Factors associated with mortality and morbidity in small intestinal volvulus in horses

OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.). STUDY DESIGN: Retrospective study. ANIMALS: Client-owned horses (115), aged 1 month to 21 years. Methods: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction. RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery. CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors. CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.     

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.     

Short-and long-term evaluation of surgical treatment of strangulating obstructions of the small intestine in horses: a review of 224 cases

A retrospective study was carried out of 224 horses operated for strangulating small intestine obstructions. Fifty-four horses were euthanized and 5 horses died during surgery which means that 165 (73%) were allowed to recover. Of these, 53 horses were euthanized or died in the clinic and 112 (50%) were discharged from the hospital. Of 90 horses available for follow-up 1 year postoperatively, 76 (84%) were still alive. The most important causes of death or reasons for euthanasia in the direct post-operative period were post-operative paralytic ileus, (adhesive) peritonitis and intra-abdominal haemorrhage. After discharge from the hospital the reasons were (adhesive) peritonitis and (recurrent) colic. Of the horses which survived for at least 1 year, 16% sometimes suffered from colic, 12% experienced problems with incisional woundhealing and 4% suffered from jugular vein thrombosis. All were in good or reasonable condition and 88% performed at (approximately) the same level as before the operation. The type of surgical intervention (i.e. enterotomy, enterectomy) did not significantly influence the outcome of surgery, whereas the type of anastomosis did. End-to-end jejunojejunostomy had a better prognosis than side-to-side jejunocaecostomy. It was concluded that strangulating obstructions of the small intestine still carry a poor to guarded prognosis. Mortality was highest in the direct peri-operative period. Once discharged from hospital, prognosis can be considered to be fair to good. Attempts to improve outcome should be directed at a better handling of the ileal stump during surgery and at the prevention of post-operative ileus and the formation of adhesions.     

Small intestinal segmental volvulus in horses after gastroscopy: Four cases (2011–2012)

Gastroscopy is the most common technique used in veterinary medicine to evaluate the stomach in horses and to date, no complications have been described associated with the procedure. This paper reports 4 cases developing a nonstrangulating segmental volvulus of the small intestine after gastroscopy at 3 referral institutions over a 2 year period. After performing diagnostic gastroscopy, all horses developed acute and severe clinical signs of colic unresponsive to medical management. Time range between gastroscopy and onset of colic signs varied from 10 min to 3 h. An exploratory laparotomy revealed a nonstrangulating segmental volvulus of the small intestine that was manually corrected without need for resection in all horses. In all cases, affected small intestine was severely gas distended. Three of those horses survived to discharge and were alive at follow‐up. One horse was subjected to euthanasia 2 days after surgery due to diffuse intestinal lymphoma.     

Small-intestinal volvulus as a complication of acquired inguinal hernia in two horses

Volvulus of the small intestine was diagnosed as a complication of acquired inguinal herniation in 2 horses. One of the horses continued to have signs of pain after reduction of the hernia. The volvulus was diagnosed at a second surgery, but the intestine was devitalized, and the horse was euthanatized. Ventral midline exploratory surgery was performed on the second horse, in conjunction with an inguinal approach. The small-intestinal volvulus was diagnosed and corrected at this time. It is suggested that ventral midline abdominal exploration be performed when acquired inguinal herniation causes acute small-intestinal obstruction in horses.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival

REASONS FOR PERFORMING STUDY: Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis. OBJECTIVE: To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed. METHODS: History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection. CONCLUSIONS: This study identified various factors that appear to predispose horses to long-term complications after colic surgery. POTENTIAL RELEVANCE: Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.     

Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990-1997)

OBJECTIVE: To describe the clinical findings in horses with small intestinal strangulation through mesenteric rents, and to determine the recurrence and survival rates after surgery. DESIGN: Retrospective study. ANIMALS: 15 horses with small intestinal obstruction via a mesenteric rent. PROCEDURE: Medical records of horses with obstruction of the small intestine via a mesenteric rent between January 1990 and December 1997 were reviewed. The signalment, history, initial physical examination findings, results of abdominocentesis, and clinical laboratory values were recorded. Surgical findings, including location of the mesenteric rent and surgical procedure performed, were recorded. Short- and long-term survival rates were calculated. RESULTS: Most mesenteric rents were located in the mesentery of the small intestine (13 horses). Two horses had multiple mesenteric defects. Seven horses were euthanatized at surgery because of an inability to reduce the entrapped intestine (3 horses), uncontrollable hemorrhage (2), inability to close the rent (1), and the amount of compromised intestine involved (1). Seven horses required intestinal resection and anastomosis. The median length of intestine resected was 2.6 m (range, 0.6 to 4.5 m). The mesenteric rents created during resection were not closed in 2 horses. One of these 2 horses subsequently developed a strangulating obstruction through the open rent. Seven of 15 horses in our study were discharged from the hospital (i.e., short-term survival rate of 47% [7/15]). Long-term follow-up information was available for 5 of the 7 horses (follow-up duration of 5 months to 9 years), of which 2 died as a result of colic, and 1 horse was euthanatized because of severe arthritis (i.e., long-term survival rate of 40% [2/5]). CONCLUSIONS AND CLINICAL RELEVANCE: Inability to reduce the intestinal obstruction, severe hemorrhage from the mesentery, and the length of intestine involved are the main factors that decrease survival rates in horses with small intestinal strangulation caused by mesenteric rents.     

Outcome of medical and surgical treatment of cecal impaction in horses: 114 cases (1994-2004)

OBJECTIVE: To determine short- and long-term outcomes, including recurrence rates, for horses with cecal impaction treated medically or surgically. DESIGN: Retrospective case series. ANIMALS: 114 horses. PROCEDURES: Medical records were reviewed for information on signalment, history, clinical findings, treatment (medical vs surgical), and short-term outcome. Information on longterm outcome was obtained through a mail survey and telephone interview with owners. RESULTS: 54 horses were treated medically, 49 horses were treated surgically, and 11 horses were euthanized after initial examination without further treatment. Horses treated surgically were significantly more likely to have signs of moderate or severe pain than were horses treated medically. Forty-four of the 54 (81%) horses treated medically were discharged from the hospital. Twelve of the 49 horses treated surgically were euthanized at surgery because of cecal rupture. Thirty-five of the 37 (95%) horses that were allowed to recover from surgery were discharged from the hospital. In 34 horses treated surgically, typhlotomy without a bypass procedure was performed. Long-term (>or= 1 year) follow-up information was available for 19 horses treated medically and 28 horses treated surgically. Eighteen (95%) and 25 (89%) of the horses, respectively, were alive at least 1 year after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that medical and surgical treatment were both associated with favorable outcomes in horses with cecal impactions. In this population, typhlotomy alone without cecal bypass was associated with a low recurrence rate. The long-term prognosis for horses that were discharged from the hospital was good.     

Treatment of supraspinous bursitis by use of debridement in standing horses: 10 cases (1968-1999)

OBJECTIVE: To evaluate efficacy of debridement for treatment of supraspinous bursitis in horses and to evaluate the outcome. DESIGN: Retrospective study. ANIMALS: 10 horses with clinical signs of supraspinous bursitis. PROCEDURE: Medical records were reviewed for signalment, anamnesis, results of physical and radiographic examination, microbial culture results of supraspinous bursa tissue or exudate, Brucella abortus titers, type of antimicrobial and anti-inflammatory therapies, surgical technique, complications of the surgical procedure, and findings on histologic examination of excised nuchal ligament and bursal tissue. Telephone follow-up with owners, trainers, or referring veterinarians was performed. RESULTS: The described surgical technique was effective in resolving drainage from the supraspinous bursal region in 5 of 6 horses available for long-term follow-up. The most common complication following surgery was the development of purulent wound drainage. Two horses required multiple surgeries to resolve clinical signs of supraspinous bursitis. The most common organism isolated from the supraspinous bursa was beta-hemolytic Streptococcus spp. All horses were discharged from the hospital and long-term follow-up was available for 6 horses. All 6 horses could be used for their intended use. CONCLUSIONS AND CLINICAL RELEVANCE: Debridement in standing horses is an effective method of resolving clinical signs of supraspinous bursitis.     

Surgical Reduction of Ileal Impactions in the Horse: 28 Cases

Objective —To evaluate the seasonal influence, signalment, type of hay consumed, clinical examination findings, and outcome after surgery for horses with ileal impaction. Study Design —A retrospective study. Results —Between 1988 and 1993, 28 horses had surgical correction of ileal impaction. There was a significantly higher rate of ileal impaction during the Fall (September-November, P= .0041). Mean duration of clinical signs of abdominal pain before referral was 15 hours. Transrectal palpation was used to localize the impaction in 11 horses. The ileal impaction was reduced by extraluminal massage aided by admixing of intestinal fluid oral to the impaction or injection of fluids intraluminally and then movement of the ingesta into the cecum alone in 24 horses. A total of 26 horses recovered from surgery; 24 horses were discharged from the hospital and eventually returned to previous use. Two horses had fatal postoperative complications: jejunocec-ostomy dehiscence and development of extensive small intestine adhesions after manual reduction of the impaction. One horse initially treated by manual reduction required jejunocecostomy twice for management of recurrent ileal impaction. Follow-up information was obtained for 21 horses, of which 20 were alive 1 year or longer after surgery. A total of 27 of 28 horses were fed Coastal Bermudagrass hay as the primary type of hay consumed. A total of 9 horses continued to be fed Coastal Bermudagrass hay as the only roughage source, whereas 6 horses were fed Coastal Bermudagrass with at least 50% other hay, and in 6 horses, Coastal Bermudagrass hay was entirely eliminated from the diet. Conclusion and Clinical Relevance—Ileal impactions can be successfully reduced by celiotomy and extraluminal massage and injection techniques to soften the ingesta for passage into the cecum without enterotomy or bypass techniques in most horses. Changes in weather and feeding practices in the Fall may account for an increased risk of ileal impaction in horses in the southeastern United States at that time of year.     

Acute small intestinal obstruction associated with Parascaris equorum infection in young horses: 25 cases (1985-2004)

AIMS: To retrospectively evaluate the medical and surgical records of horses with acute small intestinal obstructions associated with Parascaris equorum infection; to describe the gastrointestinal lesions; and to determine the outcome of cases with such lesions. METHODS: Records of 25 horses with acute small intestinal obstruction associated with P. equorum between 1985 and 2004 were reviewed to determine signalment, history, physical examination, surgical or post-mortem findings, and outcome. RESULTS: All horses except one were less than 12 months old. Standardbreds were over-represented in the population studied. Sixteen horses (72%) had been administered anthelmintics, including pyrantel (n=8), ivermectin (n=7), and trichlorphon (n=1), within 24 h prior to the onset of colic. Of the 25 cases reviewed, 16 had simple obstructive ascarid impactions (SOAIs), and nine had complicated obstructive ascarid impaction (COAI) including volvulus (n=6) or intussusception (n=3), both concurrent with ascarid impaction of the small intestine. Short-term survival (discharge from hospital) occurred in 79% of horses treated for SOAI, and was 64% for all horses. Long-term survival (>1 year) occurred in 33% of horses with SOAI, and the overall long-term survival was 27% for all horses. Formation of adhesions was the most frequent finding associated with death for horses that did not survive long-term. CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of anthelmintic treatment within 24 h of the onset of colic in this study population (72%) was higher than that previously reported. Resistance of P. equorum to ivermectin recently reported in Ontario may be associated with increased ascarid burdens, predisposing horses to ascarid impaction. The long-term survival of these horses was better than that reported previously.     

Circumferential mural bands in the small intestine causing simple obstructive colic: a case series

REASONS FOR PERFORMING STUDY: Circumferential mural band (CMB) in the small intestine is an emerging condition in Ireland. The clinical presentation is a simple obstruction of the small intestine of unknown aetiology. HYPOTHESIS: Horses affected with CMB in the small intestine have a good prognosis following surgical decompression into the caecum. METHODS: A retrospective study was carried out and 28 cases identified from 559 colic surgeries performed over a 5.5 year period. An exploratory celiotomy was performed in every case. A simple obstruction at the mid or distal jejunum was identified caused by a CMB, which was multiple in some cases. All of the horses except 2 had undergone a regular anthelmintic programme. RESULTS: Manual decompression of the small intestine into the caecum resulted in resolution of the simple jejunal obstruction. A constricted segment of small intestine was resected in one case, as the degree of constriction was severe. A full thickness biopsy was taken from another case. Histopathology was performed on both samples. All horses recovered from surgery and were discharged from the hospital 7-32 days post operatively. Short-term complications were observed. Survival rate was 100% at long-term follow-up. Histopathology showed inflammatory infiltration in the submucosa, muscularis and serosa with eosinophils predominating. Parasites were not detected. CONCLUSION AND POTENTIAL RELEVANCE: Small intestine circumferential mural bands have a good prognosis after surgical decompression of the small intestine into the caecum.     

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.     

Clinical assessment and outcome of three techniques for jejunal resection and anastomosis in horses: 59 cases (1989-2000)

OBJECTIVE: To compare postoperative complications, short- and long-term survival, and surgical times for hand-sewn end-to-end (EE), stapled functional end-to-end (FEE), and stapled side-to-side (SS) anastomotic techniques for jejunal resection in horses. DESIGN: Retrospective study. ANIMALS: 59 horses. PROCEDURE: Medical records were reviewed to obtain signalment, diagnosis, treatment, and outcome for horses that underwent jejunojejunostomy in our hospital. Only horses that recovered from anesthesia were included in the study. RESULTS: Among the 59 horses, there were 33 EE, 15 FEE, and 11 SS anastomoses. No difference was found in duration of surgery among the 3 techniques. The most common postoperative complications were colic episodes (56%), ileus (53%), diarrhea (20%), and adhesions (15%). Horses with SS anastomosis had a significantly shorter duration of postoperative ileus than the EE group did. No significant difference in duration of postoperative ileus was found among the other groups. No difference was found among the 3 anastomotic techniques in regard to survival rate at the time of discharge, 6 months after surgery, or 1 year after surgery. Overall survival rates after jejunal anastomosis were 88% at the time of discharge, 65% at 6 months after surgery, and 57% at > or = 1 year after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: The hand-sewn EE, stapled FEE, and stapled SS anastomotic techniques should be considered equivalent methods for small intestinal anastomosis in the horse. However, the stapled SS technique may be preferred because of possible decreased duration of postoperative ileus.     

Inflammatory bowel disease in horses: 11 cases (1988-1998).

OBJECTIVE: To determine clinical and surgical abnormalities in, and long-term outcome of, horses that undergo surgery because of colic secondary to inflammatory bowel disease (IBD). DESIGN: Retrospective study. ANIMALS: 11 horses. PROCEDURE: Medical records of horses that had undergone abdominal surgery and in which IBD had been diagnosed on the basis of histologic examination of intestinal biopsy specimens were reviewed. RESULTS: 5 horses were examined because of acute colic and 6 were examined because of chronic colic. At surgery, all 11 horses had edematous or hemorrhagic bowel segments suggestive of IBD. In addition, 6 horses had circumferential mural bands (CMB) causing constriction of the small (4 horses) or large (2) intestine. Intestinal resections were performed in 7 horses. All 11 horses survived surgery and were discharged from the hospital; 10 horses were still alive at the time of follow-up (1.5 to 7 years after surgery). CLINICAL IMPLICATIONS: Results suggest that IBD is an uncommon cause of colic in horses. Surgical resection of segments of intestine with constrictive CMB may relieve clinical signs of colic. Horses with IBD that had surgery had a good prognosis for long-term survival.     

Acute small intestinal obstruction associated with Parascaris equorum infection in young horses: 25 cases (1985–2004)

AIMS: To retrospectively evaluate the medical and surgical records of horses with acute small intestinal obstructions associated with Parascaris equorum infection; to describe the gastrointestinal lesions; and to determine the outcome of cases with such lesions.

METHODS: Records of 25 horses with acute small intestinal obstruction associated with P. equorum between 1985 and 2004 were reviewed to determine signalment, history, physical examination, surgical or post-mortem findings, and outcome.

RESULTS: All horses except one were less than 12 months old. Standardbreds were over-represented in the population studied. Sixteen horses (72%) had been administered anthelmintics, including pyrantel (n=8), ivermectin (n=7), and trichlorphon (n=1), within 24 h prior to the onset of colic. Of the 25 cases reviewed, 16 had simple obstructive ascarid impactions (SOAIs), and nine had complicated obstructive ascarid impaction (COAI) including volvulus (n=6) or intussusception (n=3), both concurrent with ascarid impaction of the small intestine. Short-term survival (discharge from hospital) occurred in 79% of horses treated for SOAI, and was 64% for all horses. Long-term survival (>1 year) occurred in 33% of horses with SOAI, and the overall long-term survival was 27% for all horses. Formation of adhesions was the most frequent finding associated with death for horses that did not survive long-term.

CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of anthelmintic treatment within 24 h of the onset of colic in this study population (72%) was higher than that previously reported. Resistance of P. equorum to ivermectin recently reported in Ontario may be associated with increased ascarid burdens, predisposing horses to ascarid impaction. The long-term survival of these horses was better than that reported previously.     

Surgical management of foreign body obstruction of the small and large colons in 29 equids (2004–2016)

The objectives of the study were to describe the clinical presentation, surgical findings, complications and outcome of a case series of small and large colon obstruction by foreign bodies (FBs) in horses. The study is a retrospective case series which included 29 equids (28 horses and one donkey). Medical records of cases diagnosed with FB obstruction of the large or small colon between the years 2004 and 2016 that underwent surgery were reviewed. Data regarding signalment, clinical signs, surgical findings and post-operative variables were recorded. Short- (survival to hospital discharge) and long- (1 year after surgery) term survival rates were obtained. Cases had a mean age of 4.2 years, with both females and Arabian horses being overrepresented. Abdominal distention was the most common observation on presentation and the FB could be palpated in 20% of the cases during rectal examination. The most common reason to go into surgery was severe pain with abdominal distention. Significantly more FBs were found in the small colon during surgery (P<0.0001) and most were removed by small colon enterotomy. Complications rate post-operatively was relatively high (41%) with fever and diarrhoea being most common. Twenty-three cases (79%) were released from the hospital and all cases that were available for long-term follow-up were alive and returned to previous activity. No correlation between the chosen method of surgical removal of the FB and survival or complications post-operatively was noted. These data reflect favourable prognosis for surgical removal of colonic FBs. Few techniques are available to improve the safety of removal and the preferred method depends on the FB location, appearance and mobility. As FB obstruction resembles ‘noncomplicated’ colonic impaction, it is essential to try and recognise FB cases since deterioration can be rapid and surgery is the only sufficient treatment.     

Surgical management of sand colic impactions in horses: a retrospective study of 41 cases

OBJECTIVE: A retrospective review of the medical records of 41 horses requiring abdominal surgery for sand colic. RESULTS: The diagnosis of sand colic was made when sand was found to be the cause of impaction of the gastrointestinal tract during surgical exploration. The most common clinical signs at presentation were abdominal pain, abdominal distension and diarrhoea. A statistically significant association was found between the respiratory rate on arrival and short-term survival. Sand impaction at multiple locations was detected in one-third of the horses. Concurrent pathology was detected in half of the horses. Four horses were euthanased during surgery; of those that recovered from surgery, 35/37 (95%) were discharged from hospital. Short- and long-term complications were similar to those previously reported. Long-term (1 year) survival of the horses discharged was 100%. CONCLUSION: The good prognosis for horses undergoing surgery for the treatment of sand impaction supports early surgical intervention in cases where large amounts of sand are suspected.     

Surgery: Short‐ and long‐term evaluation of surgical treatment of strangulating obstructions of the small intestine in horses: A review of 224 cases

Summary

A retrospective study was carried out of 224 horses operated for strangulating small intestine obstructions. Fifty‐four horses were euthanized and 5 horses died during surgery which means that 165 (73%) were allowed to recover. Of these, 53 horses were euthanized or died in the clinic and 112 (50%) were discharged from the hospital. Of 90 horses available for follow‐up 1 year postoperatively, 76 (84%) were still alive. The most important causes of death or reasons for euthanasia in the direct post‐operative period were post‐operative paralytic ileus, (adhesive) peritonitis and intra‐abdominal haemorrhage. After discharge from the hospital the reasons were (adhesive) peritonitis and (recurrent) colic. Of the horses which survived for at least 1 year, 16% sometimes suffered from colic, 12% experienced problems with incisional woundhealing and 4% suffered from jugular vein thrombosis. All were in good or reasonable condition and 88% performed at (approximately) the same level as before the operation.

The type of surgical intervention (i.e. enterotomy, enterectomy) did not significantly influence the outcome of surgery, whereas the type of anastomosis did. End‐to‐end jejunojejunostomy had a better prognosis than side‐to‐side jejunocaecostomy.

It was concluded that strangulating obstructions of the small intestine still carry a poor to guarded prognosis. Mortality was highest in the direct peri‐operative period. Once discharged from hospital, prognosis can be considered to be fair to good. Attempts to improve outcome should be directed at a better handling of the ileal stump during surgery and at the prevention of post‐operative ileus and the formation of adhesions.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 4: Early (acute) relaparotomy

REASONS FOR PERFORMING STUDY: Early (acute) relaparotomy after surgery for equine colic is widely considered to be an acceptable treatment option for management of certain post operative complications. However, there is relatively little published information about resulting complication rates and short- and long-term outcomes. OBJECTIVES: To document the proportions, indications, complication rates and survival rates of horses undergoing acute relaparatomy following colic surgery. METHODS: History, clinical findings, surgical findings and procedures, post operative treatments and outcome of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: Acute relaparotomy was performed in 27/254 horses (10.6%) that recovered from initial general anaesthesia. The indications for relaparotomy included persistent pain, persistent ileus, peritonitis and wound breakdown. Of these 27 horses, 21 (77.8%) recovered from the second surgery, of which 8 (29.6%) died during the immediate post operative period. Thirteen of the 27 horses (48.2%) were discharged. Of these 13 horses, 5 (38.5%) were re-admitted to the hospital for surgical treatment of a subsequent bout of colic. The long-term survival rate for the 27 horses that underwent relaparotomy was 22.2%. Colic following discharge after relaparotomy was recorded in 69.2% of cases. CONCLUSIONS: Relaparotomy is necessary in approximately 10% of horses undergoing surgery for acute colic. Persistent pain and post operative ileus were the most common indications. The short-term survival rate for horses requiring relaparotomy was approximately 50% and the long-term survival rate 22%. Nearly 40% of horses surviving relaparotomy developed episodes of acute colic that necessitated further surgery. POTENTIAL RELEVANCE: Owners of horses requiring early (acute) relaparotomy should be advised of the high complication rates for this procedure.