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

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

lleocolostomy A Technique for Surgical Management of Equine Cecal Impaction

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.     

Surgical Management of Cecal Impaction/Dysfunction by Ileocolostomy in a Horse

A four-year-old Appaloosa brood mare was referred for evaluation of a colic episode of 24 hours' duration. Physical examination revealed a distended cecum filled predominantly with fluid. A tentative diagnosis of cecal dysfunction was determined, and surgical intervention was performed by means of typhlotomy and ileocolostomy techniques through a complete bypass of the cecum. Postanaesthetic myopathy and incisional infection developed as postoperative complications. The mare was discharged 13 days after surgery. Follow-up information obtained from the owner and referring veterinarian 4 months after discharge revealed full recovery of the mare.     

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.     

Survival after Small Intestine Resection and Anastomosis in Horses

The authors examined factors influencing survival in 140 horses that recovered from anesthesia after small intestinal resection between 1968 and 1986, using Kaplan-Meier estimated survival curves and the Cox proportional hazards regression model. Seventy-two horses (51%) died during the initial postoperative period, 19 horses (14%) died after discharge from the hospital, 33 horses (24%) were alive, and 16 horses (11%) were classified as censored. Mean age at surgery was 8 years. Horses 15 years of age or older, Arabians and Stallions, were overrepresented in the hospital population. The most common reason for resection was strangulation of bowel through a mesenteric rent. The mean and 50% median survival times were 1540 and 27 days, respectively. Horses admitted after January 1, 1980, had a significantly longer survival than those admitted before that time. Survival was longer after anastomosis of two small intestinal segments than after anastomosis of a small intestinal segment to the cecum; however, the length of bowel resected and the method of anastomosis had no demonstrable influence on survival. Of the variables studied, the heart rates at presentation and 24 hours after surgery were the most accurate predictors of survival.     

A Modified Technique for Extensive Large Colon Resection and Anastomosis in Horses

Objective —To describe an alternative technique for large colon resection and anastomosis in horses.
Study Design —Retrospective study of clinical patients.
Animal Population —37 horses that had ventral midline celiotomies between July 1, 1990, and July 1, 1994.
Methods —Large colon resection and anastomosis was performed using a modification of previously described techniques. Modifications include mesocolon ligation with a stapling device and an end-to-end apposition of the right ventral and right dorsal colon.
Results —Twenty-one of the 37 horses were discharged from the hospital without complications. Two horses were euthanatized immediately after recovery from anesthesia because of hindlimb fracture. Fourteen horses were euthanatized in the initial postoperative period because of persistent endotoxemia and abdominal pain.
Conclusions —The described technique is a safe, reliable method for large colon resection and anastomosis in horses.
Clinical Relevance —The described technique is fairly simple to perform and requires less surgical time compared with other techniques.     

Esophageal Disorders in 61 Horses: Results of Nonsurgical and Surgical Management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.     

Acellular Dermal Matrix for Surgical Repair of Ventral Hernia in Horses

The aim of the present study was to evaluate acellular dermal matrix (ADM) of rat origin for the repair of ventral hernia in horses. The skin from rats, to be used as a graft, was de-epithelialized using hypertonic solution and further decellularized with 0.5% sodium dodecyl sulfate and 0.25% tri-(n-butyl)-phosphate. Under general anesthesia, the hernial ring was exposed and repaired with the ADM graft using inlay graft technique. Blood samples were collected at postimplantation days 0, 15, and 30 and were used for sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis to assess the serum protein concentration of the animals, as well as for gelatin zymography for the identification of matrix metalloproteinases. All animals had an uneventful recovery without clinical signs of wound dehiscence, infection, or recurrence of hernias during 6-month follow-up period. Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of concentration of the serum proteins revealed that this was increased at day 15 and had decreased again at day 30. Gelatin zymography showed only one major band of 92 kDa in the serum of all the horses with the implant, but the relative amount of 92 kDa was higher at day 15 as compared with day 0 and day 30. It may be concluded that ADM of rat origin can be used safely in horses for repair of ventral hernia.     

Diagnosis and Surgical Management of Pythiosis in Draft Horses: Report of 33 Cases in Egypt

A total of 33 draft horses suffering from cutaneous pythiosis were referred to Mansoura Veterinary Teaching Hospital, Egypt, between October 2008 and January 2011. The animals presented ulcerative, granulomatous lesions located at the ventral aspect of the thorax (n = 10), abdomen (n = 14), forelimbs (n = 5), hind limbs (n = 2), and presternal region (n = 1) and at withers (n=1). The animals suffered from ulcerations composed of whitish yellow tissue having numerous draining tracts that discharge serosanguineous or bloody exudates. Initial diagnosis was based on location, gross lesion, and presence of kunkers. Histopathological evaluation revealed an eosinophilic granulomatous reaction associated with intralesional hyphae characteristic of Pythium insidiosum visualized by Gomori methenamine silver stain. The outcome of surgical excision revealed complete cure in 24 cases. Euthanasia was indicated in 9 cases.     

Surgical Treatment of Colic Results in 181 Horses

A retrospective study was performed of 181 horses that underwent an exploratory celiotomy because of acute abdominal disease. Forty-four horses died or were euthanized during surgery. Of the 137 horses that recovered from anesthesia, 72 died of associated diseases or complications, 86 were discharged from the hospital of which 60 survived at least 7 months. Horses with disorders affecting the small intestine had a significantly lower survival rate. Causes of death early in the postoperative period included long bone fracture, shock, ileus, gastric rupture, and peritonitis. After discharge from the hospital, deaths were attributed to colic of unknown cause, malabsorption syndrome, adhesive small bowel obstruction, small and large intestinal volvulus, perforated bowel, and laminitis. Of the 60 horses that were alive at the time of survey, 93.3% had returned to their previous use. A second occurrence of the initial acute abdominal disease was not documented in any horse.     

Oxidative Stress Associated With Spasmodic,Flatulent, and Impaction Colic in Draft Horses

The aim of the present study was to evaluate the oxidative stress level and antioxidant trace elements status associated with spasmodic, flatulent, and impaction colic in draft horses. For this purpose, venous blood samples were obtained from 20 randomly selected clinically healthy draft horses (control group) and 60 draft horses with different types of colic (spasmodic colic, n = 20; flatulent colic, n = 20; and impaction colic, n = 20). In horses with flatulent and impaction colic, there was a significant (P < .05) decrease in the total antioxidant capacity and activity of reduced glutathione (GSH) and catalase (CAT) as well as level of selenium, copper, zinc, and iron. However, there was a significant (P < .05) increase in the activity of superoxide dismutase (SOD) and in the level of malondialdehyde (MDA), interleukin-6 (IL-6), and manganese. Meanwhile, glutathione reductase (GR) was significantly (P < .05) increased in flatulent colic and significantly (P < .05) decreased in impaction colic. The oxidative stress index (OSI) was significantly (P < .05) increased in horses with flatulent and impaction colic. In horses with flatulent colic, there was a negative correlation between CAT and SOD (r = −0.446), MDA and zinc (r = −0.450), and IL-6 and zinc (r = −0.470). However, those with impaction colic, a negative correlation was recorded between CAT and MDA (r = −0.602), copper and GSH (r = −0.474), iron and GR (r = −0.511), and OSI and GR (r = −0.662). The results of the present study indicate that oxidative stress, with alteration of antioxidant trace element levels, is a feature of flatulent and impaction colic in draft horses.     

Surgical Correction of Strictures of the Large Colon in Three Horses

An extensive stricture of the left dorsal colon in a Thoroughbred colt was resected and the colon was anastomosed. In two horses, circumferential strictures at the pelvic flexure 2.5 to 3 cm long were corrected with a modified Heineke-Mikulicz pyloroplasty technique. The horses were reported to be doing well at 6, 8, and 45 months, respectively.     

Surgical Treatment of Septic Jugular Thrombophlebitis in Nine Horses

Objective: To report a technique for surgical treatment of septic jugular thrombophlebitis unresponsive to medical treatment. Study Design: Case series. Animals: Horses (n=9) with septic jugular thrombophlebitis unresponsive to medical treatment. Methods: Jugular vein thrombectomy was performed under standing sedation and local anesthesia. The contents of the affected portion of vein were removed by multiple incisions in the vein, with the incisions left open to drain and heal by second intention. Results: The technique was curative in all instances, although 2 horses required a 2nd procedure. One horse required ligation of the linguofacial vein to control postsurgical hemorrhage. Conclusions: The technique is an effective surgical treatment for septic jugular thrombophlebitis unresponsive to medical treatment. Clinical Relevance: Jugular vein thrombectomy is a straightforward technique, and has minimal postoperative complications. It allows expedient and cost‐effective resolution of medically recalcitrant cases of septic jugular thrombophlebitis.     

Effects of Feeding Management on the Equine Cecal Microbiota

The effects of meal size and frequency on equine cecal microbiota are not well documented. We hypothesized that changes in feeding management (including differing meal size and frequency) would alter the equine cecal microbiota. Cecally cannulated horses (n = 6) were utilized in a 3 × 3 Latin square where they received group pasture turnout daily and were stalled overnight in box stalls (3 × 4 m). Treatment diets consisted of Strategy^® concentrate and were as follows: A = one meal, 2.72 kg, 6 AM; B = two meals, 1.36 kg/meal, 6 AM and 4 PM; and C = three meals, 0.91 kg/meal, 6 AM, 12 PM, and 4 PM. Treatment periods consisted of 8 days of acclimation followed by 3 days of collection. All horses received ad libitum access to water, a white salt block, and 3 kg of mixed alfalfa/grass hay offered overnight. Cecal samples were sequenced using 16S rRNA gene-based Illumina technology. Data were analyzed using QIIME 1.8.0 and Proc MIXED of SAS. Weighted principal coordinates analysis values indicated that feeding management impacted cecal microbiota composition with horses fed one large meal having different microbial community than those fed three smaller meals throughout the day (P = .028). Furthermore, treatment affected (P < .05) Prevotella, YRC22, Lactobacillus, Streptococcus, Coprococcus, and Phascolarctobacterium. These data demonstrate that feeding a single large bolus meal affects both abundance and composition of the cecal microbiota. Further research is necessary to understand the metabolic and/or health implications related to changes the equine cecal microbiota.     

Surgical Treatment of Sand Colic Results in 40 Horses

A retrospective study of 40 horses that underwent surgical treatment for sand colic was performed. Three horses were euthanatized and one died during surgery. Of the 36 horses that recovered from anesthesia, five died before discharge from the hospital and seven died after discharge. Twenty-four horses survived at least 12 months. Sand impaction of the right dorsal colon was present in 26 horses. In addition to sand impaction, 10 horses also had colonic displacement or volvulus.     

Surgical and Conservative Management of Bilateral Dynamic Laryngeal Collapse Associated with Poll Flexion in Harness Race Horses

Objective— To test the hypothesis that in bilateral dynamic laryngeal collapse associated with poll flexion, vocal fold collapse (VFC) is the initial abnormal event that induces further laryngeal collapse, and that racing performance would therefore be substantially improved after bilateral ventriculocordectomy in affected individuals.
Study Design— Retrospective study.
Animals— Twenty-six horses.
Methods— Medical records (1998–2006) of harness racehorses admitted for high-speed treadmill videoendoscopy (HSTV) that had bilateral dynamic laryngeal collapse associated with poll flexion were reviewed. Race records, owner interviews, and follow-up HSTV were used to evaluate outcome after either surgical treatment including bilateral ventriculocordectomy or conservative management.
Results— Bilateral dynamic laryngeal collapse, defined as bilateral VFC with concurrent arytenoid cartilage collapse (ACC), was identified in 26 horses. Norwegian Coldblooded Trotters (NCT) were overrepresented. Sixteen horses had surgical treatment and 10 were treated conservatively. Return to racing and racing performance was not improved within or between groups after the treatment. On follow-up HSTV of 6 surgically treated horses, there was no residual soft tissue collapse in the ventral portion of the rima glottidis; however, ACC and other abnormalities were still evident.
Conclusion— Bilateral ventriculocordectomy resolved VFC, but failed to stabilize the arytenoid cartilages or to significantly improve racing performance.
Clinical Relevance— Bilateral dynamic laryngeal collapse associated with poll flexion is a serious performance-limiting upper respiratory tract disorder that is overrepresented in NCT racehorses. Our results suggest that VFC is not the initiating event in this complex obstructive airway disorder for which there is currently no consistently effective treatment.