Initial investigation of mortality rates and prognostic indicators in horses with colic in Israel: A retrospective study

Reasons for performing study: Initial assessment of the mortality rates and prognostic indicators in horses with colic presented to a referral hospital in Israel. Objectives: To determine mortality rates and to identify potential prognostic indicators in horses undergoing treatment for colic. Methods: The medical records of 208 colic cases were reviewed and mortality rates calculated including 95% confidence intervals. Mortality rates in surgical cases were calculated separately for strangulating and nonstrangulating lesions as well as for lesions of the large and small intestines. Potential prognostic indicators were identified and evaluated by Student's t test or X² test, where appropriate. Those found to be significant (P<0.05) were evaluated in 2 logistic regression models; one including all horses with colic and one for surgical cases only. Results: The overall mortality rate was 51/208 (25%); 5/72 (7%) in medically treated cases, 46/136 (34%) in surgical cases, 30/50 (60%) in strangulating lesions and 15/85 (18%) in nonstrangulating lesions, 17/27 (63%) in cases involving small intestinal lesions and 28/108 (26%) in cases with large intestinal lesions. Clinical parameters found to be significantly associated with death by univariate analysis were medical/surgical treatment, location of lesion, severity of lesion, mucous membrane colour (MM), capillary refill time (CRT) and heart rate. Using a multivariate logistic regression model, including all cases, medical/surgical treatment, CRT and MM were found to be prognostic indicators and when using the surgical cases alone, only CRT and lesion severity remained related to mortality. Conclusions: Mortality rates were similar or better than those previously reported in most cases, however, studies from the USA and the UK published better success rates for small intestinal surgeries. Cultural attitudes toward euthanasia may be associated with mortality rates. Potential relevance: These results assist clinicians in providing an immediate prognosis based on clinical findings at presentation and contribute to an international database that may aid future research in improving treatment of colic.     

Determination of lactate concentrations in blood plasma and peritoneal fluid in horses with colic by an Accusport analyzer

BACKGROUND: Intestinal hypoperfusion can lead to increased lactate concentrations in plasma and peritoneal fluid of horses with colic. HYPOTHESIS: The purposes of this study were to (1) evaluate the reliability of the Accusport analyzer to assess peritoneal fluid lactate (PFL) concentrations in healthy horses and those with colic, (2) identify clinical features associated with abnormal blood plasma lactate (BPL) and PFL concentrations, and (3) evaluate the prognostic value of BPL and PFL. ANIMALS: BPL and PFL were determined in 20 healthy horses and in 106 horses with colic. RESULTS: The Accusport was reliable for determining BPL concentrations < 13 mM and PFL concentrations < 20 mM. Multivariate analysis indicated that PCV and the need for intestinal resection were independently associated with the BPL; pulse, PCV, venous pO2, the presence of necrotic intestine, an increased amount of peritoneal fluid, and fluid total protein content were independently associated with PFL. With a 1 mM increase in BPL or PFL, the respective odds ratios for required abdominal surgery increase to 1.23 (BPL) and 1.58 (PFL), odds ratios for a required intestinal resection increase to 1.20 (BPL) and 1.41 (PFL), and odds ratios for developing ileus increase by 1.33 (BPL) and 1.36 (PFL). PFL concentrations of 1, 6, 12, and 16 mM correspond to a probability of death of 11, 29, 63, and 82%, respectively, in horses without strangulating obstruction and of 25, 52, 82, and 92%, respectively, in horses with strangulating obstruction. CONCLUSION: PFL is more useful and sensitive than BPL for prognostic purposes in horses with colic.     

The use of clinical findings in the identification of equine peritonitis cases that respond favorably to medical therapy

Objective: To compare clinical findings in horses/foals with peritonitis that: (1) had no concurrent (NCA) versus a concurrent abnormality found during hospitalization, (2) survived to discharge versus did not survive to discharge, and (3) survived to discharge without surgery versus did not survive to discharge without surgery. Design: Retrospective study. Setting: George D. Widener Hospital for Large Animals at New Bolton Center. Animals: Horses/foals admitted between 1992 and 2002 with a diagnosis of peritonitis. A diagnosis of peritonitis within 4 days of presentation and peritoneal fluid nucleated cell count >10,000/μL were required for study inclusion. Horses/foals were excluded if the peritonitis was secondary to gastrointestinal or reproductive tract perforation, a complication of exploratory celiotomy, or if peritonitis was not diagnosed until surgery or necropsy. Interventions: None. Measurements and main results: Information obtained from the medical records included clinical findings at presentation and during the initial 4 days of hospitalization. Outcome was defined as: (1) NCA (yes/no), (2) survived to discharge (yes/no), and (3) survived to discharge without surgery (yes/no). Forty‐two percent (23/55) of horses/foals had NCA; 78% (43/55) survived to discharge, and 68% (36/55) survived to discharge without surgery. Horses/foals with peritonitis that had any one of the following clinical findings were likely to survive to discharge without surgery: no signs of abdominal pain, normal/improved rectal temperature, normal/improved intestinal borborygmi, normal fecal production, no abnormal findings on abdominal palpation per rectum, no nasogastric reflux, or yellow/orange peritoneal fluid. Conclusion: Clinical findings can be used to identify equine peritonitis cases that will respond favorably to medical therapy.     

Peritoneal concentrations of transforming growth factor beta in horses with colic

Reasons for performing the study: In man, peritoneal transforming growth factor beta (TGF‐β) is associated with peritoneal diseases and subsequent adhesion formation. No studies on plasma and peritoneal TGF‐β concentrations in horses with colic are available. Objectives: 1) To determine both plasma and peritoneal TGF‐β₁ and TGF‐β₃ concentrations in horses with different types of colic (not previously subjected to abdominal surgery); 2) to compare these concentrations according to the type of peritoneal fluid (transudate, modified transudate and exudate); and 3) to compare and correlate plasma and peritoneal concentrations of TGF‐β₁ and TGF‐β₃ and the types of peritoneal fluid according to the colic group and outcome. Methods: Peritoneal fluid and plasma samples from 78 horses with colic and 8 healthy horses were obtained. Patients were classified according to diagnosis (obstructions, enteritis, ischaemic disorders and peritonitis), peritoneal fluid analysis (transudate, modified transudate and exudate), and outcome (survivors and nonsurvivors). Plasma and peritoneal TGF‐β₁ and TGF‐β₃ concentrations were determined by ELISA. Data were analysed by parametric and nonparametric tests. P≤0.05 was considered as statistically significant. Results: Concentrations of peritoneal fluid TGF‐β₁ were significantly (P = 0.01) higher in horses with peritonitis in comparison with all other colic groups and controls. Horses with ischaemic lesions had significantly (P = 0.01) higher concentrations of peritoneal TGF‐β₁ in comparison with controls and the group of horses with obstructions. Peritoneal TGF‐β₁ concentration also was significantly (P = 0.01) higher in exudates in comparison with transudates. Peritoneal TGF‐β₁ and TGF‐β₃ concentrations and plasma TGF‐β₁ concentration were significantly increased in nonsurvivors compared to survivors (P = 0.001, P = 0.004 and P = 0.05, respectively). Conclusions: Peritoneal TGF‐β₁ concentration was higher in horses with severe gastrointestinal diseases (ischaemic intestinal lesions and peritonitis), in horses with an altered peritoneal fluid (exudate), and in nonsurvivors. Potential relevance: Peritoneal TGF‐β concentration increases in horses with severe gastrointestinal disease as an anti‐inflammatory response.     

Risk factors for methicillin-resistant Staphylococcus aureus colonization in horses admitted to a veterinary teaching hospital

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging problem in horses; however, the epidemiology of infection and colonization is poorly understood. This study evaluated factors associated with MRSA colonization at the time of admission to a veterinary teaching hospital. A case-control study evaluating historical factors was performed. Previous colonization of the horse, previous identification of colonized horses on the farm, antimicrobial administration within 30 days, admission to the neonatal intensive care unit, and admission to a service other than the surgical service were risk factors for community-associated colonization. A better understanding of risk factors for MRSA colonization is important to elucidate the epidemiology of this emerging veterinary and zoonotic pathogen, and to design evidence-based infection control programs.     

Equine duodenal motility,assessed by ultrasonography,as a predictor of reflux and survival following colic surgery

Intestinal dysmotility following equine colic surgery contributes negatively to financial and prognostic outcomes. This study assessed duodenal contractility as a predictor of post-operative reflux and survival to discharge in horses following colic surgery. Duodenal contractility was assessed using daily transabdominal ultrasound examinations in 49 horses for up to 7 days (Day 1 scan performed between 6 and 36 h post-surgery and sequential daily scans performed between 08.00 and 20.00 h) following colic surgery (September 2014–April 2017). The duodenum was visualised ventral to the right kidney, and duodenal contractions were measured over 2 min. The signalment of each horse and surgical findings were noted. Outcomes were defined as horses that refluxed (>5 L/24 h beyond 24 h) or did not reflux post-operatively and those that were survivors or were nonsurvivors. A significant difference in duodenal contractions at Day 1 post-operatively was identified between horses that refluxed (n = 8) and those who did not reflux (n = 32; P = 0.013) but not between those who were nonsurvivors (n = 7) and survivors (n = 32; P = 0.113). Horses in the reflux group had reduced duodenal contractility comparatively. There were no significant differences in duodenal contractions in the sequential days after the Day 1 scan or between duodenal contractions and surgical findings. A significant association was identified between duodenal contractions and survivors (P = 0.039; odds ratio 1.88). The main study limitations were the single centre design with consequent small numbers of horses included. The study did not account for other factors that may contribute to alterations in motility such as drug administration or stages of re-feeding. This preliminary study indicates that Day 1 (6–36 h post-operatively) duodenal contractions may predict reflux (>5 L/24 h beyond 24 h) and that increased duodenal contractions are associated with survival. However, there was no clear distinction or cut-off between groups. Future studies with greater numbers of horses yielding better statistical power are required.     

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.     

A giant nonstrangulating mesenteric lipoma as a cause of recurrent colic in a horse

Colic is a major cause of veterinary attendance in general practice and although most colic episodes remain isolated, recurrence may occur and definitive diagnosis can be difficult to obtain. This report describes an unusual presentation of a lipoma in a middle‐aged horse presented for recurrent colic. A massive lipoma causing a nonstrangulating space occupying obstruction of the small intestine was found during an exploratory celiotomy and was considered to be the most likely cause of the recurrent episodes of abdominal discomfort.     

Evaluation of peritoneal fluid lactate as a marker of intestinal ischaemia in equine colic

REASONS FOR PERFORMING STUDY: The most common cause of death as a direct result of colic is acute circulatory failure secondary to intestinal ischaemia. Early and accurate recognition of ischaemic bowel is essential to decrease complications and increase survival. Blood to peritoneal lactate values have been evaluated as a prognostic indicator, but lactate values characterised by type of lesion have not been reported. HYPOTHESIS: Plasma and peritoneal lactate values are higher in horses with intestinal ischaemia secondary to a strangulating obstruction (ISSO). METHODS: Venous blood and peritoneal fluid were collected sequentially from 20 clinically healthy horses and 189 horses admitted for colic during a one-year period. Blood gas, pH, electrolyte (K+, Na+, Ca++, Cl-), glucose and lactate values were determined for blood and peritoneal fluid samples; other values recorded for peritoneal fluid included gross appearance, total protein and nucleated cell count. Information regarding diagnosis, treatment and outcome was retrieved from the medical records. RESULTS: Peritoneal and plasma levels of lactate were lower in control compared to clinical cases. Horses with ISSO had a higher peritoneal lactate value (8.45 mmol/l) than those with nonstrangulating obstruction (2.09 mmo/l). Factors with the strongest correlations with the presence of ISSO were changes in the gross appearance of the peritoneal fluid and values of peritoneal fluid chloride, pH and log10 lactate. CONCLUSIONS: Analysis of peritoneal fluid gross appearance, pH, lactate and chloride can be used for diagnosis of ISSO. POTENTIAL RELEVANCE: Peritoneal fluid lactate is a better predictor of ISSO than blood lactate and may aid in early detection of catastrophic peritoneal lesions such as intestinal strangulation and rupture.     

Evaluation of a PCR to detect Salmonella in fecal samples of horses admitted to a veterinary teaching hospital.

The diagnostic accuracy of a PCR used to identify horses shedding Salmonella spp. in their feces during hospitalization was estimated, relative to bacterial culture of serially collected fecal samples, using longitudinal data. Five or more fecal samples were collected from each of 116 horses admitted as inpatients, for reasons other than gastrointestinal disease, between July 26, 2001 and October 25, 2002. All 873 fecal samples collected were tested with a PCR based on oligonucleotide primers defining a highly conserved segment of the histidine transport operon gene of Salmonella typhimurium, and each sample was cultured for Salmonella spp. One or more samples from 87 (75%) horses were PCR positive, and Salmonella was cultured from 1 or more samples from 11 (9.5%) horses. All culture-positive horses had at least 1 PCR-positive result, whereas only 29 (28%) culture-negative horses were PCR negative on all fecal samples tested. The PCR was most specific, relative to bacterial culture of serially collected fecal samples, when used to test samples from Quarterhorse or breeds other than Thoroughbred or Standardbred, or from clinical (vs. healthy, accompanying horses) cases. Overall, the PCR had the greatest agreement (70%), compared with bacterial culture of serially collected fecal samples, using a cutoff of 2 or more positive PCR test results to define a Salmonella-positive horse. The reasons why some fecal samples, from which Salmonella organisms cannot be isolated, are PCR positive need to be determined before the PCR can be incorporated into Salmonella surveillance programs for hospitalized equine populations.     

Sparing the gut: COX-2 inhibitors herald a new era for treatment of horses with surgical colic

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage a wide variety of conditions in horses, including management of colic. Flunixin meglumine is by far the most commonly used drug in the control of colic pain and inflammation and has become a go-to for not only veterinarians but also horse-owners and nonmedical equine professionals. NSAID use, however, has always been controversial in critical cases due to a high risk of adverse effects associated with their potent cyclo-oxygenase (COX) inhibition. There are two important COX isoenzymes: COX-1 is generally beneficial for normal renal and gastrointestinal functions and COX-2 is associated with the pain and inflammation of disease. Newer selective NSAIDs can target COX-2-driven pathology while sparing important COX-1-driven physiology, which is of critical importance in horses with severe gastrointestinal disease. Emerging research suggests that firocoxib, a COX-2-selective NSAID labelled for use in horses, may be preferable for use in colic cases in spite of the decades-long dogma that flunixin saves lives.     

Rupture of the mesocolon as a cause of recurrent colic in a showjumper mare

An 11‐year‐old Italian Saddlebred showjumper mare was referred for investigation of recurrent colic. The mare had undergone surgery for left dorsal displacement of the ascending colon 5 years previously and had subsequently experienced several episodes of colic that had responded to medical treatment. Due to deterioration of the mare's clinical condition in the last episode, characterised by unrelenting pain and worsening of the cardiovascular parameters, the mare underwent repeat surgery for suspected colonic displacement. Exploratory laparotomy revealed a complete rupture of the mesocolon of the ascending colon. The mesocolon was repaired and the mare recovered uneventfully. She returned to training and competition and only a single episode of mild transient colic was recorded in the follow‐up.     

Clinical comparison between a continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one-layer jejunojejunostomy in horses

Reasons for performing study: Although experimental studies have demonstrated differences in performance between methods for handsewn jejunojejunostomy in horses, information on clinical results after different methods of anastomosis are rare. Hypothesis: A continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane would perform better than an interrupted Lembert pattern for jejunojejunostomy in horses. Methods: Data was reviewed on 32 horses that underwent jejunojejunostomy from 1993–2002. Kaplan‐Meier analyses and rates for post operative colic and death were used to compare outcomes after an interrupted Lembert pattern (15 horses with strangulating lesions and 5 horses with nonstrangulating lesions) and a continuous Lembert pattern with membrane (12 horses with strangulating diseases). Results: None of the 32 horses had post operative ileus or post operative endotoxaemia. One horse with a continuous pattern required a repeat celiotomy for anastomotic impaction. Short‐term survivals for the interrupted Lembert were 100% (nonstrangulating lesions) and 93% (strangulating lesions) and for the continuous pattern 92% (all strangulating). Long‐term rates for mortality and colic episodes were less for the continuous Lembert pattern with membrane compared with the interrupted Lembert for strangulating lesions (P<0.05) and were less for strangulating lesions than for nonstrangulating lesions (P<0.05). For strangulating lesions, Kaplan‐Meier analyses yielded a survival probability of 70% for up to 9 years after the interrupted Lembert pattern and 80% for up to 5 years for the continuous Lembert pattern. Conclusions and relevance: Both Lembert patterns performed well in clinical use, although the continuous pattern with the carboxymethylcellulose and hyaluronate membrane had superior long‐term outcomes with less colic and mortality from colic.     

Effect of detomidine or romifidine constant rate infusion on plasma lactate concentration and inhalant requirements during isoflurane anaesthesia in horses

Objective

Influence of detomidine or romifidine constant rate infusion (CRI) on plasma lactate concentration and isoflurane requirements in horses undergoing elective surgery.