Radical surgical resection of locally invasive oro-cutaneous tumors in the buccal region of 2 horses

OBJECTIVE: To report treatment and wound healing after radical surgical mass excision in the equine buccal region. STUDY DESIGN: Clinical case reports. ANIMALS: An 11-year-old Warmblood gelding and a 9-year-old Norwegian Trotter gelding. METHODS: Large tumoral masses were removed from the buccal region by radical electrosurgery, creating large defects into the oral cavity. Wound ultimately healed by second intention. RESULTS: Buccal defects in both horses healed well by second intention without tumor recurrence. CONCLUSIONS: Locally invasive tumors involving the cheek region of the horse can be successfully treated by radical electroexcision alone, creating transmural defects up to 14 cm length x 8 cm height. CLINICAL RELEVANCE: Large transmural defects in the cheek region of the horse, formed by radical surgery can heal satisfactorily by second intention healing without undue discomfort to the patient or major complications.     

Tracheal perforation managed by temporary tracheostomy in a horse

Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.     

Treatment of traumatic tracheal collapse with extraluminal titanium mesh screens

A 12‐year‐old Thoroughbred gelding presented with a history of exercise intolerance and inspiratory stridor. Physical examination revealed a blunt crush injury to the ventral neck and underlying trachea of unknown duration. Tracheoscopy revealed a grade 3 tracheal collapse. Surgical management of the case involved placement of extraluminal titanium mesh screens circumferentially around the trachea for complete support. During the period of hospitalisation, the only post operative complication was seroma formation, which resolved with routine care. Follow‐up after 5 years revealed no further evidence of exercise intolerance, inspiratory dyspnoea or stridor. The horse returned to his previous level of work as a show hunter.     

Articular sagittal and medial parasagittal patellar fracture repair using lag screws in two mature horses

This report describes the clinical experience with internal fixation of a sagittal and a medial parasagittal patellar fracture using lag screws. Severely displaced sagittal and medial parasagittal fractures of the patella were diagnosed in 2 horses (a 10‐year‐old Thoroughbred gelding and a 5‐year‐old Thoroughbred mare) and were repaired using internal fixation. A direct approach through the fascia latae was used. In both cases, the leg was placed in full extension and the fracture was corrected by a combination of digital manipulation and application of bone reduction forceps. Articular congruency was assured by arthrotomy and digital assessment, and radiographic skyline projection. Then, the leg was placed in flexion and two 5.5 mm cortical screws with washers were inserted in lag fashion, under radiographic guidance (skyline projection). In one case, an additional 6.5 mm cancellous screw was used. Both fractures healed without evidence of degenerative joint disease. However, the first horse's wound dehisced, then healed by second intention uneventfully. The second horse was put in a sling in order to prevent lying down. Both horses were able to be used for their intended purpose. In these clinical cases, sagittal and medial parasagittal patellar fractures were treated successfully by open reduction and internal fixation. Post‐operative management in a sling was used successfully in the second case to prevent wound dehiscence.     

Direct preputial hernia associated with a ventral abdominal wall defect in a two‐year‐old gelding

The case of a 2‐year‐old gelding with acute onset of preputial swelling and prolapse is presented. After initiating conservative management using a penile repulsion device, the horse repeatedly displayed signs of mild abdominal discomfort with sudden deterioration to an episode of violent colic after 5 days of hospitalisation. Ultrasonographic examination of the preputial swelling at that time demonstrated the presence of small intestine between the internal and external laminae of the prepuce and led to the diagnosis of a direct preputial hernia. The contents of the hernia were readily reduced through a defect in the ventral abdominal wall after the anaesthetised horse was placed in dorsal recumbency. The historical information, clinical progression and surgical findings were supportive of an acquired ventral abdominal wall defect. To the authors' knowledge, this is the first reported case of a direct preputial hernia associated with an acquired ventral abdominal wall defect.     

Tracheal rupture following general anaesthesia in a horse

A Dutch Warmblood, with no other underlying clinical disease, presented for surgical excision of a sarcoid tumour on the distal right pinna under general anaesthesia. At the end of the procedure, immediately before being moved to recovery, the horse became light and made repeated attempts to move whilst attached to the hoist. Anaesthesia was deepened with intravenous thiopental sodium (Thiopentone)¹ and the horse was moved into the recovery room. The trachea was extubated with the cuff of the endotracheal tube inadvertently left partially inflated. Recovery was smooth and the horse stood uneventfully. The following day subcutaneous emphysema was noted along the neck and tracheoscopy revealed an abnormal dorsoventrally flattened trachea and a 5 cm tear in the dorsal aspect of the trachea. Symptomatic treatment resulted in progressive healing of the lesion and the horse recovered fully with no evidence of respiratory complications.     

Tracheal perforation secondary to suture irritation in a dog following a ventral slot procedure

An eight-year-old springer spaniel was presented with acute-onset subcutaneous emphysema of five days' duration. The dog had undergone ventral slot decompression of the C5-C6 intervertebral disc space eight weeks before presentation. Cervical tracheoscopy demonstrated perforation of the dorsal tracheal membrane of the distal cervical trachea. Perforation of the dorsal tracheal membrane secondary to suture knot irritation was confirmed by exploratory surgery. Repair of the perforation was performed by plication of the dorsal tracheal membrane. The dog was re-presented nine days after the initial surgery with acute recurrence of subcutaneous emphysema. Air leakage at the plicated dorsal tracheal membrane was observed at exploratory surgery, and a bipedicle sternothyroideus muscle flap was used to support the plicated membrane. Recovery was uneventful and 10 months postoperatively there had been no recurrence of clinical signs.     

Equine immune-mediated hemolytic anemia associated with Clostridium perfringens infection

Background: Previous studies have suggested an association between equine immune-mediated hemolytic anemia and clostridial infections or neck abscesses.
Objective: The purpose of this report was to describe and characterize the hematologic abnormalities in a horse with Clostridium -associated immune-mediated hemolytic anemia. We also retrospectively evaluated hematologic abnormalities in 8 horses with clostridial myositis or subcutaneous emphysema.
Methods: A 7-year-old Foreign Warm-Blood gelding was evaluated for anemia and a cervical abscess. CBCs and reticulocyte counts were obtained using an Advia 120 analyzer and evaluation of Wright's-stained smears. All cases of equine Clostridium spp. myositis or subcutaneous emphysema over a 7-year period were identified in a retrospective search of the University of Minnesota Veterinary Teaching Hospital database. Clinical, hematologic, and microbiological findings were recorded.
Results: Clostridium perfringens genotype A was isolated from the neck wound of the gelding. The CBC was characterized by severe regenerative anemia, intravascular hemolysis, and RBC agglutination. A direct Coombs' test was positive. Moderate numbers of spheroechinocytes were observed. The total automated reticulocyte count was 4.5% (56,700/μL), with most reticulocytes having low absorbance (mature reticulocytes). The anemia responded to penicillin and steroidal and nonsteroidal immunosuppressive drugs. Of 8 horses with myositis, all of which involved the cervical region, 5 were anemic, 1 had a positive direct Coombs' test, and 2 had increased numbers of type III echinocytes and spheroechinocytes.
Conclusions: The presence of type III echinocytes or spheroechinocytes may be helpful in diagnosing immune-mediated hemolytic anemia associated with clostridial infections in horses. Automated reticulocyte counts may detect very low levels of reticulocytosis in hemolytic anemia in horses.     

Differentiation of Chronic Lymphocytic Leukemia in the Horse: A Report of Two Cases

Chronic lymphocytic leukemia (CLL) was diagnosed in two horses: an 18-year-old Quarter Horse gelding that was examined because of edema of the prepuce and ventral abdomen; and a 20-year-old mixed breed gelding that was referred because of lymphocytosis, ventral edema, and weight loss. The first horse had enlarged peripheral lymph nodes and cool nonpainful pitting edema of the ventral abdomen and prepuce. The second horse had enlarged peripheral lymph nodes, cool nonpainful pitting edema of the ventral thorax and cranial ventral abdomen, and a 3/5 holosystolic heart murmur. The diagnosis of CLL was based on increased blood lymphocyte counts and infiltration of marrow and other tissues by lymphocytes. In horse 1, the lymphocytosis persisted for 2 months between initial examination and death. The results of flow cytometric analysis on blood lymphocytes using anti-lymphocyte antibodies suggested that horse 1 had T-cell CLL, and horse 2 had B-cell CLL. In addition, the second horse had a monoclonal gammopathy (IgG), with light-chain proteinuria.     

Collateral ligament reconstruction in two horses following traumatic avulsion fracture using a knotless suture anchor construct

This case report describes a technique for repair of medial collateral ligament avulsions in two horses. Both horses sustained traumatic injuries resulting in avulsion fractures at the origin of their medial tarsal and carpal collateral ligaments. This report describes the use of a knotless suture anchor to mechanically reconstruct medial collateral ligament avulsion injuries in two horses. The first horse, a 9‐year‐old Hannovarian Warmblood gelding presented for an acute nonweightbearing lameness in the right hindlimb. The injury was localised to the medial malleolus of the tibia and an avulsion fracture of the origin of the short medial collateral ligament of the tibiotarsal joint with disruption of the ligament was found on radiographs and ultrasound. The horse was taken to surgery and a reconstruction of the short medial collateral ligament was performed with a modified single row construct using a biocompatible, multistrand, long chain ultra‐high molecular weight polyethylene braided composite suture tape (2 mm Fibertape) and a single knotless suture anchor (5.5 × 19.1 mm PEEK SwivelLock C). The second horse, a 5‐year‐old Thoroughbred gelding presented for an acute nonweightbearing lameness in the left forelimb. The injury was localised to the medial styloid process of the radius and an avulsion fracture of the origin of the medial collateral ligament of the antebrachial carpal joint was found on radiographs and ultrasound. The horse was taken to surgery and a similar reconstruction procedure was performed to the collateral ligament. Both horses were recovered in a Robert Jones bandage without the use of casts or splints and recovered without incident. Both horses are sound and returned to previous level of athletic performance at 18 months and 8 months, respectively.     

Penetrating injury at the thoracic inlet in a Paint‐Arab mare

A 12‐year‐old Paint‐Arab mare was admitted for evaluation of a penetrating chest laceration at the thoracic inlet. The left brachiocephalic muscle was transected and the recurrent laryngeal nerve was traumatised. Subsequent to the injury, the horse developed Horner's syndrome on the left side of the neck and face, Grade IV left laryngeal hemiplegia, dysphagia, cough and subcutaneous emphysema. The defect was closed in multiple layers. Antimicrobial and antiinflammatory therapy was instituted along with local wound care. The mare remained bright and responsive and the wound healed normally. The mare showed no signs of respiratory distress. Dysphagia and ptosis persisted at 30 days post trauma.     

Acute normovolaemic haemodilution in a Clydesdale gelding prior to partial resection of the left ventral concha under general anaesthesia

A 16‐year‐old Clydesdale gelding underwent oral extraction of tooth 210 under standing sedation with partial resection of the left ventral concha under general anaesthesia 4 days later. Due to the highly vascular nature of the surgical site, significant intraoperative haemorrhage was anticipated. A lack of compatible donor horses confirmed by crossmatching prompted an autologous donation of 6 l of blood and acute normovolaemic haemodilution using a gelatine solution immediately prior to surgery. Intraoperative haemorrhage was estimated at 5% circulating volume and autologous transfusion was commenced once haemostasis was confirmed. The horse recovered uneventfully from general anaesthesia and surgery. To our knowledge this is the first report of acute normovolaemic haemodilution used in a clinical equine case.     

Idiopathic aseptic pericardial effusion with cardiac tamponade in a horse

This report describes the successful treatment of pericardial effusion and cardiac tamponade in a 10‐year‐old Hanoverian gelding. Pericarditis and pericardial effusion are uncommon conditions in horses. Although many potential causes for the effusion have been described most cases are classified as idiopathic. The most valuable diagnostic procedure for the detection of pericardial effusion is echocardiography. Pericardiocentesis and drainage of the fluid were carried out in this case. At one year follow‐up there were no clinical signs of recurrence and the horse has returned to his previous level of athletic performance.     

Tracheal perforation and widespread subcutaneous emphysema in a horse

A twelve year old Quarterhorse mare exhibited subcutaneous emphysema of the head, neck, upper forelimbs and thorax, and walked with a stiff gait, characterized by decreased flexion of the forelimbs. Endoscopy of the trachea revealed a small tracheal wound ninety centimeters from the external nares. The location of the lesion corresponded with a seroma present at the base of the neck. The subcutaneous emphysema and the seroma resolved without specific therapy. Blunt trauma was suggested as the cause of the tracheal lesion and subsequent subcutaneous emphysema.     

Management and complications associated with treatment of cervical oesophageal perforations in horses

Six horses were evaluated for colic and anorexia, choke or suspected oesophageal rupture with and without tracheal laceration. Clinical findings were variable, but a painful ventral neck swelling was noted in all cases. Two of the horses had signs of dehydration and sepsis. Additional findings included evidence of previous trauma over the trachea and oesophagus, ventral neck abscessation, choke and aspiration pneumonia. A diagnosis of oesophageal perforation was made using endoscopy. Two horses were subjected to euthanasia without treatment. All horses where treatment was attempted received debridement of the oesophageal perforation and surrounding tissues with or without surgical closure of the oesophageal defect. Other therapies included broad spectrum antimicrobials, anti‐inflammatory drugs, fluid and nutritional support as well as additional therapeutics for sepsis and individual complications. Complications included diverticulum formation, thrombophlebitis, diarrhoea, laryngeal hemiplegia, azotaemia, aspiration pneumonia, oesophageal obstruction, weight loss and laminitis. All 4 treated horses recovered from the oesophageal perforation and are able to eat a normal diet. Two of the 4 horses have had infrequent episodes of recurrent choke. Oesophageal rupture should be considered as a differential diagnosis for horses with a painful swelling of the ventral neck. With surgical debridement and adequate supportive care, oesophageal perforation cases can have a fair to good long‐term survival, although chronic complications can occur, therapy is prolonged, and a significant economic commitment is required.     

Transitional cell carcinoma of the urinary bladder in a 12‐year‐old Belgian Warmblood gelding

A 12‐year‐old Belgian Warmblood gelding was examined for haematuria and dysuria of 24 h duration. Cystoscopy revealed an intraluminal multinodular soft tissue mass originating from the dorsal bladder neck. Histopathological examination of biopsies identified transitional cell carcinoma. The bladder mass was surgically debulked via a temporary perineal urethrotomy. The horse commenced treatment with oral piroxicam. Follow‐up examination 18 months post operatively revealed no evidence of tumour recurrence. Neoplasia of the equine bladder is uncommon and this case describes the successful short‐term outcome of treatment of a transitional cell carcinoma by surgical debulking and oral piroxicam.     

Castration of Horses with Primary Closure and Scrotal Ablation

Fourteen horses and one pony, 1 to 16 years of age, were castrated with a technique designed to promote primary healing and ablation of the scrotum following removal of descended testicles. Twenty-six testicles (10 nondescended, 15 normal descended testicles, and 1 neoplastic descended testicle) were removed. Nondescended testicles were removed through a skin incision over the external inguinal ring. Descended testicles were removed, and the scrotum was ablated by excision of the ventral scrotum. All testicles were removed by emasculation. The common vaginal tunic was not opened prior to emasculation of the descended testicles, and transfixation liqation sutures were used in only two horses. All incisions were closed with multiple layers of synthetic absorbable sutures in the subcutaneous and subcuticular tissues. All incisions healed by primary intention, and 14 recovered without complications. As a result of incomplete scrotal ablation, one horse had temporary lameness and swelling of the scrotal area that resembled the presurgical appearance.     

Guttural pouch empyema secondary to a periocular foreign body

This report describes a 3‐year‐old gelding presenting with signs of injury to its left eye following an accident in which the horse crashed into a hedge. The first treatment attempted to treat infections in the eye and respiratory tract due to secretions identified in the trachea. The horse did not improve and further clinical and radiographic evaluations detected a guttural pouch empyema. Surgical drainage was performed and antimicrobial treatment continued. However, the horse presented with severe epistaxis and euthanasia was elected due to suspected arterial rupture. At necropsy, a round and stiff branch plant was found creating a fistula from the left orbit to the left guttural pouch. Another branch was found inside the pouch, confirming the origin of the persistent infection and severity of the tissue lesion.     

Single‐port laparoscopic incisional hernia repair in a horse

A 16‐year‐old Italian Saddle Horse gelding was referred for treatment of an incisional hernia that developed 7 months after a ventral midline laparotomy for treatment of acute abdominal pain. Physical examination revealed a hernia approximately 20 cm long and 15 cm wide on the ventral aspect of the abdomen. Ultrasonography revealed the dimensions of the hernia ring to be approximately 15 cm in length and 10 cm in width. A single‐port laparoscopic incisional hernia repair using an operating 0° laparoscope was performed with an appropriately sized (24 × 18 cm) piece of mesh fixed in place with simple interrupted transabdominal sutures. At 4 weeks post operatively, follow‐up physical examination and ultrasonography confirmed healing of the surgical site with no evidence of hernia recurrence. The same evaluation was done 6 months post operatively, and the horse returned to its previous level of activity 8 months post operatively. In horses, laparoscopic application of mesh should be considered among the treatment options for incisional hernia. In the present case, this technique was performed with a single port using an operative laparoscope, in contrast to the multiportal techniques reported previously. The case presented here demonstrates that single‐port laparoscopic herniorrhaphy is feasible, and allows proper placement of an expanded polytetrafluoroethylene intraperitoneal mesh in horses