of fluid consistency (type II). Horses that develop a caecal impaction have often been administered a nonsteroidal anti-inflammatory drug (NSAID) during hospitalisation for treatment of a painful condition such as an ocular or orthopaedic disease. Clinical signs of caecal impaction can be mild, and progress to more moderate to severe signs of abdominal pain as the impaction enlarges. Since an impacted caecum has a high risk of rupture, early diagnosis and treatment are important. Horses with a caecal impaction can be treated medically or surgically, and treatment decisions are based on clinical signs, results of transrectal palpation, character of peritoneal fluid and response to medical management. For type I caecal impaction, medical management consists of aggressive fluid therapy, both intravenous and enteral, to soften ingesta. Fluid therapy can be combined with laxatives, motility-enhancing drugs and analgesic drugs. Surgery is indicated if results of transrectal abdominal examination indicate that the impaction is unchanged or has enlarged, signs of abdominal pain increase, or if there is cardiovascular deterioration. Horses with type II caecal impaction have a greater chance of survival if managed surgically. Using a ventral mid-line celiotomy approach, a caecal impaction can be resolved via a typhlotomy. When caecal motility is poor, or there are signs of chronic caecal dysfunction, a caecal bypass procedure (jejunocolostomy or ileocolostomy) should be considered. Although the prognosis for horses with a caecal impaction is claimed to be fair to good, choice of treatment is controversial and may influence prognosis. If the affected horse survives to discharge from the hospital, the long-term prognosis is generally good. Many retrospective studies of cases of caecal impaction are weakened by failure to distinguish between types I and II.     

Fecalith impaction in four miniature foals.

Four miniature foals admitted with signs of progressive nonresponsive abdominal pain and no fecal production had fecalith impaction of the small colon. Duration of clinical signs ranged from 10 hours to 5 days. Removal of the fecalith via small colon enterotomy was a successful treatment in all 4 cases. Miniature foals may be predisposed to fecalith impaction of the small colon. If a miniature foal has signs of progressive nonresponsive abdominal pain, fecalith impaction needs to be considered. Surgical correction may be required.     

Ileal impaction in the horse

Twelve cases of ileal impaction in the horse were reviewed. Clinical features of the disease included evidence of mild abdominal pain, reduced or absent intestinal sounds, rectally palpable distended small intestine, gastric reflux, and in the early stages, normal peritoneal fluid. Surgical correction of the impaction was accomplished in 10 horses. Of 8 horses discharged from the hospital, 7 returned to full function. It was concluded that the shorter the duration of colic before surgical intervention, the better the prognosis.     

Primary gastric impaction in horses: A retrospective study of 20 cases (2005–2008)

Primary gastric impaction is an uncommon condition. Furthermore, the factors associated with gastric impaction and the optimal method of treatment are not clear. The aim of this article is to describe the clinical findings, treatment and outcome of horses with a primary gastric impaction. Medical records of horses that presented with a primary gastric impaction between 2005 and 2008 were reviewed and 20 horses with a primary gastric impaction identified. Diagnosis of a primary gastric impaction was made if the horse had been fasted for a minimum of 16 h, a concretion of ingesta precluded visualisation of the margo plicatus and there was no evidence of concurrent intestinal pathology. Thirteen of 20 (65%) horses were presented on an emergency basis. The most common complaint was inappetence (50%) followed by acute colic (35%) and recurrent colic (35%). On initial examination for colic, all horses had a normal heart rate and 7 of 20 (35%) had decreased gastrointestinal borborygmi. All horses were treated with enteral fluid therapy. The median dose of fluids administered per day was 5 doses (range 1–8 doses) of 2–10 l of isotonic electrolyte solution. The median length of treatment until resolution was 2 days (range 1–5 days). Eighteen of 20 (90%) horses survived to discharge. Primary gastric impaction appears to be a condition with clinical signs of inappetence and mild abdominal discomfort. This is the largest group of horses reported that were treated with enteral fluid therapy for a gastric impaction and it was concluded that enteral fluid therapy was of value in this study.     

Ileal impaction in 245 horses: 1995-2007

The objective of this study was to identify parameters that would assist in determining the probability of a successful outcome with medical management versus surgical intervention in horses with ileal impaction. Medical records of 245 horses admitted for ileal impaction were reviewed and placed into 2 groups: medical (med) and surgical (sx) treatment. Persistence of abdominal pain, gastric reflux, frequency of analgesic administration, and 1-year survival were evaluated. There were no differences in signalment, abdominal pain, or heart rate among groups; however, significantly more sx horses had peritoneal fluid abnormalities (51%) and produced gastric reflux (62%) than did med horses (38% and 15%, respectively). Eighty-nine percent of med horses required repeated analgesic administration for successful resolution. One-year survival was 91% for sx horses and 92% for med horses. Horses with ileal impaction responsive to analgesic therapy with minimal gastric reflux are likely to be managed successfully with medical treatment. Horses with persistent abdominal pain and gastric reflux are candidates for surgery.     

Equine Colic: Seventy-six Cases Resulting from Incarceration of the Large Colon by the Suspensory Ligament of the Spleen

Incarceration of the large colon by the suspensory ligament of the spleen was diagnosed and surgically corrected on exploratory celiotomy in 76 horses exhibiting abdominal pain. The condition was diagnosed most frequently during the winter months in mature males of mean age 4.7 years. Clinical signs progressed slowly and included mild to moderate abdominal pain and distension with moderate tachycardia. The mean duration of colic prior to surgical intervention was 20.7 hours. The mild nature of the colic, the findings on palpation per rectum, and the continued passage of feces in 40% of horses, frequently led to the diagnosis and treatment of colonic impaction prior to admission. The condition was correctly diagnosed prior to exploratory celiotomy, by palpation per rectum, in only 18% of cases. Two types of displacement were identified. Sixty-six (86.8%) animals survived and were discharged from the hospital; the longterm survival rate was 78.9%.     

Gastrojejunostomy as a treatment for gastric outflow disorders in four adult horses

Four adult horses with histories of moderate abdominal pain and inappetence were diagnosed with delayed gastric emptying and gastric impaction attributed to pyloroduodenal obstruction (three cases) or duodenitis (one case). A stapled side-to-side gastrojejunostomy was performed on all horses. Two horses returned to work and survived ≥3 years. One horse was euthanased 6 months post-surgery due to recurrent abdominal pain, and one was found dead 5 months postsurgery after an unattended foaling.     

Successful outcome after surgical correction of large colon atresia in a colt foal

This report describes successful surgical correction and long-term survival of a case of large colon atresia in a 24-h-old Warmblood colt, referred with signs of unrelenting abdominal pain and a suspicion of meconium impaction. Radiographic and ultrasonographic examination was indicative of large colon meconium impaction with secondary ileus. Due to deterioration of the foal, surgery was recommended. An atretic segment was found between the left ventral and dorsal large (ascending) colon. A band of fibrous tissue with no identifiable lumen connected the segments. Surgical correction was done by performing a stapled side-to-side anastomosis. Twelve days after surgery, the foal was discharged. Twenty-two months after discharge, the owner reported the foal developing as expected compared with its peers, but had a mild, self-limiting episode of colic at 20 months of age.     

Sand impaction of the small intestine in eight dogs

Objective : To describe signalment, clinical findings, imaging and treatment of intestinal sand impaction in the dog. Methods : Medical records of dogs with radiographic evidence of small intestinal sand impaction were reviewed. Results : Sand impaction resulting in small intestinal obstruction was diagnosed in eight dogs. All dogs presented with signs of vomiting. Other clinical signs included anorexia, lethargy and abdominal pain. Radiographs confirmed the presence of radio-opaque material consistent with sand causing distension of the terminal small intestine in all dogs. Four dogs were treated surgically for their impaction and four dogs were managed medically. Seven of the eight dogs survived. Clinical Significance : Both medical and surgical management of intestinal sand impaction in the dog can be effective and both afford a good prognosis for recovery.     

Gastric ulceration in horses: 91 cases (1987-1990).

Gastroendoscopy was performed on 111 horses (1 to 22 years old) that had signs of abdominal discomfort of variable duration and severity. At least 1 episode of colic had been observed within 48 hours of examination in 31 horses. Recurrent episodes of colic were observed in 28 horses within 2 to 10 days of examination, 31 horses within 11 to 30 days, 12 horses within 31 to 60 days, and in 9 horses at more than 60 days after the initial examination. Gastric ulceration was found in 91 of 111 horses examined. Other abnormalities involving the gastrointestinal tract or other abdominal viscera were not found on examination in 57 of 91 horses with gastric ulcers. The most frequent concurrent abnormalities found in the remaining 34 horses with gastric ulcers were impaction of the large colon (n = 6), colonic tympany (n = 6), peritonitis (n = 6), gastric impaction (n = 4), ileocecal intussusception (n = 3), small-colon impaction (n = 4), and proximal enteritis (n = 2). Thirteen horses with gastric ulceration underwent abdominal surgery, and in 5 horses, lesions were not found at surgery. Gastric ulceration was determined to be the primary cause of colic in 31 horses on the basis of the lack of other abnormalities, clinical response to treatment with histamine type-2 receptor (H2) antagonists, and confirmation of improvement or resolution of gastric ulceration via endoscopy. Gastric ulceration was the suspected cause of colic in 26 other horses on the basis of the lack of other abnormalities, severity of lesions, and clinical response to treatment with H2 antagonists.(ABSTRACT TRUNCATED AT 250 WORDS)     

Jejunocolic Anastomosis for the Surgical Management of Recurrent Cecal Impaction in a Horse

A 5-year-old Thoroughbred gelding with recurrent cecal impaction refractory to medical management was treated with a side-to-side jejunocolic anastomosis. Cecal impaction did not recur after surgery. The horse gained weight and performed successfully for 14 months, but experienced three episodes of mild abdominal pain between 14 and 20 months after surgery. Mild cecal gas distention and firm ingesta in the colon were detected on rectal examination. The horse's feces remained soft after surgery, except during the colic episodes when dry, firm feces were passed.     

Surgical management of sand colic impactions in horses: a retrospective study of 41 cases

OBJECTIVE: A retrospective review of the medical records of 41 horses requiring abdominal surgery for sand colic. RESULTS: The diagnosis of sand colic was made when sand was found to be the cause of impaction of the gastrointestinal tract during surgical exploration. The most common clinical signs at presentation were abdominal pain, abdominal distension and diarrhoea. A statistically significant association was found between the respiratory rate on arrival and short-term survival. Sand impaction at multiple locations was detected in one-third of the horses. Concurrent pathology was detected in half of the horses. Four horses were euthanased during surgery; of those that recovered from surgery, 35/37 (95%) were discharged from hospital. Short- and long-term complications were similar to those previously reported. Long-term (1 year) survival of the horses discharged was 100%. CONCLUSION: The good prognosis for horses undergoing surgery for the treatment of sand impaction supports early surgical intervention in cases where large amounts of sand are suspected.     

Acute necrotising pancreatitis following grain overload in a donkey

A donkey developed abdominal discomfort and distension together with cardiovascular collapse and gastric reflux 24 to 36 hours after ingesting a large amount of poultry feed. Rectal findings prompted a laparotomy that identified extensive gastric dilation, an empty, atonic small intestine, dry colonic content and an easily corrected caecal displacement. These findings were not consistent with the severity of the signs, which were attributed to endotoxaemia. The donkey was euthanased during recovery. Necropsy revealed acute necrotising pancreatitis with massive gastric dilation and right dorsal colon impaction. The clinicopathological features of acute equine pancreatitis associated with grain overload are discussed.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Bovine fetal fluid collection: transvaginal, ultrasound-guided puncture technique

Poisoning with Senecio jacobaea (ragwort) is a common cause of chronic liver disease in horses in Britain. The major clinical signs are the result of hepatic failure but gastric impaction has recently been associated with the disease. The present paper describes three cases of secondary gastric impaction associated with ragwort poisoning. In each case the impaction was the cause of death or necessitated euthanasia.     

Mesenteric tears of the descending (small) colon as a postpartum complication in two mares.

Segmental ischemic necrosis of the descending colon associated with discrete tears of the mesocolon were diagnosed in 2 mares following foaling. After foaling, both mares had a slow onset of signs of abdominal pain and gradual deterioration of clinical status. Increases in peritoneal fluid total protein concentration and WBC count and a palpable impaction of the descending colon on examination per rectum were useful diagnostic aids. Surgical intervention was successful in one mare, but not in the other.     

Clinicopathological features of equine primary hepatic disease: a review of 50 cases.

The clinicopathological features of 50 cases of equine hepatic disease were reviewed. There was a wide range of clinical signs and at least 50 per cent of the animals exhibited either dull demeanour, anorexia, abdominal pain, cerebral dysfunction and/or weight loss. Life-threatening complications of hepatic failure recorded were: gastric impaction in 10 cases, bilateral laryngeal paralysis in seven cases and coagulopathy in five cases. All the cases had high activities of gamma-glutamyl transferase (GGT) and most had high activities of glutamate dehydrogenase (GLDH) and high concentrations of bile acids. Fewer of the horses had abnormal concentrations of bilirubin, albumin and globulin. The horses that were euthanased or died had significantly higher concentrations of GGT, GLDH and bile acids than the survivors. There were biochemical data for 18 cases with signs of hepatic encephalopathy, all of them had plasma ammonia levels greater than 90 micromol/litre but this was not significantly correlated with the clinical severity of the condition. Half of the cases with hepatic encephalopathy were hyperglycaemic, none was hypoglycaemic, and none had abnormally low levels of plasma urea.     

A case of a colocolic intussusception in a horse

The purpose of this report is to describe the clinical course and pathological findings in a horse admitted to the emergency service of the University of Georgia Large Animal Teaching Hospital for evaluation of colic, fever and diarrhoea of several days' duration. A presumptive historical diagnosis of colitis was made initially, but, due to the lack of faecal output during the first 12 h of hospitalisation and subsequent examination findings, an impaction of the ascending colon was suspected. Initial therapy consisted of rehydration with oral fluids and management of the abdominal pain with analgesic therapy. The horse did not respond to medical therapy and because of signs of persistent abdominal pain and financial constraints, the owner elected euthanasia after several days of supportive care. At necropsy, the horse was diagnosed with a colocolic intussusception.     

Comparison of medical and surgical treatment for impaction of the small colon in horses: 84 cases (1986-1996)

OBJECTIVE: To characterize clinical findings and compare effects of treatment and outcome for horses treated medically or surgically for impaction of the small colon. DESIGN: Retrospective study. ANIMALS: 84 horses with impaction of the small colon. PROCEDURE: Medical records were reviewed for history, physical examination findings, laboratory values, treatment, response to treatment, complications, out-come, and necropsy findings. RESULTS: 47 horses were treated medically and 37 horses were treated surgically. Significant differences between groups were not identified for duration of clinical signs, physical examination findings, or laboratory values. Horses treated surgically were hospitalized longer than horses treated medically. Complications recorded during hospitalization included diarrhea, jugular thrombophlebitis, recurrent colic, fever, and laminitis. Salmonella organisms were isolated from 20 horses. Horses treated surgically were more likely to have signs of moderate abdominal pain, gross abdominal distention, and positive results for culture of Salmonella spp than horses treated medically. Follow-up information was available for 27 horses treated medically and 23 horses treated surgically. Twenty-four (72%) and 21 (75%) of the horses, respectively, survived and were being used for their intended purpose at least 1 year after treatment. CLINICAL IMPLICATIONS: Colitis may be a predisposing factor for impaction of the small colon in horses. Prognosis for horses treated surgically or medically is fair.