Diagnosis,management and prognosis of large colon impactions

The majority of large colon feed impactions occur in the left ventral colon at the pelvic flexure. Sand and enterolith impactions most commonly occur in the left ventral colon at the pelvic flexure or in the right dorsal colon; however, sand can accumulate anywhere along the gastrointestinal tract. Enteral fluid therapy can, in most cases, supplement or even replace i.v. administration of fluids and it appears effective and safe to soften large colon contents and resolve simple large colon impactions. Surgical intervention is indicated when a concurrent displacement is suspected, as lengthy medical treatment of large colon impaction secondary to large colon displacements would not be indicated and may increase the risk of colonic rupture. Other indications for surgical intervention include uncontrollable pain, when cardiovascular parameters deteriorate, or when there is evidence of intestinal devitalisation. The prognosis for horses undergoing large colon enterotomy is dependent on the extent and type of impaction, but is generally excellent.     

The equine teniae coli: An electrophysiological study

Previous morphological studies of the equine teniae coli (intestinal bands) have shown them to be highly innervated. In this study, EMG electrodes were placed in the wall of the left ventral colon in order to determine whether intestinal bands serve as major conduits of myo-electrical activity. Specifically, electrodes were implanted in the lateral mesocolic band and the adjacent tenia-free bowel of 6 horses. In 3 of these horses, a 1 cm length of the intestinal band was excised to determine if a lesion of this size would ablate local waves of depolarization. Our results indicate that sequential EMG activity persisted despite this small, focal excision. The persistence of sequential EMG activity might reflect the importance of constantly regenerating stimuli to the intestinal motility of the horse. Whether making similar or somewhat larger lesions in all four teniae of the left ventral, colon would more definitively disrupt normal pelvic flexure peristalsis will require further research.     

Surface oximetry of healthy and ischemic equine intestine

Measurements of jejunal, ileal, and large colon (pelvic flexure) surface O2 tension (PSO2) were made in halothane-anesthetized horses with a nonheated miniature oxygen polarographic electrode. Assisted ventilation with 100% O2 was used to maintain PaCO2 tension at 50 +/- 8 mm of Hg while mean arterial blood pressure was maintained greater than or equal to 70 mm of Hg. Mean +/- SD PSO2 for the intestinal segments were: jejunum (horses 1 to 4), 71 +/- 20 mm of Hg; ileum (horses 1 to 4), 61 +/- 8 mm of Hg; and pelvic flexure of the large colon (horses 1 to 10), 55 +/- 13 mm of Hg. The response of the sensor to intestinal ischemia was studied in the large colon of an additional 12 halothane-anesthetized horses, using 4 types of vascular occlusion: venous (4 horses); arterial and venous (4 horses); venous and intramural vascular obstruction (2 horses); and arterial, venous, and intramural obstruction (2 horses). Venous and arterial occlusions were maintained for 30, 60, 90, and 120 minutes, whereas intramural obstruction combined with either type of vascular obstruction was studied for 60 to 120 minutes. After vascular occlusion, PSO2 decreased to 8 +/- 7 mm of Hg for venous obstruction, 4 +/- 3 mm of Hg for arterial and venous obstruction, 6 +/- 0 mm of Hg for intramural and venous obstruction, and 3 +/- 0 mm of Hg after intramural and arterial and venous obstruction. Thirty minutes after release of the clamps, the PSO2 increased to greater than or equal to 50% of the preoccluded large colon value.(ABSTRACT TRUNCATED AT 250 WORDS)     

Morphologic alterations observed during experimental ischemia of the equine large colon

Morphologic changes that develop sequentially in the large colon during experimentally induced ischemia were documented in 14 halothane-anesthetized horses. Colonic ischemia was induced by 4 types of vascular occlusion, 24 cm proximal and distal to the pelvic flexure. The effect of transmural (colonic wall) vascular compression combined with either venous occlusion (3 horses, group A) or venous and arterial occlusion (3 horses, group B) of the colonic vessels was studied for 1, 2, and 6 hours of occlusion. Also observed was the effect of reperfusion for 0.5 hour after release of the clamps for the 1- and 2-hour occlusions and for 1 hour after release of the clamps for the 6-hour occlusion. Effects of occluding only the colonic veins (4 horses, group C), or the colonic veins and arteries (4 horses, group D) were studied for 0.5, 1, 1.5, and 2 hours of occlusion and during reperfusion for 0.5 hour. Full-thickness intestinal biopsy specimens were obtained from the antimesenteric border of the pelvic flexure at 0, 0.25, 0.5, 0.75, 1, 1.5, and 2 hours during occlusion and at 0.5 hour after release of vascular occlusion. Biopsy specimens were obtained at hourly intervals from the 2 horses in which 6-hour occlusion was performed and at 1 hour after release of vascular occlusion. Macroscopic changes (serosal color, mucosal color, serum leakage) in the colon were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)     

Large colon resection

With large colon resection and anastomosis, up to 95 per cent of the length of the large colon has been successfully removed. A hand-sewn end-to-end anastomosis is effective for lesions in the left dorsal colon and pelvic flexure. Transection and a side-to-side anastomosis with stapling equipment is most effective for extensive resections (greater than 50 per cent). Horses with extensive colon resection (95 per cent) have permanent deficiencies of water absorption and digestion of cellulose and protein. Fermentative capacity is reduced, owing to decreased particulate matter retention time in the smaller capacity colon. These deficits are minimized with alfalfa hay as the source of forage (fed at 2 per cent of the body weight), and normal blood variables and body weight can be maintained. Voluntary intake increases to help maintain a positive nutrient balance. Grass hay, owing to the higher cell wall content, is inadequate as the sole source of energy and protein, and weight loss will occur. Ad libitum intake of water is recommended at all times, owing to the increased fecal water loss.     

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.     

A Comparison of Three Techniques for Closure of Pelvic Flexure Enterotomies in Normal Equine Colon

Six enterotomies 3 cm long, spaced at 3 cm intervals, were made in the antimesenteric border of the pelvic flexure of the ascending colon in five adult horses. Ten incisions each were sutured with a Utrecht pattern (single layer), a full-thickness simple continuous oversewn with a Cushing pattern (two layer), and a mucosal simple continuous with a seromuscular simple continuous oversewn with a Cushing pattern (three layer). In all horses, chromic gut and polyglactin 910 were each used once for each pattern. On day 6, the pelvic flexure was excised and the colonic vessels were injected with a radio-opaque mass. Sections of each enterotomy were studied by light microscopy and high detail radiography. The single-layer closure led to serosa-to-mucosa healing and a thin bowel wall, and the three-layer closure resulted in distortion of the bowel wall by hematoma formation and submucosal contamination with ingesta. The two-layer closure resulted in good alignment and improved healing. There was less inflammatory reaction with polyglactin 910 than with chromic gut.     

Effects of distention and neostigmine on jejunal vascular resistance, oxygen uptake, and intraluminal pressure changes in ponies

The influence of distention (high baseline intraluminal pressure) and neostigmine methylsulfate on intestinal vascular resistance, oxygen uptake, and intraluminal pressure changes (rhythmic contractions) was studied in terminal jejunal segments, which were perfused at a constant rate, in 16 anesthetized ponies. When baseline intraluminal pressure was increased to 10 mm of Hg, the intestinal vascular resistance and amplitude of rhythmic contractions were increased. Neostigmine induced cyclic increases in amplitude of rhythmic contractions whether intraluminal pressure was 0 or 10 mm of Hg. Neostigmine also increased intestinal oxygen uptake at intraluminal pressures of 0 mm of Hg, but not at 10 mm of Hg, and vascular resistance was not altered at either intraluminal pressure. The results indicate that intestinal hemodynamics are adversely affected by distention. Further, neostigmine did not adversely affect intestinal hemodynamics while increasing rhythmic contractions, suggesting that neostigmine may be useful in the treatment of ileus in equids.     

Effect of intraluminal distention on microvascular perfusion in the equine small colon

OBJECTIVE: To determine the effect of experimental intraluminal distention on microvascular perfusion of the small colon in horses. ANIMALS: 6 mixed-breed healthy horses (mean age [+/- SDI, 9.1 +/- 2 years). PROCEDURE: Under general anesthesia, the small colon was exposed by celiotomy and 3 segments were demarcated. In 1 of these segments, intraluminal obstruction was created by placement of a latex balloon inflated to a pressure of 40 mm Hg (obstructed segment). The other segments were the sham-operated segment and the control segment. Microvascular perfusion was evaluated in the mucosal, submucosal, muscular, and serosal layers by injection of 15 microm-diameter colored microspheres into branches of the caudal mesenteric artery. Recovery of microspheres was performed by tissue digestion, washing, and centrifugation. Distribution of microspheres in the intestinal layers was evaluated by direct observation of stained frozen sections by light microscopy. RESULTS: A significant reduction was observed in total microvascular perfusion of obstructed segments, which was 26.4% of that of control segments. This reduction was not evident in the mucosal layer. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention of the equine small colon wall can promote ischemia by a reduction in microvascular perfusion in the intestinal wall. Intestinal layers do not seem to be affected to the same extent, because the absolute value for mucosal perfusion did not decrease in the obstructed segment.     

Displacement of the large colon associated with nonsurgical correction of large-colon entrapment in the renosplenic space in a mare

Nonsurgical correction of a renosplenic entrapment of the large colon was attempted in a mare, using a rolling technique. After correction, the mare had initial improvement in clinical signs, but later developed signs of abdominal discomfort. A ventral midline celiotomy was performed, and a pelvic flexure impaction and large intestinal volvulus were found and corrected.     

Sand colic in a mule: A case report

A 25-year-old mule was showing signs of colic. Clinical examination revealed acute pain, bilateral abdominal distention, stretching out and standing in this position. Rectal palpation revealed a hardened mass in the ventral region of the pelvic inlet. Surgical intervention was accomplished and faecaliths removed by colotomy. The mule died unexpectedly and postmortem examination revealed sand masses within the right ventral and right dorsal colon which caused obstruction of the intestinal tract in sternal and diaphragmatic flexures, respectively. This appears to be the first report of sand colic in a mule in Iran.     

Trials of serotonin, substance P and alpha 2-adrenergic receptor effects on the equine large colon

Some support for both serotonin and substance P as biotransmitters in the equine large colon is presented. Close arterial injections of small quantities of each of these were effective, respectively, in stimulating marked increases in coordinated pressure peaks in the vicinity of the pelvic flexure, with modest (serotonin) or marked (substance P) increase in colon artery blood flow. Both the acaricide, amitraz, and the tranquilizer xylazine appeared to act on the equine large colon via yohimbine-sensitive alpha 2-adrenergic receptors.     

Congenital malformation of the large colon causing colic in a horse

An abnormal mesocolic attachment which resulted in a stellate malformation of the left colon adjacent to the pelvic flexure was suspected to be the cause of intermittent episodes of colic in a horse. Resection and side-to-side anastomosis of the large colon at the level of the sternal and diaphragmatic flexures was performed and the horse made an uneventful recovery from surgery. Only minor serum biochemical changes were observed in the initial postoperative period. The abnormal mesocolic attachment was probably a congenital anomaly.     

Arterial supply to the rat colon

Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information regarding arterial supply is important to establish accurate and reproducible experimental procedures, this has not been studied in the rat colon. Therefore, we analysed the detailed arterial distribution pattern and its individual variations in the colon of 34 rats. The rat colon received colic branches of the ileocolic artery, and the right, middle and left colic arteries. The single left colic artery constantly arose from the caudal mesenteric artery and was distributed to the descending colon, whereas the others showed variations in number and distribution. The ileocolic artery gave rise to one (12%) or two (88%) colic branches supplying the proximal ascending colon, and these branches formed rich, mesh-like anastomoses along the initial portion of the ascending colon. One (74%) or two (26%) right colic arteries originated from the cranial mesenteric artery and supplied the ascending colon and right colic flexure. Moreover, one (38%), two (56%) or three (6%) middle colic arteries emerged from the cranial mesenteric artery and were distributed to the transverse colon, left colic flexure and proximal descending colon. In total, we categorized the individual variations in arterial branching and anastomosis into 11 patterns. Arterial supply to the rat colon showed a specific pattern and frequent individual variations. These findings thus provide essential information for establishing reproducible models of rat colic surgery.     

Cardiovascular and pulmonary effects of recumbency in two conscious ponies

Respiratory dead-space, tidal volume, respiratory rate, blood gases, cardiac output, heart rate and arterial and pulmonary arterial blood pressures were measured in two conscious, trained ponies in the standing position and in left lateral recumbency. The ponies were reluctant to remain lying down for more than about 20 mins but the reason for this did not become apparent. Tidal volume was reduced during recumbency but the respiratory rate increased, tending to maintain the minute volume at about that of the standing animal. Arterial carbon dioxide tension did not change significantly from standing values but the mean arterial oxygen tension values tended to decrease in both ponies during recumbency because of a slight increase in pulmonary venous admixture. Venous admixture in these two laterally recumbent conscious animals was considerably less than previously reported for anaesthetised subjects.     

Systolic time intervals in domestic ponies: alterations in a case of coarctation of the aorta.

This report describes the measurement of systolic time intervals in a nine year old female domestic pony which was found at necropsy to show coarctation of the aorta and bilateral ventricular hypertrophy. Electrocardiogram, phonocardiogram and direct arterial blood pressure were recorded from the pony in a standing unmedicated state and systolic time intervals were measured from the resulting tracings. A prolongation of left ventricular ejection time and shortening of the pre-ejection period were observed in comparison to a group of normal ponies similarly examined. Such changes are consistent with outflow tract obstruction. The pony was also hypotensive and this condition was interpreted as a long-term compensation for the obstructive lesion. It is likely that the changes in systolic time intervals were at this stage predominantly affected by the hypotension. The report notes that the existence of such a case of spontaneous cardiovascular disease in the pony population might suggest the utility of the animal as a resource in comparative cardiovascular physiology and medicine.     

Epiploic foramen entrapment of the large colon in a 9-month-old Thoroughbred filly

A 9-month-old Thoroughbred filly was presented for colic of a few hours’ duration. Examination revealed tachycardia at 64 beats/min, and a colon displaced to the right with wall oedema on ultrasound. After an hour of intravenous fluid therapy, the filly became restless and exploratory laparotomy was performed. Impaction and incarceration of the large colon up to the caeco-colic fold through the epiploic foramen (EF) were diagnosed. After evacuating the colonic contents through a pelvic flexure enterotomy, the EF entrapment (EFE) was reduced. The large colon appeared congested with a fragile serosa, serosal tear at its antimesenteric aspect, and amotile for the remainder of the surgery. Colon motility resumed as evidenced by ultrasonographic examination on the second day post-surgery, and despite pasty diarrhoea, the filly made a complete and uneventful recovery and was alive at 6 months’ follow-up. Epiploic foramen entrapment of the large colon is very rare but should be included as a differential diagnosis of colon displacements, even in young horses, requiring prompt surgical resolution.     

Horseradish peroxidase study of the location of extrinsic efferent and afferent neurons innervating the colon of dogs

The abdominal portion of the colon of 13 clinically normal dogs was divided into 5 regions (ascending, transverse, left colic flexure, proximal descending, and distal descending), and each region was injected with 30 mg of horseradish peroxidase (HRP). The injected colonic region, brain stem, L7-Cd1 portion of the spinal cord, sympathetic trunk ganglia, celiacomesenteric ganglia, caudal mesenteric ganglion, pelvic plexi, distal vagal (nodose) ganglia, and L1-Cd1 spinal ganglia were obtained at post-injection hour 48, sectioned, and processed by use of the tetramethylbenzidine method. The entire length of the colon was found to be under extrinsic influence of the parasympathetic nucleus of cranial nerve X (PX), with the largest average number of labeled cells resulting from injection of the ascending colon. It was also indicated that the entire colon is under extrinsic influence of the sacral portion of the spinal cord because the pelvic ganglia (second-order neurons) of the pelvic plexi contained labeled cells for all colonic regions. The largest average number of labeled cells in pelvic ganglia was seen after injection of the distal portion of the descending colon. Only after injection of the distal portion of the descending colon were labeled cells found in the S1-S3 portion of the spinal cord. Labeled cells in the PX, spinal cord, and pelvic ganglia were found bilaterally. Although the entire abdominal portion of the colon appears to be influenced by cranial and sacral parasympathetic preganglionic (via pelvic ganglia) neurons, the relative importance of the 2 areas seems to be reversed between the ascending colon and distal portion of the descending colon.(ABSTRACT TRUNCATED AT 250 WORDS)     

ULTRASONOGRAPHIC DIAGNOSIS OF COXOFEMORAL SUBLUXATION IN HORSES

The clinical and ultrasonographic features of seven horses with coxofemoral subluxation are presented. Affected horses included five adult geldings (11–20 years), one large pony (6 years) and a 3-month-old filly. All were lame at the walk except for the pony with grade 3/5 lameness. Lameness was acute in all horses, but three horses progressed after initial improvement. Crepitus, muscle atrophy, and pelvic asymmetry were inconsistent findings. Ultrasonographic diagnosis of subluxation required dynamic visualization of femoral head displacement from the acetabulum while placing weight on the affected limb and subsequent replacement into its normal position upon limb resting. Acetabular rim fractures and joint effusion were visible regardless of weight bearing status in six horses each. No fractures were identified in the pony; the only patient with a good outcome. Six horses had a poor outcome with severe chronic lameness, four of which were euthanized. Postmortem ventrodorsal radiographs obtained in two horses confirmed subluxation only on extended limb projections, but not on hip-flexed projections. Acetabular rim fractures were not visible radiographically in either horse but were confirmed at necropsy. Subluxation was due to an elongated but intact ligament of the head of the femur in both horses. Osteoarthrosis was evident ultrasonographically, radiographically, and at necropsy. Dynamic ultrasonography was readily performed in the standing horse and produced diagnostic images with a low frequency curvilinear transducer. The apparent poor prognosis for horses with subluxation and acetabular fracture illustrate the importance of this imaging technique to identify affected horses.     

In vitro evaluation of the effect of the opioid antagonist N-methylnaltrexone on motility of the equine jejunum and pelvic flexure

REASONS FOR PERFORMING STUDY: Although potent analgesics, opioids decrease intestinal activity, leading to ileus in many species. N-methylnaltrexone (MNTX), an opioid antagonist which does not cross the blood-brain barrier and antagonises the morphine effect on the intestine, directly stimulates motility and restores function without affecting analgesic properties. While its use has been reported in human subjects, there is no information with regard to its usage in the horse. OBJECTIVES: To determine whether MNTX has an effect on contractile activity of the equine jejunum and pelvic flexure. METHODS: Using circular smooth muscle strips obtained from 8 mature horses, increasing concentrations of MNTX were added to tissue baths in the range of 1 x 10(-9) to 1 x 10(-5) mol/l, and contractile responses were recorded for 3 mins. Data were analysed using a repeated measures ANOVA to determine whether there was a significant drug effect compared to baseline activity. Data were analysed between the jejunum and pelvic flexure using a Mann-Whitney U test. Statistical significance was established as P < 0.05. RESULTS: The administration of MNTX significantly increased the contractile frequency and amplitude at all concentrations relative to baseline (P < 0.0001) for the jejunum. The response was greatest at 1 x 10(-7) mol/l (P = 0.0005), with a mean difference from baseline of 115.12 g/cm2. The highest concentration evaluated (1 x 10(-5) mol/l) had a mean contractile strength of 69.76 g/cm2, which was significantly greater than baseline activity (P = 0.04). A significant increase in contractile activity for the colon was detected at 3 x 10(-7) mol/l and all subsequent concentrations (P < 0.04). Unlike the jejunum, the contractile activity of the pelvic flexure increased progressively with the addition of each subsequent concentration. CONCLUSIONS: N-methylnaltrexone has a direct effect on circular smooth muscle of the equine jejunum and pelvic flexure resulting in an increase in contractile activity. POTENTIAL RELEVANCE: N-methylnaltrexone could potentially be used in conjunction with morphine to provide potent and effective analgesia without compromising intestinal function. Further in vivo investigations are required to determine whether this agent antagonises morphine's effect on motility.