Bacterial Culturing of Ventral Median Celiotomies for Prediction of Postoperative Incisional Complications in Horses

Objective - The purpose of this study was to determine whether detection of bacterial contamination of ventral midline incisions was predictive of postoperative incisional complications in horses undergoing exploratory celiotomy for colic. Study Design - Prospective study. Animal or Sample Population - Horses that had ventral median celiotomies for colic at Colorado State University between May 1, 1991 and April 30, 1993 were studied prospectively. Complete information was obtained on 66 horses. Methods - Bacterial cultures were obtained from ventral midline incisions at surgery. Information regarding the type of surgery performed (celiotomy vs celiotomy plus enterotomy or enterectomy), preoperative total nucleated cells and presence of a left shift, postoperative fever (>38.5°C), incisional drainage, incisional herniation, and outcome were obtained from medical records. Additional information concerning incisional drainage, herniation, and survival was obtained at a minimum of 18 months after surgery. Results - Examination of odds ratio (ORs) and confidence intervals (CIs) revealed that a celiotomy plus enterotomy or enterectomy was positively, but not significantly, associated (OR > 1) with positive culture results, presence of incisional drainage and incisional herniation. A significant association between incisional drainage and hernia formation was found; odds of incisional herniation were 62.5 times greater in horses that had incisional drainage. Incisional drainage and herniation were negatively associated with patient survival. The later association was significant (OR = 0.18, P=.04). Conclusions - This study indicated that detection of bacterial contamination at incisional closure by the swab culture technique was not beneficial in the prediction of postoperative incisional problems in horses undergoing colic surgery. Incisional drainage or infection appeared to be associated with hernia formation. Clinical Relevance - Immediate treatment of incisional drainage or methods to prevent incisional infections may decrease hernia formation.     

Serum and peritoneal fluid phosphate concentrations as predictors of major intestinal injury associated with equine colic

To determine the reliability with which inorganic phosphorus (phosphate) concentrations can be used to predict major intestinal injury associated with equine colic, phosphate concentrations were measured in serum, peritoneal fluid, or both from 9 clinically normal adult horses (group A), 37 horses successfully managed medically for signs of abdominal pain (group B), 26 horses with signs of abdominal pain and undergoing exploratory laparotomy without intestinal resection (group C), and 26 horses undergoing intestinal resection or euthanasia for extensive intestinal lesions (group D). Peritoneal fluid phosphate concentration was significantly greater in horses in group D (mean, 4.58 +/- 0.34 mg/dl) than in horses in group A (mean, 2.78 +/- 0.21 mg/dl), group B (mean, 2.92 +/- 0.27 mg/dl), and group C (mean, 2.98 +/- 0.28 mg/dl; P less than or equal to 0.01). Serum phosphate concentration was significantly greater in horses in group D (mean, 3.87 +/- 0.30 mg/dl) than in horses in group A (mean, 2.73 +/- 0.22 mg/dl), group B (mean, 2.80 +/- 0.21 mg/dl), and group C (mean, 2.78 +/- 0.22 mg/dl); P less than or equal to 0.05). There was significant (P less than or equal to 0.001) correlation between serum and peritoneal fluid phosphate concentrations within each group and when pairs from all groups were pooled. When peritoneal fluid phosphate concentrations exceeded 3.6 mg/dl, intestinal lesions requiring resection or euthanasia were predicted with sensitivity of 77% and specificity of 76%. When serum phosphate concentrations exceeded 3.3 mg/dl, such lesions were predicted with sensitivity of 60% and specificity of 73%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Castration on Peritoneal Fluid in the Horse

Twenty-four clinically normal horses were castrated by routine methods. Peritoneal fluid was collected prior to castration and at 1, 3, 5, and 7 days postcastration. Peritoneal fluid was collected on days 9 and 11 if nucleated cell (NC) counts were still markedly elevated on day 7. Peritonitis, defined as NC counts greater than 10,000/microliters, was evident in 15 horses following castration. Mean NC counts peaked on day 5 but were less than 10,000/microliters for 74% of the horses by day 7, and 90% of the horses by day 9. One horse had a NC count greater than 60,000/microliters on day 11 when sampling ended. Postcastration peritoneal fluid was obviously blood-tinged in 21 horses. Peak RBC counts occurred on day 3 but markedly decreased by day 5. Elevated peritoneal RBC counts correlated well with elevated NC counts (P less than 0.001). Horses with peritonitis tended to have fever (P less than 0.05). Other clinical signs of peritonitis were not apparent.     

Effects of continuous rate intravenous infusion of butorphanol on physiologic and outcome variables in horses after celiotomy

A randomized, controlled, blinded clinical trial was performed to determine whether butorphanol administered by continuous rate infusion (CRI) for 24 hours after abdominal surgery would decrease pain and surgical stress responses and improve recovery in horses. Thirty-one horses undergoing exploratory celiotomy for abdominal pain were randomly assigned to receive butorphanol CRI (13 microg/kg/h for 24 hours after surgery; treatment) or isotonic saline (control). All horses received flunixin meglumine (1.1 mg/kg IV q12h). There were no significant differences between treatment and control horses in preoperative or operative variables. Treatment horses had significantly lower plasma cortisol concentration compared with control horses at 2, 8, 12, 24, 36, and 48 hours after surgery. Mean weight loss while hospitalized was significantly less for treatment horses than control horses, whether expressed as total decrease in body weight (13.9+/-3.4 and 27.9+/-4.5 kg, respectively) or as a percentage decrease in body weight (2.6+/-0.7 and 6.3+/-1.1%, respectively). Treatment horses were significantly delayed in time to first passage of feces (median times of 15 and 4 hours, respectively). Treatment horses had significantly improved behavior scores during the first 24 hours after surgery, consistent with the conclusion that they experienced less pain during that time. Butorphanol CRI during the immediate postoperative period significantly decreased plasma cortisol concentrations and improved recovery characteristics in horses undergoing abdominal surgery.     

Using red blood cell creatine concentration to evaluate the equine erythropoietic response

Red blood cell creatine concentration was examined to determine its association with the equine erythropoietic response. Studies were conducted on 9 healthy horses, 4 healthy ponies, 24 anemia horses, and 2 horses in which anemia was experimentally induced. A modified Jaffe reaction was used to measure RBC creatine concentration. The mean RBC creatine concentration of the 9 healthy horses was 5.72 +/- 0.42 mg/dl, and that of the 4 healthy ponies was 2.59 +/- 0.31 mg/dl. Density-separation of erythrocytes from the healthy horses revealed significantly higher (P less than 0.001) creatine content (7.72 +/- 0.57 mg/dl) in the young RBC populations than in the old RBC populations (4.03 +/- 0.27 mg/dl). The RBC creatine content was assayed in 19 hot-blooded horses which were anemic due to a variety of causes. Of these anemic horses, 12 with PCV between 25% and 30% had a mean RBC creatine concentration of 6.12 +/- 0.46 mg/dl. The 7 other anemic horses with PCV less than 25% had a mean RBC creatine value of 6.07 +/- 0.12 mg/dl. Bone marrow films were examined from 5 anemic horses and in the 2 horses in which anemia was experimentally induced. The RBC creatine concentration correlated positively (P less than 0.001) with the reticulocyte count in the bone marrow and negatively with the myeloid-erythroid ratio (P less than 0.001).     

Medical and surgical management of small-colon impaction in horses: 28 cases (1984-1989).

Medical records of 28 horses with impaction of the small colon were reviewed; 20 horses were admitted during the winter months. Diagnosis of small-colon impaction was made in 21 horses by rectal examination, and in 7 horses at exploratory celiotomy. Ten horses were treated medically, and 18 were treated surgically. Horses that were treated surgically were more likely to have abdominal distention than were those that responded to medical treatment (P less than 0.025). Signs of greater degree of abdominal pain and higher heart rate were seen in horses treated surgically, but these values were not significantly different from values in medically treated horses. Duration of hospitalization was less in horses treated medically (P less than 0.025). Long-term survival was higher for horses treated medically (P less than 0.025). All horses treated medically and 7 of the horses treated surgically were alive at follow-up evaluation, at least 1 year after discharge. Fever and diarrhea were common complications after surgery. Four horses were fecal culture-positive for Salmonella sp after surgery. Early and aggressive medical management of horses with impaction of the small colon is recommended.     

Strangulating volvulus of the ascending colon in horses

Of 57 horses with strangulating volvulus of the ascending colon, 42 were mares (including 21 postparturient mares), 8 were stallions, and 7 were geldings. Volvulus occurred most frequently in the summer (n = 24) and spring (n = 17). Pain was evaluated as severe in 41 horses, moderate in 9, and mild in 4. The abdominal fluid from 30 horses varied from clear yellow in 19 horses, to cloudy yellow in 3 horses, and serosanguineous in 8 horses. Protein content and nucleated cell count in the abdominal fluid were 2.5 +/- 1 g/dl and 1,000 +/- 900 microliters, respectively. Fifty horses had greater than or equal to 360 degrees volvulus and 7 had a 270 degrees volvulus, with 49 occurring in a counterclockwise direction. The site of volvulus in all horses was at the mesenteric attachment of the colon, except for a 360 degrees volvulus at the sternal and diaphragmatic flexures in 1 horse. Survival rates for horses with a greater than or equal to 360 degrees and a 270 degrees volvulus were 36% and 71%, respectively. The difference in survival rates reflected the severe vascular occlusion in the colon of horses with greater than or equal to 360 degrees volvulus. In nonsurvivors, hemorrhage in the submucosa and lamina propria (P less than 0.005) and edema in the submucosa (P less than 0.01) were greater than those in survivors. In nonsurvivors, greater than 97% of the superficial epithelium was lost. In horses that survived, only 60% of the cells were lost or degenerated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical and postoperative factors influencing short-term survival of horses following small intestinal resection: 92 cases (1994-2001)

Although short-term survival rates following small intestinal resection reportedly range from 48-88%, there is little information on predicting which horse may or may not survive small intestinal (SI) resection and anastomosis. The aim of this study was to identify factors that contribute to nonsurvival in horses following small intestinal resection. Medical records of horses which recovered from anaesthesia following SI resection were reviewed. Clinical and surgical variables were evaluated for their association with short-term survival using logistic regression and were reported as odds ratios (OR), including the 95% confidence interval (CI), indicating the likelihood of horses not surviving to hospital discharge. Ninety-two records met the criteria for inclusion. Thirty-six (81.8%) of the horses that underwent jejunojejunostomy (JJ) and 34 (70.8%) of the horses that underwent jejunocaecostomy (JC) survived to discharge. Multiple logistic analysis indicated that postoperative ileus (OR = 29.7; 95% CI 2.5-354.6), repeat celiotomy (OR = 18; CI 1.7-187.6), and an elevated heart rate of > or = 60 beats/min (OR = 5.6; CI 1.5-20.6) were the principal factors associated with nonsurvival. A low total plasma protein of <55 g/l (OR = 1.8; CI 0.-7.6) was incorporated in the final model because its inclusion improved the overall validity of the model, Clinicians should be aware of the factors associated with the greatest likelihood of nonsurvival following small intestinal resection, so that they can institute aggressive treatment and accurately inform owners on the likelihood of survival.     

Serum Levels of Type III Procollagen Peptide in Equidae before and after Intestinal Ischemia

Serum levels of type III procollagen peptide (P-III-P) were measured by radioimmunoassay in clinically normal adult ponies (n = 15) and horses (n = 10). The mean serum levels of P-III-P from the ponies, 10.4 +/- 2.9 (SD) ng/mL, and the horses, 12.2 +/- 2.6 (SD) ng/mL, were not significantly different. Segments of jejunum were made ischemic to induce fibrous peritoneal adhesions in two ponies, and serum P-III-P levels were measured on days 4, 5, 7, 14, and 21. An exploratory celiotomy on day 21 revealed that the ischemic injury had induced fibrosis of the mesentery and bowel, but no adhesions had formed. The fibrotic mesentery contained type III collagen. The highest mean serum level of P-III-P, 23.0 +/- 3.5 (SD) ng/mL on day 7, was more than 4 SD above the mean from the normal ponies. There was a significant difference in the serum P-III-P levels in the ponies on days 0 (7.1 +/- 1.6 ng/mL) and 7 (23.0 +/- 3.5 ng/mL). Serum levels of P-III-P may be useful to study fibrosis associated with intestinal ischemia.     

Serum tumor necrosis factor activity in horses with colic attributable to gastrointestinal tract disease.

Over a 24-month period, serum tumor necrosis factor (TNF) activity was determined in 289 horses with colic attributable to gastrointestinal tract disease. Serum TNF activity was quantitated by use of a modified in vitro cytotoxicity bioassay, using WEHI 164 clone-13 murine fibrosarcoma cells. Causes for colic, determined by clinical and laboratory evaluation, exploratory celiotomy, or necropsy included: gastrointestinal tract rupture (GTR); ileal impaction; small intestinal strangulating obstruction (SIO); proximal enteritis (PE); transient small intestinal distention; large-colon displacement; large-colon volvulus; large-colon impaction; colitis; small-colon obstruction; peritonitis; and unknown. Each diagnosis was placed into 1 of 3 lesion categories: inflammatory disorders (GTR, PE, colitis, peritonitis); strangulating intestinal obstruction (SIO, large-colon volvulus); and nonstrangulating intestinal obstruction (ileal impaction, transient small intestinal distension, large-colon displacement, large-colon impaction, small-colon obstruction, unknown). The prevalence of high serum TNF activity and/or mortality were evaluated. Differences were tested at significance level of P less than 0.05. Approximately 20% of the 289 horses has serum TNF activity greater than that found in clinically normal horses (greater than 2.5 U/ml). Twenty-three horses (8%) had marked increase in serum TNF activity (greater than or equal to 10 U/ml) which was more prevalent among horses with SIO and PE than in horses of other diagnostic groups, except those with GTR. Mortality and marked increase in serum TNF activity were greater in horses with intestinal inflammatory disorders or strangulating intestinal obstruction than in horses with nonstrangulating intestinal obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abdominal adhesions after small intestinal surgery in the horse

One hundred thirteen of 172 horses (66%) undergoing exploratory celiotomy for a small intestinal lesion survived 4 or more days after surgery. Intra-abdominal adhesions causing clinical problems requiring additional surgery or euthanasia were documented in 25 horses (22.1%). Problems developed in significantly more males than females. The most common initial small bowel lesion was ileal impaction (12 horses); 21 horses underwent small intestinal resection or bypass. However, there was no significant difference in the incidence of intra-abdominal adhesions between horses that underwent intestinal resection or bypass and those that did not. Only 4 of the 25 horses (16%) with problems associated with postoperative adhesions survived. The mean interval between surgical procedures or between the initial procedure and euthanasia for all horses was 84 days (range, 7-512 days; median, 25 days). However, 70% of the subsequent celiotomies were performed within 60 days of the previous surgery. The mean interval between celiotomies was 221 days (range, 9-512 days) for the survivors and 61 days (range, 7-358 days) for the nonsurvivors. These results indicated that most of the problems related to postoperative intra-abdominal adhesions occurred within 2 months of the initial small intestinal surgery. Furthermore, the earlier development of postoperative adhesions was associated with a poorer prognosis for survival.     

Characteristics of cerebrospinal fluid associated with canine granulomatous meningoencephalomyelitis: a retrospective study

Cerebrospinal fluid of 22 dogs with histologically confirmed granulomatous meningoencephalomyelitis was analyzed, retrospectively. Seventeen dogs had cisternal CSF analysis, 4 dogs had lumbar CSF analysis, and 1 dog had both. For cisternal CSF, the mean +/- SEM total WBC count was 800.8 +/- 300.9 cells/microliter. The WBC differential count was predominantly lymphoplasmacytic cells, but 13 of the 18 cisternal CSF had polymorphonuclear (PMN) cells, and the mean +/- SEM PMN cell percentage was 18.6 +/- 5.3%. The mean +/- SEM total protein content of cisternal CSF was 255.8 +/- 98 mg/dl. Of 5 cisternal CSF pressures measured, 4 were within the normal range. The mean +/- SEM total WBC count and total protein content of lumbar CSF were 533.4 +/- 256.5 cells/mu/microliter and 163.2 +/- 25 mg of protein/dl, respectively. As with cisternal CSF, the WBC differential count of lumbar CSF was predominantly lymphoplasmacytic cells. Of 5 lumbar CSF, 4 contained PMN cells, but the percentage was less than the PMN cell percentage of cisternal CSF. Although variable, the general pattern of CSF abnormality associated with granulomatous meningoencephalomyelitis was different from the CSF abnormalities commonly seen with viral, bacterial, or mycotic encephalitides.     

Jejunoileal anastomosis following small intestinal resection in horses: seven cases (1999-2001)

OBJECTIVE: To report the postoperative outcome in horses undergoing jejunoileal anastomosis performed with a 2-layer simple continuous technique. DESIGN: Retrospective study. ANIMALS: 7 horses. PROCEDURE: Information regarding signalment, clinical signs, findings at surgery, and postoperative complications was obtained from medical records of horses that underwent exploratory ventral midline celiotomy, small intestinal resection, and jejunoileal anastomosis to correct various small intestinal strangulating lesions. Follow-up information was obtained via telephone conversations with owners or trainers. RESULTS: Six males and 1 female of various breeds aged 10 months to 27 years and weighing 312 to 785 kg (686.4 to 1,727 lb) were included. The most common complications were mild to moderate tachycardia and mild to moderate signs of abdominal pain. Two horses developed incisional infections and soft, fluctuant swelling at the incision site following resolution of the infection. Follow-up time ranged from 7 to 17 months after surgery. Owners reported no further colic episodes and no diet change necessary following surgery. All horses had returned to their intended level of use. CONCLUSIONS AND CLINICAL RELEVANCE: Advantages to the jejunoileal technique include maintaining the normal ileocecal valve and a postoperative recovery period similar to that described following other small intestinal anastomoses. Jejunoileal anastomosis is a viable alternative to ileal bypass. This technique appears to result in a postoperative complication rate similar to that reported following jejunojejunostomy procedures.     

A rostrocaudal gradient for neurotransmitter metabolites and a caudorostral gradient for protein in canine cerebrospinal fluid

Neurotransmitter metabolites (dihydroxyphenylacetic acid [DOPAC], homovanillic acid [HVA], and 5-hydroxyindoleacetic acid [5-HIAA]) in CSF of 10 healthy dogs were evaluated with reverse-phase high-pressure liquid chromatography and electrochemical detection. Neurotransmitter metabolite concentrations determined in CSF collected from the cisterna magna were compared with those values in CSF collected from the lumbar dorsal subarachnoid space. Amounts of DOPAC (P = 0.0444), HVA (P = 0.0001), and 5-HIAA (P = 0.0316) were significantly lower in lumbar spinal fluid compared with those values in the cervical spinal fluid. Metabolite concentrations in cervical and lumbar CSF were: DOPAC = 2.81 +/- 0.73 ng/ml of CSF and 1.28 +/- 0.57 ng/ml; HVA = 98.29 +/- 12.42 ng/ml and 4.68 +/- 1.61 ng/ml; and 5-HIAA = 46.29 +/- 8.17 ng/ml and 36.96 +/- 4.07 ng/ml, respectively. Cytologic evaluations of cervical and lumbar CSF revealed a similar concentration of 3 +/- 1 WBC/microliters in both fluids. A significant (P = 0.0002) difference in protein concentration between the 2 regions was observed, with 16.1 +/- 1.8 mg of protein/dl in the cervical CSF and 27.2 +/- 2.3 mg of protein/dl in the lumbar CSF. Between the cisterna magna and lumbar dorsal subarachnoid space of dogs, a rostrocaudal gradient existed for neurotransmitter metabolites, and a caudorostral gradient existed for protein.     

Effects of blood contamination on equine peritoneal fluid analysis.

Peritoneal fluid and blood was collected from 8 healthy adult horses. Four 1-ml aliquots of peritoneal fluid from each horse were then contaminated with 0 ml (normal), 0.05 ml (1 drop), 0.10 ml (2 drops), and 0.20 ml (4 drops) of blood from the same horse. Samples were analyzed for RBC count, nucleated blood cell count, total protein concentration, and nucleated cell differential count. Statistical analysis revealed no significant changes in nucleated cell number, nucleated cell differential, or total protein concentration in peritoneal samples contaminated with blood. The RBC count significantly increased with blood contamination. It was concluded that up to 17% blood contamination of peritoneal fluid in clinically normal horses did not significantly alter interpretation of the nucleated cell count or protein concentration.     

Comparison of duodenitis/proximal jejunitis and small intestinal obstruction in horses: 68 cases (1977-1985)

Sixty-eight horses with colic caused by small intestinal disease were allotted into 2 groups of 34 on the basis of recorded findings during exploratory celiotomy, necropsy, or response to medical treatment alone. Signalment, history, physical examination findings, and laboratory findings were compared between the group of horses with small intestinal obstruction and the group with duodenitis/proximal jejunitis. A significantly greater proportion of horses with duodenitis/proximal jejunitis were older than 2 years old (P less than 0.05). Differences in sex or breed distribution, or in seasonality of the 2 disease syndromes were not observed. Horses with duodenitis/proximal jejunitis had significantly greater signs of depression than those with small intestinal obstruction (P less than 0.01), and horses with small intestinal obstruction had significantly greater signs of abdominal pain (P less than 0.05). The mean heart and respiratory rates were significantly lower (P less than 0.01) and the volume of nasogastric reflux was significantly greater (P less than 0.05) in the group of horses with duodenitis/proximal jejunitis. Sections of small intestine that were palpable per rectum were less distended and there were more auscultable borborygmi in horses with duodenitis/proximal jejunitis, compared with those with small intestinal obstruction (P less than 0.05 and P less than 0.01). The group of horses with duodenitis/proximal jejunitis had lower mean plasma potassium and higher mean plasma bicarbonate concentrations (P less than 0.05) than the group with small intestinal obstruction. The mean nucleated cell count and total protein concentration of peritoneal fluid specimens were significantly less in the group with duodenitis/proximal jejunitis (P less than 0.01); however, these values were greater than normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of and Risk Factors for Postoperative Ileus after Small Intestinal Surgery in Two Hundred and Thirty-Three Horses

Objectives— To determine the incidence of postoperative ileus (POI) in a population of horses after small intestinal surgery and the effect of multiple variables on development of POI.
Study Design— Case series.
Animals— Horses (n=233) aged ≥1 year that had exploratory celiotomy for small intestinal disease that recovered from surgery from 1995 to 2005.
Methods— Sixty-eight variables were collected from medical records (1995–2005) for each horse. POI was defined as nasogastric reflux volume >20 L over 24 hours or >8 L at any single time after surgery.
Results— Twenty-seven percent (64/233) of horses developed POI; 29 of 64 (46%) horses with POI had duodenitis proximal jejunitis (DPJ). When no intestinal resection was required at surgery, excluding horses with DPJ, 15% of horses had POI; 30% horses had POI after intestinal resection. Ten percent of horses had POI for >24 hours. When horses with DPJ were excluded, factors associated with increased risk of POI included high packed cell volume at hospital admission ( P =.024), increasing age ( P =.0004), and length of intestinal resection ( P =.05).
Conclusions— Risk factors for POI in this study were nonspecific although horses with intestinal resection are at higher risk compared with horses without intestinal resection.
Clinical Relevance— Predicting with certainty which cases will develop POI remains elusive.     

Effect of an external nasal dilator strip on cytologic characteristics of bronchoalveolar lavage fluid in Thoroughbred racehorses

OBJECTIVE: To determine the effects of an external nasal dilator strip on cytologic characteristics of bronchoalveolar lavage (BAL) fluid in racing Thoroughbreds. DESIGN: Clinical trial. ANIMALS: 23 Thoroughbred racehorses in active training. PROCEDURE: Each horse raced on 2 occasions: once while wearing an external nasal dilator strip and once while not. Bronchoalveolar lavage was performed 12 to 18 hours after each race, and BAL fluid was analyzed for RBC and leukocyte counts and hemosiderin content. RESULTS: Mean +/- SEM count of RBCs in BAL fluid when horses raced without the nasal dilator strip (84.6 +/- 275 cells/microL) was not significantly different from count when they raced with it (41.7 +/- 12.2 cells/microL). Horses were grouped as having mild or severe bleeding on the basis of RBC count in BAL fluid after horses raced without the nasal dilator strip. Mean count when horses with severe bleeding raced without the nasal dilator strip (271.0 +/- 63.7 cells/microL) was significantly higher than mean count when these horses raced with the strip (93.8 +/- 376 cells/microL). Mean count of lymphocytes in BAL fluid was significantly lower after horses raced with the external nasal dilator strip. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that use of an external nasal dilator strip in Thoroughbred racehorses may decrease pulmonary bleeding, particularly in horses with severe exercise-induced pulmonary hemorrhage.     

Abdominal Adhesions after Small Intestinal Surgery in the Horse

One hundred thirteen of 172 horses (66%) undergoing exploratory celiotomy for a small intestinal lesion survived 4 or more days after surgery. Intra-abdominal adhesions causing clinical problems requiring additional surgery or euthanasia were documented in 25 horses (22.1%). Problems developed in significantly more males than females. The most common initial small bowel lesion was ileal impaction (12 horses); 21 horses underwent small intestinal resection or bypass. However, there was no significant difference in the incidence of intra-abdominal adhesions between horses that underwent intestinal resection or bypass and those that did not. Only 4 of the 25 horses (16%) with problems associated with postoperative adhesions survived. The mean interval between surgical procedures or between the initial procedure and euthanasia for all horses was 84 days (range, 7–512 days; median, 25 days). However, 70% of the subsequent celiotomies were performed within 60 days of the previous surgery. The mean interval between celiotomies was 221 days (range, 9–512 days) for the survivors and 61 days (range, 7–358 days) for the nonsurvivors. These results indicated that most of the problems related to postoperative intra-abdominal adhesions occurred within 2 months of the initial small intestinal surgery. Furthermore, the earlier development of postoperative adhesions was associated with a poorer prognosis for survival.     

Evaluation of a bioresorbable hyaluronate-carboxymethylcellulose membrane for prevention of experimentally induced abdominal adhesions in horses

OBJECTIVE: To evaluate the efficacy of a bioresorbable hyaluronate-carboxymethylcellulose membrane (HA-membrane) for prevention of experimentally induced abdominal adhesions in horses. STUDY DESIGN: Experimental study. ANIMAL POPULATION: Twelve healthy adult horses. METHODS: The effect of an HA-membrane on adhesion formation was evaluated in 12 healthy horses using an established model of serosal trauma to induce adhesions. A ventral median celiotomy and two jejunal resections and end-to-end anastomoses were performed. Two separate jejunal areas were abraded, and three 2-0 chromic gut sutures placed in the abraded areas. In treated horses (n = 6), HA-membranes were applied to the jejunum to completely cover the anastomoses and abraded areas of jejunum. Nontreated horses (n = 6) served as controls. All horses were killed 10 days after surgery. The abdominal cavity was evaluated for adhesion formation. The frequency of intra-abdominal adhesions between groups was compared with a chi2 test with statistical significance set at P < .05. RESULTS: All control horses had intra-abdominal adhesions; fibrous adhesions were associated with both jejunal abrasion sites in 5 horses. One treated horse developed adhesions. There were significantly fewer adhesions in the HA-membrane-treated group (P < .0034). CONCLUSIONS: In this experimental model, application of an HA-membrane to a localized area of serosal trauma reduced the frequency of intra-abdominal adhesion formation. CLINICAL RELEVANCE: Application of an HA membrane may decrease the frequency of adhesions in horses at an increased risk of postoperative adhesion formation.