Models for estimating digesta passage kinetics in the gastrointestinal tract of the horse

Fecal samples were collected to evaluate mathematical models to describe the kinetics of digesta passage in the segments of the equine gastrointestinal tract and to compare the passage kinetics of hay and oats. Four Norwegian Cold-blooded trotters (cecally cannulated, approximately 500 kg of BW) were fed Cr-mordanted hay and Yb-marked oats with their morning meal. The meal consisted of 2 kg of hay and 1 kg of oats processed as ground, pelleted, extruded, or micronized. Each horse was fed each type of oats on different days of collection, after a 5-d adaptation period, in a 4 x 4 Latin square design. Fecal samples were collected 5, 6, 7, 8, 9, 10, 11, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 48, and 52 h after administration of the marker dose. The samples were analyzed for Cr and Yb, and values were plotted using 1- and 2-compartment nonlinear passage models and an algebraic model. The 1-compartment G4 model and the 2-compartment G4G1 model showed an equally good fit to the observed excretion curves, based on low mean square error and SE. The excretion curves for hay (Cr) and oats (Yb) showed a striking similarity, and there seemed to be no difference in retention time between hay and oats in the horse. The mixing compartments in the horse are believed to be the cecum or both the cecum and the right ventral and dorsal segments of the colon, but further research in this area is needed to make a final conclusion.     

Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses

OBJECTIVES: To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses. STUDY DESIGN: Retrospective study. ANIMALS: Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy. METHODS: Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern. RESULTS: The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function. CLINICAL RELEVANCE: Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.     

Cecocolic Anastomosis for the Surgical Management of Cecal Impaction in Horses

Fourteen horses with cecal impaction were treated by cecocolic anastomosis. In nine horses, the anastomosis followed enterotomy and evacuation of the cecal contents, and in two horses it followed saline infusion and massage of the cecum. In three horses, the anastomosis was the only surgical procedure performed. Cecocolic anastomosis was performed between the lateral and dorsal cecal teniae, and the lateral and medial free teniae of the right ventral colon. The anastomosis was hand sutured in five horses. In all other horses, the GIA surgical stapling instrument was used in combination with hand sutured seromuscular layer closures and became the preferred surgical technique. The anastomosis allowed an alternative route for the transit of ingesta from the cecum to the right ventral colon.
Twelve of the 14 horses survived 2 months or longer after surgery (short-term survival rate, 86%) and 10 horses survived 12 months or longer after surgery (long-term survival rate, 71%). Early postoperative complications included mild abdominal pain (6 horses), wound infections (3 horses), fatal peritonitis (2 horses), and large colon distention necessitating reoperation (2 horses).     

Alteration in intestinal morphologic features associated with extensive large-colon resection in horses

Light microscopy, morphometry, and scanning electron microscopy were used to examine the mucosal morphologic features of 7 intestinal specimens (3 from the small intestine; 4 from the large intestine) from each of 8 horses 1 year after sham operation (group 1; n = 3) or extensive large-colon resection (group 2; n = 5). Qualitative light microscopic examination did not reveal differences between groups, but morphometry revealed significantly (P less than 0.05) greater intercrypt area and distance in horses with colon resection and this was most pronounced in the cecum and remaining right ventral and dorsal colon. Crypt area and depth were similar for horses with colon resection and sham operation (P greater than 0.05). Qualitative evaluation of the scanning electron micrographs revealed more prominent crypt orifices in the large intestine of horses with colon resection. The larger intercrypt distance in the colon of horses with resection was not an obvious feature of the qualitative evaluation of the surface with scanning electron microscopy. Small intestinal morphologic features were variable and significant differences were not detected between horses with sham operation and colon resection. Horses adapted to extensive large-colon resection within 1 year by increasing the absorptive (intercrypt) surface area of the remaining large intestine.     

Resection and Anastomosis of the Descending Colon in 43 Horses

Objectives: To determine (1) the short‐ (to hospital discharge) and long‐ (>6 months) term survival, (2) factors associated with short‐term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Study Design: Multicentered case series. Animals: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995–June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short‐term survival (hospital discharge). Long‐term survival was defined as survival ≥6 months after hospital discharge. Results: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty‐eight of 30 horses with follow‐up information survived ≥6 months. No significant associations between perioperative factors and short‐term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). Conclusions: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival ≥6 months. The most common cause of small colon incarceration was strangulating lipoma. Clinical Relevance: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.     

Digestion, fecal, and blood variables associated with extensive large colon resection in the horse

Nutritional alterations were evaluated in 9 horses before surgery and 3 weeks, 3 months, and 6 months (4 total trials) after sham operation (group 1; n = 3) or extensive large colon resection (group 2; n = 6). Feed and fecal analyses were performed to determine apparent digestion of dry matter, organic matter, crude protein, calcium, phosphorus, magnesium, potassium, manganese, zinc, copper, and iron, and true digestion of dry matter, organic matter, crude protein, total plant cell wall, hemicellulose, cellulose, and lignin. Additional fecal and metabolic variables included the percentage of fecal water (water in the feces), total fecal water, metabolic organic matter, metabolic crude protein, and metabolic nitrogen. A CBC and standard series of biochemical tests were performed. Large colon resection decreased (P less than 0.05) the true digestion of dietary crude protein and cellulose and apparent digestion of phosphorus, and it increased the fecal metabolic matter and water loss. Total fecal output increased 45% and total fecal water increased 55%. Phosphorus digestion was decreased (P less than 0.05) in group-2 horses, but effects of this were not detected on analysis of blood variables or on physical examination. Nevertheless, after extensive large colon resection, horses can regain body weight lost after surgery and have no overt physical changes when fed an alfalfa pellet diet that meets greater-than-maintenance requirements. Ad libitum water access is suggested, because these horses may have to consume 2 gal/day more than would normal horses.     

Mean retention time of digesta in the different segments of the equine hindgut

Six Thoroughbred horses were used to determine the mean retention time (MRT) of digesta in the different segments of the hindgut. The horses were fed timothy hay or silage in equal amounts (1.6% bodyweight [BW]/day) every 3 h/day. Hay or silage labeled with the rare earth elements cerium, dysprosium, neodymium, ytterbium, lanthanum, samarium and praseodymium, were fed to the horses 36, 30, 24, 18, 12, 6 and 3 h before slaughter, respectively. Just after slaughter, digesta samples in the different segments were collected and determined for the contents of the rare earth elements. Using these data, a method to calculate the MRT in the different segments was proposed. There were no significant differences between diets in the MRT of each segment. The averaged MRT of hay and silage in the cecum, right ventral colon, left ventral colon, left dorsal colon, right dorsal colon and small colon was 2.9, 3.1, 5.9, 1.0, 4.0, and 4.0 h, respectively. The dry matter weight of the digesta was related to the MRT in the right ventral colon (r = 0.94, P = 0.005), left ventral colon (r = 0.87, P = 0.03), left dorsal colon (r = 0.98, P < 0.001) and right dorsal colon (r = 0.95, P = 0.004), but it was not related to the MRT in the cecum and small colon.     

Experimental Large Colon Resection at the Cecocolic Ligament in the Horse

Ten normal horses had approximately 95% of the length of the large colon resected with a side-to-side anastomosis between right ventral and right dorsal colon performed with surgical stapling equipment. Four horses died shortly after surgery of colitis (1 horse) or failure of the TA 90 transection staple line (3 horses). Another horse died 4 months after surgery from disseminated streptococcal infection but had recovered well from the colon resection. Five horses survived long term (18 months) with no clinical evidence of adverse effects of the resection. Surviving horses had weight loss and soft fecal consistency for 3 to 12 weeks after surgery but returned to preoperative values within 12 months. At a second surgery 1 year later (5 horses) or at necropsy 4 months later (1 horse), fibrous omental adhesions were present over the transection staple line in four horses and over the anastomotic staple line in two horses. Omental adhesions to the everted staple line were moderate but not associated with any clinical sequellae. An incisional hernia was present in one horse. The anastomotic stomata measured between 8 and 9 cm, which was 60% of the size of the original surgically created stomata. Failure of the transection staple line occurred in the first three of five horses in which the procedure was attempted due to improper configuration of the staples or crushing of the tissue between the staples. Experience corrected this complication.     

Fiber digestion and voluntary intake in horses after adaptation to extensive large-colon resection

Each of 3 digestion trials (3 forage diets) was performed on 2 groups of horses 6 to 12 months after sham operation (group 1; n = 3) or large-colon resection (group 2; n = 5). Diets were alfalfa pellets, alfalfa hay, and grass hay. Feed and fecal analyses were performed to determine apparent digestion of dry matter, organic matter, and crude protein and true digestion of dry matter, organic matter, crude protein, total plant cell wall, hemicellulose, cellulose, and lignin. Additional fecal and metabolic variables determined were percentage of fecal water, total fecal water, metabolic organic matter, metabolic crude protein, and metabolic nitrogen. Large-colon resection decreased the digestion of plant cell wall because of decreased digestion of cellulose in alfalfa pellet and grass hay diets, but not in alfalfa hay diet. Insufficient digestible energy and/or protein from grass hay was obtained by horses with colon resection, and significant (P less than 0.05) weight loss was observed. Voluntary intake was significantly (P less than 0.05) increased by horses with colon resection. Of the diets studied, alfalfa hay was the most appropriate forage diet, compared with average grass hay and alfalfa pellet diet, for horses after extensive large-colon resection. Additionally, horses with colon resection may have higher levels of feed intake than do horses without colon resection.     

Strangulated umbilical hernias in horses: 13 cases (1974-1985)

The medical records of 13 horses with strangulated umbilical hernias were reviewed. Typical history included increased swelling, warmth, and firmness of the hernial sac. Enterocutaneous fistulas had developed in 2 horses. Four horses had signs of abdominal pain. Surgery was performed on all horses, and the hernia was reduced by an open reduction technique. Incarcerated tissue included omentum (1 horse), jejunum (5), ileum (4), cecum (1), and ventral colon (2). All horses survived and were discharged from the hospital. Follow-up information on 9 horses (5 to 52 months after discharge) revealed no complications in 6 horses. Of the remaining 3 horses, one horse was euthanatized 5 months after discharge because of laminitis. One horse had persistent drainage from the skin incision requiring removal of nonabsorbable suture material 8 months after discharge. One foal required a second surgery because of signs of abdominal pain 17 days after the initial surgery. The foal was euthanatized during surgery because of severe peritonitis secondary to anastomotic leakage.     

Digestion in horses after resection or ischemic insult of the large colon

The effect of 60% resection of the large colon vs ischemic insult without resection on the ability of horses to digest grass hay was investigated. Digestion trials were performed on 9 horses before surgery (base line) and 3 weeks, 6 weeks, and 6 months after surgery. The percentage of apparent digestion of crude protein, crude fiber, nitrogen-free extract, calcium, phosphorus, magnesium, manganese, copper, and zinc was calculated. Horses that had resection (n = 5) had decreased apparent digestion of crude protein, crude fiber, and phosphorus 3 weeks after surgery, compared with those in horses with ischemic insults (n = 4) and with base-line values. Horses with ischemic insults also had a decrease in crude protein digestion 3 weeks after surgery, compared with base-line values. All horses returned to base-line values of digestion at the 6-month trials, although horses that had resection had higher fecal concentrations of phosphorus and nitrogen-free extract than did horses with ischemic insult. During the study, all horses had maintained good body condition.     

Extension large colon resection in 12 horses

Extensive resection (50-75%) of the large colon was performed in 12 horses. Indications for resection were: loss of viability due to large colon volvulus (seven), thromboembolic episode (three), impairment of flow of ingesta due to adhesions (one), or congenital abnormalities (one). The time required to correct the primary cause of abdominal pain and complete the resection ranged from 2.5 to 4.75 hours. Three horses had severe musculoskeletal problems postoperatively and were euthanized in the recovery stall. Four other horses were euthanized early in the postoperative period because of: further large colon infarction (two), ileus (one), or small intestinal problems (one). Five horses survived with no apparent nutritional or metabolic problems during two to three weeks of hospitalization. Clinical data were obtained from these horses from nine months to eighteen months postoperatively and revealed no clinical or clinicopathological abnormalities in four of them; the fifth horse exhibited diarrhea and weight loss four months postoperatively but responded to diet change.     

A Pilot Study Exploring the Relationship Between Digesta Retention Time in the Equine Gastrointestinal Tract and Compartment Models

Digesta retention time within specific segments of the equine gastrointestinal tract (GIT) may be more relevant to scientific inquiries than total tract mean retention time (TTMRT); however, measuring retention time in individual segments requires access to the digestive tract. The objective of this study was to compare prececal, cecal, and colonic mean retention time (MRT) with model-derived compartment MRT. A cecally fistulated gelding was fed indigestible particulate and liquid markers to determine TTMRT and dosed with different pairs of particulate and liquid markers into the cecum (hindgut MRT) and into the right ventral colon through the cecocolic orifice (colon MRT). Fecal marker concentrations were fit to stochastic and mechanistic models using nonlinear least squares methods (MATLAB). Total tract MRT and MRT for each GIT segment were compared with model-derived compartment MRT using paired t-test to determine differences and two one-sided tests to determine equivalence. All models resulted in parameter estimates and an acceptable fit to fecal marker excretion curves, but some parameter estimates did not differ from zero (95% CI included 0). Model-derived TTMRT were equivalent (P < .05) to arithmetically calculated MRT. Most GIT segment MRT differed (P < .05) from model-derived compartment MRT. Differences ranged from −26.1 hours to 25.8 hours. In these exploratory data, model derived compartment retention times failed to pair with MRT in different GIT segments. Significant methodological and analytical challenges remain to describe retention time in individual segments of the equine GIT.     

Cecal perforation in the horse

The case records of 23 horses with cecal perforation (CP) were reviewed. The horses averaged 4.5 years of age (6 weeks to 13 years) and included 9 intact males, 12 mares, and 2 geldings. Twelve of the horses were Standardbreds, 9 were Thoroughbreds, and 1 each, a Belgian and Morgan. The horses were allotted to 2 groups: group I-13 hospitalized horses in which CP occurred unexpectedly, and group II-10 horses with CP at the time of admission. The horses characteristically had been sick or affected with disease unrelated to the cecum. Sixteen horses had been given nonsteroidal anti-inflammatory drugs before the onset of CP. Twelve of the 13 hospitalized patients (group I) had vague, scarcely recognizable clinical signs of gastrointestinal disease before CP. The clinical signs and clinical laboratory changes that appeared in affected horses were identifiable with severe endotoxin shock, secondary to peritoneal contamination with ingesta and bacteria. All horses died. At necropsy of the horses, the cecum was large and firm and was filled with ingesta, and the colon was empty; however, in 1 postpartum mare, the cecum and colon contained the usual amount of ingesta and were normal in size. In all horses, a single perforation was present, which appeared at various sites. The most common was a transverse perforation along the ventral aspect of the cecal body. Gross and microscopic examinations uncovered no existing disease near the perforation site or in other areas of the cecal wall or cecocolic orifice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Survival rates for horses undergoing stapled small intestinal anastomosis: 84 cases (1988-1997)

OBJECTIVE: To determine whether location and type of small intestinal anastomosis and other variables were associated with short- and long-term survival rates in horses undergoing stapled small intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 84 horses that underwent small intestinal anastomosis. PROCEDURE: Medical records from 1988 to 1997 were examined for horses that underwent stapled small intestinal anastomosis. Horses were allotted into 4 groups: jejunojejunostomy (n = 27), jejunoileostomy (11), jejunoileocecostomy with small intestinal resection (20), and jejunoileocecostomy without small intestinal resection (26). Survival rates and other variables were determined. RESULTS: Horses that underwent jejunoileocecostomy without resection had a significantly higher survival rate at all intervals than did horses in the other 3 groups. At 180 and 365 days after surgery, horses that underwent jejunojejunostomy had a significantly lower survival rate than those that underwent jejunoileocecostomy with intestinal resection. Horses that underwent jejunoileocecostomy with intestinal resection had a significantly higher survival rate at 1 year, compared with the combined jejunojejunostomy and jejunoileostomy groups. Preoperative heart rate was inversely associated with survival rate. Overall survival rates at discharge and 1 year were 81 and 56%, respectively. For horses that underwent small intestinal resection, survival rates at discharge and 1 year were 65 and 47%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that underwent anastomosis of the small intestine to the cecum without resection had the highest survival rate, compared with horses that required intestinal resection. In some instances, resection and anastomosis involving the cecum had better prognosis than resections involving 2 segments of the small intestine.     

Protein quality and utilization of timothy, oat-supplemented timothy, and alfalfa at differing harvest maturities in exercised Arabian horses

To evaluate the protein quality and postgut N utilization of full-bloom timothy hay, oat-supplemented timothy-hay diets, and alfalfa hay harvested at different maturities, apparent whole tract N digestibility, urinary N excretion, and serum AA profiles were determined in light to moderately exercised Arabian horses. Six Arabian geldings (16.0 ± 0.3 yr; 467 ± 11 kg of BW) were randomly allocated to a 6 × 6 Latin square design. Diets included full-bloom timothy grass hay (G), G + 0.2% BW oat (G1), G + 0.4% BW oat (G2), mid-bloom alfalfa (A1), early-bloom alfalfa (A2), and early-bud alfalfa hay (A3). Forages were fed at 1.6% of the BW of the horse (as-fed). Each period consisted of an 11-d adaptation period followed by total collection of feces and urine for 3 d. Blood samples were taken on d 11 for analysis of serum AA concentrations. During the 3-d collection period, urine and feces were collected every 8 h and measured and weighed, respectively. Approximately 10% of the total urine volume and fecal weight per period was retained for N analyses. Fecal DM output was less (P < 0.05) in A1, A2, or A3 compared with G, G1, or G2. Apparent whole tract N digestibility was greater (P < 0.01) in A1, A2, and A3 compared with G, G1, or G2, and was greater (P < 0.05) in G1 and G2 compared with G. Nitrogen retention was not different from zero, and there were no differences (P > 0.05) in N retention among diets. Urinary N excretion and total N excretion were greater (P < 0.05) in A1, A2, and A3 compared with G, G1, or G2. Plasma concentrations for the majority of AA increased curvilinearly in response to feeding G, A1, A2, and A3 (quadratic, P < 0.05), with values appearing to maximize 2-h postfeeding. Although alfalfa N digestibility increased with decreasing harvest maturity, N retention did not differ and urinary volume and N excretion increased, indicating that postabsorptive N utilization decreased. In contrast, inclusion of oats at either 0.2 or 0.4% of the BW of the horse to timothy hay markedly enhanced N digestibility without increasing N excretion, indicating improvement in postgut N utilization. These findings indicate that feeding oat-supplemented timothy hay is more environmentally sustainable than feeding alfalfa to the horse at maintenance or under light to moderate exercise.     

Identification of normal parameters for ultrasonographic examination of the equine large colon and cecum

Six healthy horses were examined by using transabdominal ultrasonography, as described (1-3), to evaluate activity and size of the large colon and cecum at various locations. Using size and number of sacculations, activity patterns and contractile frequency; significant differences that would allow ultrasonographic identification of dorsal versus ventral colons, if they were displaced, were not found. The cecum had significantly greater activity than the colon, and a trend was seen towards smaller sacculations in the cecum than in the large colon.     

Surgical diseases of the equine cecum

Cecal impaction and cecal perforation, the two most common equine cecal diseases, are thought to develop after slowing or interruption of a single progressive motility pattern, which begins in a pacemaker area near the apex, occurs once every 3 minutes, and propels ingesta from the cecum to the right ventral colon. Rectal examination in horses with cecal impaction is the most useful technique to grade the severity of the condition. Medical treatment is undertaken if the impaction is judged to be mild to moderate. Surgical correction of cecal impaction in severe cases requires a ventral midline celiotomy, and exploration reveals a large ingesta-filled cecum and relatively empty large colon. Currently, the techniques of typhlotomy with manual evacuation of ingesta, combined with a complete bypass of the cecum by use of a jejunocolostomy, is the preferred method of surgical management. The use of a cecocolic anastomosis remains a viable alternative surgical procedure. Cecal perforation (CP), a uniformly fatal disease of horses, most often develops when the subtle signs of cecal impaction are missed or are masked by the administration of nonsteroidal antiinflammatory agents. CP can occur in mares around the time of foaling and, in this form, is not associated with cecal outflow dysfunction. Surgical management of cecocecal or cecocolic intussusception is required and involves resection of the diseased portion of cecum, either with extra- or intraluminal techniques. Both the side-to-side and end-to-side jejunocecal anastomoses are useful and successful techniques for bypass of simple or strangulating lesions of the ileum.     

Use of multichannel electrointestinography for noninvasive assessment of myoelectrical activity in the cecum and large colon of horses

OBJECTIVE: To evaluate whether changes in myoelectrical activity in the cecum and large colon of horses can be detected via multichannel electrointestinography (EIG). ANIMALS: 6 healthy mature horses. PROCEDURES: Each horse underwent 3 EIG procedures. Intestinal myoelectrical activity (cecum and large colon) was recorded during a 20-minute period following i.v. administration of physiologic saline (0.9% NaCl) solution (20 mL; baseline), erythromycin lactobionate (0.5 mg/kg), or detomidine (0.015 mg/kg); intestinal contractions were concurrently viewed via B-mode ultrasonography. By use of computer software, 8-channel EIG recordings were analyzed and the mean of the dominant frequency (a measure of the rhythmicity of gastric electrical activity) expressed in cycles per minute (cpm) was obtained. Total power (muV(2)) was calculated, and treatment effect was expressed as the power ratio (ie, treatment-associated power divided by the baseline power). RESULTS: The dominant frequency cpm values were not stable, and no significant differences between treatments were detected. Compared with the effects of saline solution treatment, detomidine significantly reduced the mean cecal and colonic power ratios. Erythromycin significantly reduced the cecal power ratio and increased the colonic power ratio, although the increase was significant in only 1 channel. Ultrasonographic findings and total power (predominantly from the long-distance electrode pairs) were significantly correlated. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, EIG was useful for assessment of changes in myoelectrical activity in the cecum and large colon. Multiple electrodes should be used to cover a larger area of the intestine, and agreement between multiple channels is needed to make the analysis meaningful.     

Strangulating obstruction caused by intestinal herniation through the proximal aspect of the cecocolic fold in 9 horses

OBJECTIVE: To report the clinical and surgical findings and outcome for horses with strangulating obstruction caused by herniation through the proximal aspect of the cecocolic fold. STUDY DESIGN: Retrospective study. ANIMALS: Nine horses. METHODS: Medical records were reviewed for clinical signs, surgical findings and technique, and outcome. Cadaver ponies and necropsy specimens were also used to study the regional anatomy of the cecocolic fold. RESULTS: The ileum and distal jejunum were strangulated in 8 horses, whereas in 1 horse the small intestine and the left ascending colons were incarcerated in a rent in the cecocolic fold. Two horses were euthanatized at surgery, 6 horses had a small intestinal resection (mean length, 3 m; range, 1.5-6.4 m) and an end-to-side jejunocecostomy, and the entrapment was reduced without resection in the horse that had small intestine and ascending colon incarceration; cecocolic fold defects were not closed. One horse was euthanatized 36 hours after surgery because of endotoxemia. Six horses were discharged; 4 were available for long-term follow-up, of which 2 were euthanatized, and 2 were euthanatized 12 and 18 months after surgery because of colic signs. Variations in thickness of the cecocolic fold were observed in specimens obtained from necropsy of other horses and ponies. CONCLUSIONS: Reasons for this defect are unknown, although observed anatomic differences in cecocolic fold thickness may contribute to the development of defects. CLINICAL RELEVANCE: Reduction of the entrapped bowel is easiest when traction is placed on the bowel at a 90 degrees to the base of the cecum. Intestinal incarceration through rents within the proximal part of the cecocolic fold should be considered as a differential diagnosis for strangulating obstruction in horses.