Colopexy of the equine large colon: comparison of two techniques

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

Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses

Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.     

Use of cecal bypass via side-to-side ileocolic anastomosis without ileal transection for treatment of cecocolic intussusception in three horses

CASE DESCRIPTION: 3 horses were evaluated for signs of colic; cecocolic intussusception was detected. CLINICAL FINDINGS: Abnormalities detected included diminished intestinal sounds, inflammatory leukogram, dehydration, unremarkable fi ndings via rectal palpation, and ultrasonographic evidence of large intestine intussusception. Laparotomy revealed cecocolic intussusception. TREATMENT AND OUTCOME: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection was performed in each horse by use of an intraluminal anastomosis stapler device. Postoperative complications were minimal, and all horses recovered rapidly and were clinically normal at > 12 months after surgery. CLINICAL RELEVANCE: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection seemed to offer 2 potential advantages over traditional surgical techniques for treating this condition. The risk of abdominal contamination was far less than with techniques in which the colotomy is needed to enable resection of the cecum or techniques in which the ileum is transected. Also, it was technically simpler to perform because there was no need to transect the ileum, oversew the ileal stump, perform cecal resection, or close the mesenteric space created by relocating the jejunal stump to the right ventral colon.     

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).     

Intestinal Entrapment and Strangulation Caused by Rupture of the Duodenocolic Ligament in Four Dogs

Objective — The purpose of this study was to describe four dogs with intestinal entrapment and strangulation caused by a rupture of the duodenocolic ligament.
Study Design — This case series documents historical findings, physical examination findings, diagnostic workup, surgical intervention, and outcome of four dogs confirmed at surgery with duodenocolic ligament rupture.
Results — Three of four dogs were German shepherds, and two of three German shepherds were intact males. The history, clinical signs, and physical examination findings were not specific for intestinal entrapment. The clinical signs in three of four dogs included chronic vomiting, diarrhea, anorexia, and lethargy. In the remaining dog, the clinical signs were vomiting and peracute collapse. This dog rapidly deteriorated over a few hours because of strangulation of the entrapped intestines. In two of four dogs, abdominal radiographs showed a distended colon displaced to the right side of the abdominal cavity. Surgery involved transection of the remaining ventral remnant of the duodenocolic ligament and replacing the colon into its normal anatomic position. The three dogs with chronic clinical signs were either still alive, or were euthanatized for unrelated problems. The dog with strangulation of the entrapped intestines was euthanatized at the time of surgery.
Conclusions and Clinical Relevance — Duodenocolic ligament rupture with secondary bowel entrapment can occur in dogs. The prognosis for these animals is favorable provided there is no vascular compromise of the entrapped bowel segments. The peracute history, progression of the disease process, and outcome of the fourth dog in this study indicate that surgery should be performed as an emergency procedure.     

Inguinal Herniation of the Ascending Colon in a 6‐month‐old Standardbred Colt

Objective— To report inguinal herniation of the ascending colon in a Standardbred colt. Study Design— Case report. Animals— A 6‐month‐old Standardbred colt. Methods— The colt underwent surgical exploration of the hernia with large colon resection and anastomosis. Results— A successful large colon resection and anastomosis was completed, however, the colt was euthanatized at the end of surgery upon owner request. Conclusions and Clinical Relevance— Although uncommon, indirect inguinal herniation of the ascending colon can occur in young horses.     

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.     

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

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

Failure of Psyllium Mucilloid to Hasten Evacuation of Sand From the Equine Large Intestine

Objective —To examine the efficacy of psyllium mucilloid in evacuating sand from the equine large intestine.
Animals —12 clinically healthy pony geldings.
Procedure—Twelve ponies were assigned to 2 groups of six each. One group was treated with psyllium and the second was a control group. All ponies had an exploratory celiotomy and 10 g/kg body weight of sand was placed into the cecum. Ponies were fed a grain mixture alone at 1 g/kg (controls), a grain mixture plus psyllium pellets, each at 1 g/kg body weight (3 ponies), or fed a grain mixture and given psyllium powder by nasogastric tube at 1 g/kg body weight divided into two daily doses in 3 L of water (3 ponies). Radiographs were taken on days 1 (3 per group), 5 (all ponies), and 11 (3 per group) to monitor sand transit through the large intestine. Ponies were euthanatized 11 days after surgery. Sand was collected from the contents of the cecum, ventral colon, dorsal colon, and small colon. Dry weight of the recovered sand was compared between the two treatment groups as a percentage of the dry weight of sand placed in the cecum.
Results —No significant differences were detected in the mean percentage of sand recovered between the two treatment groups ( P < .05), with 39.2% recovered in ponies treated with psyllium and 27.4% recovered in control ponies.
Clinical Relevance —Psyllium mucilloid had no apparent effect on sand evacuation from the equine large intestine. When intake of sand is prevented, the equine large intestine can reduce and possibly eliminate its sand burden.     

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.     

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.     

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.     

Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.     

Survival and Complications After Large Colon Resection and End‐to‐End Anastomosis for Strangulating Large Colon Volvulus in Seventy‐Three Horses

Objective— To report complications and survival after large colon resection and end‐to‐end anastomosis in horses with strangulating large colon volvulus. Study Design— Retrospective case series. Animals— Horses (n=73) with strangulating large colon volvulus. Methods— Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow‐up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. Results— The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short‐term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long‐term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. Conclusion— None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self‐limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. Clinical Relevance— Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long‐term survival with minimal negative impact on quality of life and use.     

Laparoscopic Cryptorchidectomy in Standing Horses

Objective — The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses.
Study Design — Prospective clinical study.
Animals or Sample Population — Eleven client-owned horses ranging in age from 4 months to 2 years.
Methods — Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique.
Results — Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes.
Conclusions and Clinical Relevance — Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.     

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

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

Use of Colostomy to Manage Rectal Disease in Dogs

Objective — The purpose of this study was to develop a diverting colostomy technique for use in dogs.
Study Design — Clinical case series.
Animals — Five client-owned dogs presented for diseases requiring diverting colostomy during treatment.
Methods — Diverting colostomy was performed in five dogs. A ventral approach was used in the first dog and the colon was exteriorized adjacent to the linea alba. The technique used in the next four dogs involved creation of a left flank rod-supported loop colostomy in which the colon was exteriorized through a muscle-separating flank approach to the abdomen.
Results — Peritoneal leakage of fecal material resulted in the perioperative death of the first dog. The flank colostomies were maintained for times ranging from 3.5 weeks to 7 months. No major complications were observed, but skin excoriation occurred occasionally around the stomasites in all dogs.
Conclusion — Diverting colostomy is a technique that is suitable for use in treatment of dogs with obstruction or leakage involving the distal colon or rectum.     

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.     

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.