SIMULTANEOUS PRESENCE OF A DIRECT AND AN INDIRECT INGUINAL HERNIA IN A STALLION

SUMMARY: The case history, clinical findings, surgical procedure and post mortem results are described of a horse showing signs of colic which at surgery had both a direct and an indirect left inguinal hernia. The etiology of inguinal hernias in the horse and the surgical management of the direct inguinal hernia are discussed.     

The equine gastrosplenic ligament: Anatomy and clinical considerations

A gelding was referred for colic and inguinal wound evaluation. Abdominal ultrasound showed distended, oedematous and immotile small intestine abaxial to the spleen. An exploratory laparotomy revealed jejunal incarceration through a rent in the gastrosplenic ligament (GSL). The rent in the GSL was opened and surgical correction (resection and anastomosis of nonviable jejunum) performed. The GSL was left open. The horse recovered uneventfully and one year after surgery no further episodes of colic have been observed.     

Removal of a fragmented nasogastric tube from the transverse colon of a horse undergoing exploratory celiotomy for colic

This report describes the clinical course and surgical findings of a 5-year-old Warmblood gelding referred for colic with a previous history of intermittent colic episodes, and gastric ulcers diagnosed by gastroscopy in the preceding months. The horse underwent medical treatment but remained painful and surgery was elected. The horse underwent an exploratory laparotomy during which an impaction was identified in the transverse colon that was associated with an approximately 1 metre segment of nasogastric tube. The foreign body was removed via an enterotomy in the left dorsal colon, and the horse recovered well from surgery. No complications were encountered post-operatively.     

Partial gastrectomy and total splenectomy for the treatment of a gastric mass in a horse

A 9-year-old cob mare with a history of recurrent colic presented during an acute colic episode. Ultrasonography revealed a mass emanating from the greater curvature of the stomach and was tightly adhered to the cranial edge of the spleen. Partial gastrectomy and total splenectomy were performed via a midline celiotomy incision. The mass was subsequently confirmed to be granulomatous inflammation, postulated to be secondary to a penetrating injury to the stomach. Post-operatively, the mare had episodes of recurrent colic that were successfully managed with optimisation of the horse's diet and feeding regime. At 10 months’ post-operatively the mare was managed on full turn out, with no evidence of colic and had returned to the previous level of ridden work. The horse then presented 14 months post-operatively with severe colic due to a large colon impaction and displacement and was euthanased. This is the first report to describe successful partial gastrectomy as a treatment option for a gastric mass in the horse.     

A cross-sectional study of colic in horses on thoroughbred training premises in the British Isles in 1997

The aim of this study was to estimate the incidence of colic in horses in Thoroughbred training premises in 1997 in the British Isles. The seasonal pattern and outcome of colic episodes were also investigated, together with any association between premises level variables and colic. Data were collected by a postal questionnaire. The results showed a colic incidence density of 7.19/100 horse years (s.e. 0.42) and a cumulative incidence of colic of 5.80% (s.e. 0.30). Premises were grouped according to whether they had more Flat than National Hunt horses (Flat premises) or more National Hunt than Flat horses (NH premises). A similar rate of colic episodes was found in each group. However, significantly higher cumulative incidences of one episode of colic were found in the Flat premises and of multiple episodes in the NH premises, respectively. The outcome of each episode of colic showed spontaneous recovery in 28.7%, medical recovery in 63.1%, surgical recovery in 2.0% and death in 6.2% of cases. This indicated an overall mortality rate from colic of 0.45 deaths/100 horse years. The seasonal pattern of episodes of colic showed a spring and autumn peak, with significant differences in the seasonal pattern between the Flat and NH premises. Relative risk analysis and logistic regression modelling with random effects showed significant associations between the number of episodes of colic and the number of horses on the premises (allowing for the number of horses on each premises, the larger premises had a decreased risk of colic). After adjusting for the number of horses, 3 other variables were associated with colic; Flat premises (with an increased risk), the owner being the sole person looking after the horses (a decreased risk) and the premises being a combined training and breeding establishment (a decreased risk).     

Transrectal decompression as a new approach for treatment of large intestinal tympany in horses with colic: Preliminary results

A common feature of colic in horses is tympany in the large intestine and medical treatment of this condition can be unsuccessful. In this article we describe and evaluate a new approach for decompression of large intestinal tympany in equine colic patients using transrectal puncture. We evaluated horses showing colic symptoms and colonic or caecal tympany and the final diagnosis, complications and final outcome were recorded for each horse. A special transrectal decompression device (TDD) was developed and used to perform transrectal decompression (TD) by gas aspiration. In order to assess pain reduction as a result of TD, heart rate (HR) was recorded before and after the decompression procedure. Twenty‐five horses were included in the study. In 17 cases, tympany was recognised as primary in origin while in 8 it was secondary to other conditions. A total of 33 TDs were performed and no horses developed short‐ or long‐term complications. All horses were alive after the first month post TD, while 5 died from diseases not related to TD. The TD could safely and easily be performed in all horses presenting tympany. Transrectal decompression can easily be performed, 2 or even 3 times to treat a single colic episode by using the transrectal device connected to a surgical aspirator. It was not possible from available information to relate the timing of HR decrease to resolution of colic or to administration of drugs because a retrospective study and all such data were not readily accessible. Our clinical results support the relevance of the TD as an elective treatment of primary large intestinal tympany, emergency treatment of tympany secondary to other surgical entities and as palliative treatment in surgical patients, in which surgery could not be achieved.     

Technical note: a 2-stage cecal cannulation technique in standing horses

Cecal cannulation is necessary for sampling of intestinal contents for a variety of nutritional or digestive physiology studies. This report describes a 2-stage technique for permanent cecal cannulation in standing horses. For the first procedure, a right flank laparotomy is performed and a small pouch of the cecal base exteriorized and sutured to the body wall. The second procedure is performed approximately 1 wk later. During the second procedure, the exposed cecal pouch is removed and the cannula inserted. Ten horses were cannulated using this technique. After the first procedure, 1 horse developed a cecal impaction unresponsive to medical therapy and ruptured its cecum, whereas 2 other horses developed mild transient colic that responded to medical management. Insertion of the cecal cannula after creation of the stoma in the second procedure resulted in transient colic in 4 of 9 horses, but they responded to analgesic therapy in less than 24 h in all instances. The time to complete healing of the cannula site was approximately 30 d. The technique described in this report decreases the risk of peritonitis due to intestinal leakage and is technically easier to perform than previously described techniques.     

Surgical Treatment of an Abdominal Abscess Caused by a Migrating Iron Wire From the Ventral Colon,a Case Report

A 13-year-old mare presented for evaluation of recurrent colic episodes. The horse was diagnosed with a mass within the spleen at the ultrasound examination of the abdomen; the levels of Serum Amyloid A and the fibrinogen were high and so a presumptive diagnosis of an abscess involving the spleen was made base on clinical, ultrasonographic and laboratory findings and it was decided to perform n exploratory laparotomy for a definitive diagnosis and possible treatment. Upon abdominal exploration a mass involving the spleen, the lateral wall of the ventral colon adherent to the left abdominal wall was diagnosed and with an intraoperative ultrasound examination a linear hyperechoic foreign body was diagnosed within the mass. It was removed through an enterotomy of the left ventral colon that allowed the digital exploration of the mass without spilling of pus within the peritoneal cavity. The horse was discharged and the long term follow-up revealed no complications and no more signs of abdominal pain.     

Successful small intestinal resection and anastomosis in a late term broodmare with colic via a standing left flank laparotomy

A late term broodmare presented with low‐grade intestinal colic. Clinical findings were consistent with a small intestinal lesion requiring surgical intervention. The risks of general anaesthesia to the fetus, combined with clinical findings in an otherwise quiet natured horse influenced the decision to choose an alternative standing left flank approach first. A small intestinal resection and anastomosis was performed successfully and the mare delivered a healthy foal without complications a month later. Standing colic surgery might be a preferred alternative to general anaesthesia in certain circumstances as discussed in this case report.     

Acute myelomonocytic leukemia in a horse

A 7-year-old Quarter Horse stallion with a myeloproliferative disorder was examined because of colic, and an enterolith was removed surgically. The horse experienced secondary complications after abdominal surgery, and leukopenia and thrombocytopenia were detected. Five months later, the horse was examined for recurrent peripheral edema and for repair of an abdominal incisional hernia. Acute myelomonocytic leukemia was diagnosed, and treatment with low-dose (noncytocidal) cytosine arabinoside was unsuccessful. Necropsy revealed neoplastic infiltrate in the spleen, liver, lung, adrenal gland, testes, and eye. The persistent hematologic abnormalities before the onset of overt leukemia may represent hematopoietic dysplasia or preleukemia.     

Chronic intestinal pseudo-obstruction in a horse: a case of myenteric ganglionitis

An 11-year-old Quarter horse mare was presented for recurrent episodes of colic. A chronic intestinal pseudo-obstruction was diagnosed. Medical treatment and surgical resection of the colon were performed but the condition did not improve and the horse was euthanized. Histopathological examination revealed a myenteric ganglionitis of the small intestine and ascending colon.     

Use of Ultrasound In Horses for Diagnosis of Left Dorsal Displacement of the Large Colon and Monitoring its Nonsurgical Correction

During a 28 month period, 82 horses with clinical signs of abdominal pain were examined for left dorsal displacement of the large colon (LDDLC) using percutaneous ultrasound. Left dorsal displacement of the large colon was diagnosed when a gas echo dorsal to the spleen obliterated the dorsal splenic border, or when the colon was observed lateral to the spleen. In 42 horses, ultrasound confirmed a diagnosis of LDDLC and 40 horses had no evidence of LDDLC. There were five false negative results and no false positives. In four horses with LDDLC, the colon was displaced between the spleen and body wall; three of these colic episodes resolved with medical therapy and the fourth required a celiotomy to relieve a sand impaction. The remaining 38 horses had a renosplenic entrapment; surgical correction was elected in 4 horses, 21 horses were corrected by a nonsurgical rolling procedure, 12 were corrected at surgery after an unsuccessful rolling attempt, and one was corrected by rolling but required surgery later because of an additional lesion. Percutaneous abdominal ultrasound was a valuable aid in the diagnosis of LDDLC and in confirming correction of the displacement after a nonsurgical rolling procedure.     

Successful treatment of a splenic abscess secondary to migrant metallic wires in a horse

This case report discusses a successful partial splenectomy for treatment of a splenic abscess in a horse. A 2-year-old Thoroughbred colt was hospitalised 5 weeks after an episode of severe colic that was followed by gradual weight loss and anorexia, pyrexia for 5 days and dehydration on the day of referral. A large splenic abscess was identified ultrasonographically. Following initial medical treatment, an exploratory laparotomy was performed. Multiple adhesions were released and a partial splenectomy conducted to remove the abscess. Migrant metallic wires penetrating from the small intestine into the splenic parenchyma were found to be the cause for the adhesions and the abscess. This paper summarises the potential advantages of utilising a partial vs. a total splenectomy and highlights the potential complications of these surgical procedure in equines.     

Diaphragmatic herniation in the horse: 31 cases from 2001-2006

Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46% for those cases for which surgical management was elected.     

Cecocolic intussusception in a horse

A 10-month-old 160 kg bilateral cryptorchid Quarter Horse was presented for acute colic and profuse diarrhea. The horse was a bottle-raised orphan with stunted growth, a pot belly and a rough hair coat. The colt had been on a good deworming program and had a hearty appetite until the onset of colic. Economic considerations prohibited a thorough laboratory evaluation and surgical intervention.     

Indications, surgical technique, and long-term experience with laparoscopic closure of the nephrosplenic space in standing horses

OBJECTIVE: To describe surgical technique and outcome after laparoscopic closure of the nephrosplenic space for treatment of recurrent left dorsal displacement of the left colon (LDDLC) in standing horses. STUDY DESIGN: Retrospective study. ANIMALS: Forty-four horses with LDDLC. METHODS: Laparoscopic portals were located in the left flank region. After administration of etilefrin intravenously to contract the spleen, the dorsal splenic margin was sutured to the nephrosplenic ligament to obliterate the nephrosplenic space. Horses were re-examined (< or = 3 years) for history of recurrence. In addition, medical records of 4,852 horses treated for colic over 16 years were evaluated to establish incidence of LDDLC and recurrence after treatment. RESULTS: Splenic contraction facilitated suture placement and closure of the nephrosplenic space was achieved without complications. LDDLC recurrence did not occur although 5 horses had subsequent episodes of colic; 4 horses had displacement of the ascending colon between the spleen and body wall. Review of medical records revealed an incidence of LDDLC of 6% and recurrence of 21% in a population of horses with signs of colic. CONCLUSION: Laparoscopic closure of the nephrosplenic space, facilitated by etilefrin-induced splenic contraction can be efficiently performed in standing horses. CLINICAL RELEVANCE: Laparoscopic ablation of the nephrosplenic space should be considered in horses that are predisposed to recurrent LDDLC.     

Emphysematous gastritis in a horse

A 12-year-old Morgan gelding was examined for colic of 3 days duration. Signs of depression, colic, diarrhea, and endotoxemia persisted despite aggressive medical therapy and surgical exploration. Culture results from gastric fluid and feces yielded many colonies of Clostridium perfringens. This organism also was recovered from peritoneal fluid 10 days after admission; consequently, the horse was euthanized. At necropsy, a localized gas-filled, necrotic stomach wall was found; many mucosal and submucosal gas blebs were visible. Culture of this tissue yielded Clostridium perfringens. Emphysematous gastritis is a fulminant infection of the stomach wall caused by gas-forming organisms that gain access to the submucosa via mucosal defects such as ulcers. This condition has been reported infrequently in people, and the case reported herein represents the first instance of emphysematous gastritis in the horse.     

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.     

Fifty years of colic surgery

Colic surgery is one of few treatments in which a veterinarian can use a skill to save an animal's life from a deadly disease within a short timeframe. Unfortunately, such success is not achieved without considerable risk for surgical failure, which is responsible for most complications in the immediate post‐operative period. The last 50 years have witnessed considerable improvements in colic surgery, although a ranking of the most important ones might not meet with universal agreement. Teamwork plays a critical role in the final outcome, starting and finishing with the referring veterinarian and owner. These individuals are responsible for promptly transferring the horse to a surgical facility and then dealing with aftercare and delayed complications. The surgeon is responsible for the intervening steps, including the decision on the need for surgery, and works with the anaesthesiologist to help a metabolically challenged patient to tolerate surgery and anaesthesia. Although early referral and improved diagnostic procedures can have a positive influence on survival, perceived improvements in surgery and anaesthesia need to be reviewed with some circumspection. Although more rigorous definitions and statistical analyses used in recent studies can invalidate comparisons with older studies, complication rates appear to be on the rise, despite putative improvements in dealing with them. This trend tends to diminish the value of colic surgery through increasing costs, overreliance on post‐operative pharmacological management, growing pessimism, high rates of intraoperative euthanasia, and possibly reduced long‐term survival. Future efforts should address these concerns, mostly through emphasis on prompt referral, good surgical technique and reducing the cost of colic surgery to an affordable level that saves more lives.     

Effect of Omentectomy on Adhesion Formation in Horses

Objective —To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions. Study Design —Retrospective study. Animals or Sample Population—44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery. Methods —Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model. Results —Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P= .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P= .001) than the frequency only in the large intestine. Conclusions —Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine. Clinical Relevance —Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.