Volvulus of the cecum and large colon caused by multiple mesenteric defects in a horse.

A 2-year-old Standardbred colt was examined because of signs of abdominal pain of 12 hours' duration. Clinical signs of disease, including tachycardia and abdominal distention, and rectal palpation findings of distention and thickening of the ventral colon, were consistent with displacement or early strangulation obstruction of the large colon. Surgical exploration revealed volvulus of the large colon around an axis formed by the dorsal mesenteric attachment of the transverse colon. The cecum could be completely exteriorized and lacked the cecocolic ligament and dorsal mesenteric attachments. The dorsal mesenteric attachments of the right ventral and dorsal colons were also lacking. The viscera were repositioned, and the horse was discharged 13 days after surgery. The horse developed severe colic 6 months later and was euthanatized. Mesenteric volvulus and omental adhesions were found at necropsy.     

Colonic gastrointestinal stromal tumor resulting in recurrent colic and hematochezia in a warmblood gelding

A 14-year-old Trakehner gelding was evaluated for recurrent colic, with episodes occurring over 1 year. Signs were consistent with intermittent ascending colon obstruction and hematochezia. Necropsy examination revealed an ulcerated mass extending into the lumen of the right dorsal ascending colon. Gross and histologic appearance and immunoreactivity to c-kit (CD117), desmin, vimentin, and smooth muscle actin, were consistent with a diagnosis of gastrointestinal stromal tumor.     

Treatment of right dorsal ulcerative colitis in a horse

Excessive administration of phenylbutazone was associated with development of right dorsal ulcerative colitis. The clinical signs of right dorsal colitis include chronic colic and weight loss. The laboratory abnormalities include panhypoproteinemia and a high WBC count in the abdominal fluid. Medical management of the chronic colic and protein-losing enteropathy associated with the ulcerative lesions in the right dorsal colon and surgical bypass of the right dorsal colon did not result in long-term resolution of clinical signs. Resection of the ulcerated right dorsal colon through a right lateral approach at the 16th rib resulted in resolution of intestinal protein loss and colic. The results of this case suggest that surgical resection of the ulcerated right dorsal colon may be the recommended treatment for right dorsal ulcerative colitis.     

Ultrasonographic findings in horses with right dorsal colitis: five cases (2000-2001)

OBJECTIVE: To determine whether ultrasonography would be useful in the diagnosis of right dorsal colitis in horses. DESIGN: Retrospective study. ANIMALS: 5 horses with right dorsal colitis and 15 healthy adult horses. PROCEDURE: Mural thickness and appearance of the right dorsal colon were determined from ultrasonographic images obtained at right intercostal spaces 10, 11, 12, 13, and 14. RESULTS: The right dorsal colon could be imaged most consistently at the right 11th, 12th, and 13th intercostal spaces, below the margin of the lung and axial to the liver. Mural thickness measured from ultrasonographic images was significantly greater in horses with right dorsal colitis than in healthy horses. The right dorsal colon in affected horses had a prominent hypoechoic layer associated with submucosal edema and inflammatory infiltrates. Successful treatment of 1 horse with right dorsal colitis was associated with a decrease in mural thickness coincident with an increase in serum albumin and total protein concentrations and weight gain. A decrease in mural thickness was also observed in a second horse treated for right dorsal colitis that was not associated with healing of the right dorsal colon or an increase in serum albumin concentration but rather thinning of a segment of the right dorsal colon that eventually ruptured. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that ultrasonographic measurement of mural thickness and evaluation of the appearance of the right dorsal colon may be useful in the diagnosis of right dorsal colitis in horses.     

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.     

Liquid flow and capacity of the caecum and colon of the horse

The rate of flow of fluid from the caecum and from the large colon was measured in four Shetland-type ponies fed a hay diet. In two ponies with cannulas in the caecum and at the origin of the right ventral colon, a continuous intracaecal infusion of a solution of chromium EDTA was used and samples were obtained from the cannula at the origin of the right ventral colon. Based on four determinations, the liquid flow from the caecum was 54.2 +/- 1.89 litres d-1. In the other two ponies with cannulas in the origin of the right ventral colon and near the end of the right dorsal colon, a continuous infusion of chromium EDTA was made into the right ventral colon and samples were obtained from the right dorsal colon. The flow rate towards the end of the dorsal colon was 49.4 +/- 1.25 litres d-1, based on four determinations. The capacities of the caecum and large colon after death were 7.0 +/- 0.8 and 17.7 +/- 3.7 litres, respectively.     

Megacolon with myenteric hypoganglionosis in a foal

A 6-month-old Clydesdale filly had chronic abdominal distention and intermittent febrile episodes. Abdominal surgery revealed impaction of the right dorsal colon, which was relieved by evacuation of contents through an enterotomy. Four days after surgery, abdominal distention recurred and progressed. The filly was euthanatized. Necropsy revealed the right dorsal colon to be markedly distended with digesta. Microscopically, there was a marked reduction in myenteric ganglion cells in the right dorsal colon and cecum and mild to moderate reduction of myenteric ganglion cells in the left ventral and transverse colon.     

Colopexy of the Left Large Colon to the Right Large Colon in the Horse

Three colopexy techniques were examined in 11 normal horses to determine which would prevent recurrence of targe colon displacement and volvulus. The medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon (technique A). The free band of the left dorsal colon was sutured to the free band of the right dorsal colon (technique B). In technique C, both the ventral and dorsal colon were sutured as in techniques A and B, and the pelvic flexure was sutured to the mesocolon between the right dorsal and right ventral colon. Absorbable (surgical gut) and nonabsorbable (polypropylene) suture material were compared.
One horse from each group was euthanized 2 weeks and 6 months after surgery. The position of the colon and the integrity of the colopexy were examined. At necropsy, attempts were made to produce displacement and volvulus of the colon. In the remaining horses, exploratory celiotomy 1 year after surgery was used to examine the integrity of the colopexy.
Although all horses initially lost weight after surgery, all but one began gaining weight 2 to 4 weeks later and had attained their preoperative weight by 6 months. The horse that continued to lose weight was euthanized 2 months after surgery. Numerous small colon, omental, and large colon adhesions were found at necropsy.
For all colopexy techniques, the colopexy adhesion remained short and intact at polypropylene suture sites. At surgical gut sites, the adhesion had lengthened by 6 months and was absent at 1 year. At necropsy, all colopexies prevented manual displacement of the large colon and volvulus of the colon at the sternal and diaphragmatic flexures. The colopexies did not prevent manual creation of volvulus at the base of the colon. Technique A was the easiest to perform.     

Fiber digestion in various segments of the hindgut of horses fed grass hay or silage

We studied in vivo fiber digestibility and fermentation parameters such as volatile fatty acid concentration and in vitro degradation in each segment of hindgut of horses fed timothy hay or silage made from the same sward. Six Thoroughbred horses were fed timothy hay or silage in equal amounts (1.6% of bodyweight per day, bodyweight mean 572 kg) every 3 h per day, then slaughtered. There were no differences between hay and silage in the concentration of the total volatile fatty acids, the apparent digestibility of dry matter, organic matter, and fiber, and in vitro neutral detergent fiber (NDF) disappearance rate in each segment. The total volatile fatty acid concentration and the apparent digestibility of dry and organic matter and fiber differed ( P  < 0.01) depending on the digestive segments. Both for hay and silage, the concentration of total volatile fatty acids in the digesta liquid phase largely increased ( P  < 0.01) from the cecum to the right ventral colon, and kept a constant value from the right ventral colon to the right dorsal colon, and then decreased from the right dorsal colon to the small colon. For dry and organic matter and fiber components, the apparent digestibility changed in the same manner from former to hinder segments of the hindgut. Regardless of diet, dry and organic matter and fiber components showed lower values in the cecum and the right ventral colon and increased ( P  < 0.01) largely from the right ventral colon to the left dorsal colon, then kept constant values in segments to the rear of left dorsal colon. There were no differences in in vitro NDF disappearance among cecum, ventral colon and dorsal colon.     

Mean retention time of digesta in the different segments of the equine hindgut

Six Thoroughbred horses were used to determine the mean retention time (MRT) of digesta in the different segments of the hindgut. The horses were fed timothy hay or silage in equal amounts (1.6% bodyweight [BW]/day) every 3 h/day. Hay or silage labeled with the rare earth elements cerium, dysprosium, neodymium, ytterbium, lanthanum, samarium and praseodymium, were fed to the horses 36, 30, 24, 18, 12, 6 and 3 h before slaughter, respectively. Just after slaughter, digesta samples in the different segments were collected and determined for the contents of the rare earth elements. Using these data, a method to calculate the MRT in the different segments was proposed. There were no significant differences between diets in the MRT of each segment. The averaged MRT of hay and silage in the cecum, right ventral colon, left ventral colon, left dorsal colon, right dorsal colon and small colon was 2.9, 3.1, 5.9, 1.0, 4.0, and 4.0 h, respectively. The dry matter weight of the digesta was related to the MRT in the right ventral colon (r = 0.94, P = 0.005), left ventral colon (r = 0.87, P = 0.03), left dorsal colon (r = 0.98, P < 0.001) and right dorsal colon (r = 0.95, P = 0.004), but it was not related to the MRT in the cecum and small colon.     

Colopexy in broodmares: 44 cases (1986-1990).

Colopexies were performed in 44 broodmares requiring abdominal surgery for large colon volvulus or right dorsal displacement of the large colon. Colopexies were performed by suturing the lateral bands of the left and right ventral colon to the ventral abdominal wall. Forty-seven percent of the mares in which a colopexy was performed had previous surgery for a large colon volvulus or right dorsal displacement of the large colon. Postoperative complications considered directly associated with the colopexy procedure were intermittent abdominal pain in 7, reoperation in 5, subcutaneous fistulous tracts in 1, and catastrophic rupture of the left ventral colon in 2 horses. Thirty-six horses survived greater than 6 months after colopexy, 34 of which had complete follow-up examinations. Twenty-seven mares have foaled at least once subsequent to the colopexy procedure, totalling 40 foals. Colopexy was considered a viable technique to prevent recurrence of large colon displacement or volvulus in selected predisposed populations.     

THE APPLICATION OF TECHNETIUM-99m HEXAMETHYLPROPYLENEAMINE OXIME (99mTc-HMPAO) LABELED WHITE BLOOD CELLS FOR THE DIAGNOSIS OF RIGHT DORSAL ULCERATIVE COLITIS IN TWO HORSES

The application of 99mTc-HMPAO labeled white blood cells to support the diagnosis of right dorsal ulcerative colitis was studied in two horses with a history and clinical signs consistent with phenylbutazone toxicity. These images were compared to a reference horse unaffected by right dorsal ulcerative colitis. Blood was collected aseptically in heparinized syringes from the patients for in vitro white blood cell (WBC) radiolabeling. The buffy coat was separated out and radiolabeled with 99mTc-HMPAO. The radiolabeled blood was re-injected i.v. and four images of the right and left side of the patient's abdomen were acquired at 4 hours and 20 hours post-injection. Results of the nuclear study revealed no abnormal findings in the abdomen at the four-hour post-injection images in any horse. Images obtained 20 hours post-injection revealed a linear uptake of radiolabeled WBCs in the right cranioventral abdomen in the region of the right dorsal colon in both horses with right dorsal ulcerative colitis. The reference horse had no radiopharmaceutical uptake in this region. This nuclear imaging study was a rapid, non-invasive method to identify right dorsal colon inflammation. These findings not only supported the diagnosis of right dorsal ulcerative colitis, but also facilitated appropriate medical management of each horse.     

Serum gamma glutamyl transferase activity in horses with right or left dorsal displacements of the large colon

The purpose of this study was to test the hypothesis that horses with right dorsal displacement of the large colon (RDDLC) have elevations in serum gamma glutamyl transferase (GGT) activity when compared with horses with left dorsal displacement of the large colon (LDDLC). Medical records from 37 horses with RDDLC and 48 horses with LDDLC were reviewed. Horses were included for study if the RDDLC or LDDLC was confirmed by exploratory laparotomy or postmortem examination and if a serum GGT measurement was obtained within 24 hours before surgery. The proportion of horses with GGT activity within or above the reference range was determined. Of 37 horses, 18 (49%; exact binomial 95% confidence interval, 32-66%) with RDDLC and, of 48 horses, 1 (2%; 95% CI, 0-11%) with LDDLC had GGT above the reference range. Horses with RDDLC had higher serum GGT than did horses with LDDLC. Of 37 horses, 36 (97%) with RDDLC were discharged with a good prognosis and none returned as a result of hepatic disease. Evaluation of surgical and postmortem examinations revealed that positioning of the colon in horses with RDDLC results in compression of the bile duct, which can cause extrahepatic bile duct obstruction and a subsequent elevation in serum GGT activity.     

Fluorometric evaluation of large and small intestinal ischaemia in the horse

Arteriovenous (ischaemic strangulating obstruction, ISO) and venous obstructions (haemorrhagic strangulating obstruction, HSO) were created for 70 min in the small intestine of eight anaesthetised horses, and ISO was created in four horses for 2 h and four horses for 3 h at the sternal and diaphragmatic flexures of the large colon. Five minutes following release of the occlusions, sodium fluorescein 20 per cent (0.5 mg/kg bodyweight intravenously) was administered. Serial quantitative measurements of serosal surface fluorescence of the injured segments and a control segment were made at 2, 10, 15, 20 and 30 mins using a fibreoptic perfusion fluorometer. Significant differences in fluorescence were seen in small intestine segments between HSO vs control, ISO vs HSO, but not ISO vs control segments. In the large colon, significant differences were seen between the fluorescence in the ischaemic 3 h ventral colon and control segments, and a trend for difference in fluorescence between the 2 and 3 h ischaemic segments. Differences in fluorescence between 2 vs 3 h dorsal colon segments and 2 or 3 h dorsal colon vs control segments were not significant.     

Segmental atresia of the transverse colon in a foal with concurrent equine herpes virus-1 infection

Segmental atresia of the transverse colon was observed at necropsy in a neonatal foal. The dorsal and ventral components of the large colon were fused, and ended blindly. The small colon was collapsed and completely closed at its cranial end. The right and left dorsal and ventral colons were fused into one blind-ended tube. Histologically, eosinophilic intranuclear inclusion bodies demonstrative of Equine Rhinopneumonitis were present in the thymus.     

Ultrasonographic visualization of colonic mesenteric vasculature as an indicator of large colon right dorsal displacement or 180�� volvulus (or both) in horses

Visualization of colonic mesenteric vasculature during transabdominal ultrasonographic examination of horses with colic can be a predictor of right dorsal displacement of the large colon or 180° large colon volvulus, or both. Medical records of 82 horses having had surgical treatment of colic and having received a transabdominal ultrasonographic examination on admission were reviewed. Colonic mesenteric vessels were sonographically identified coursing laterally on the right side of the abdomen in 24 of the 82 cases. Horses with colonic vessels identified on ultrasound were 32.5 times more likely to be diagnosed at surgery with either large colon right dorsal displacement or 180° large colon volvulus than those in which vessels were not seen (P < 0.001). Visualization of colonic mesenteric vessels on ultrasound provided a sensitivity of 67.7%, specificity of 97.9%, positive predictive value of 95.8%, and negative predictive value of 81% for large colon right dorsal displacement or 180° large colon volvulus, or both.     

Medical Management of Right Dorsal Colitis in 5 Horses: A Retrospective Study (1987–1993)

Right dorsal colitis in horses has been associated with administration of phenylbutazone. Although reports of right dorsal colitis in this species have described surgical treatment associated with a poor prognosis, we have had success treating this condition medically. This report describes 5 horses with right dorsal colitis confirmed during celiotomy that were initially managed medically. All horses had a history of intermittent abdominal pain; weight loss was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5 to 30 days) of administration of phenylbutazone were not unusually high relative to those recommended (4.4 mg/kg PO bid). Hypoproteinemia and hypoalbuminemia were observed in all horses at the time of admission; packed cell volume was low in 4 horses, and hypocalcemia was also observed in 4 horses. Three of 5 horses (60%) appeared to respond to dietary management and discontinuation of administration of nonsteroidal anti-inflammatory drugs. Dietary management consisted of feeding pelleted feed, and restricting or eliminating roughage for a period of at least 3 months. Two horses developed strictures of the right dorsal colon. One horse that developed a colonic stricture, possibly because its owners did not comply with recommendations for management, was subsequently treated surgically. The remaining horse that developed a stricture of the right dorsal colon was euthanized. These data indicate that some horses with right dorsal colitis can be successfully managed with medical treatment.     

Right Dorsal Colon Resection and Bypass for Treatment of Right Dorsal Colitis in a Horse

Objective: To describe a novel surgical technique for management of right dorsal colitis in the horse. Study Design: Clinical report. Animals: 14‐year‐old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side‐to‐side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery. Results: Resection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long‐term antimicrobial treatment. Conclusion: Right dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity. Clinical Relevance: RDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.     

Laparoscopic repair of a small intestinal mesenteric rent in a broodmare

OBJECTIVES : To describe standing laparoscopic repair of mesoduodenal rent inaccessible by ventral median celiotomy. STUDY DESIGN : Clinical case report. SAMPLE POPULATION : A 6-year-old Thoroughbred broodmare with a right displacement of the dorsal colon and small intestinal incarceration in a mesoduodenal rent. METHODS : Two days after correction of a right dorsal displacement of the ascending colon, small intestinal incarceration, and partial closure of mesoduodenal rent, standing left and right flank laparoscopy was used to explore the abdomen to identify the mesoduodenal defect. The mesenteric rent was repaired from right flank portals by approximation with hemostatic clips. RESULTS : Approximation of the mesoduodenal rent was achieved with laparoscopic clips. No further complications or signs of abdominal pain occurred over the following year. CONCLUSIONS : Mesenteric rents in the mesoduodenum can be repaired by laparoscopic techniques in the standing horse. CLINICAL RELEVANCE : Use of laparoscopic techniques in the standing horse should be considered for mesoduodenal rents that are not accessible form a ventral median celiotomy.     

Intramural tracheal haematoma causing acute respiratory obstruction in a dog

Respiratory obstruction resulting from a discrete haematoma within the dorsal tracheal membrane was seen in an 11-year-old neutered female greyhound that had been involved in a fight two days earlier. There was no history or evidence of rodenticide toxicity or other coagulopathy, and it is suggested that the tracheal haematoma resulted from trauma. A right third intercostal thoracotomy was performed and this allowed resection of the haematoma from within the dorsal membrane of the cranial thoracic trachea, relieving the obstruction with no subsequent signs of dyspnoea. Intramural haematoma should be considered as a rare differential diagnosis for dogs presenting with acute respiratory obstruction.