Ileocecal intussusception corrected by resection within the cecum in two horses.

Irreducible ileocecal intussusceptions pose a difficult surgical problem. Strangulating ileocecal intussusceptions involving the ileum and jejunum were identified in 2 horses undergoing exploratory laparotomy because of colic. Surgical correction in both horses was achieved by amputation of the ileocecal intussusception from within the cecal lumen, via typhlotomy. The inverted ileal stump was blindly stapled near the ileocecal orifice after pulling the intussusceptum into the cecum. A jejunocecostomy was performed to reestablish intestinal continuity.     

Use of cecal bypass via side-to-side ileocolic anastomosis without ileal transection for treatment of cecocolic intussusception in three horses

CASE DESCRIPTION: 3 horses were evaluated for signs of colic; cecocolic intussusception was detected. CLINICAL FINDINGS: Abnormalities detected included diminished intestinal sounds, inflammatory leukogram, dehydration, unremarkable fi ndings via rectal palpation, and ultrasonographic evidence of large intestine intussusception. Laparotomy revealed cecocolic intussusception. TREATMENT AND OUTCOME: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection was performed in each horse by use of an intraluminal anastomosis stapler device. Postoperative complications were minimal, and all horses recovered rapidly and were clinically normal at > 12 months after surgery. CLINICAL RELEVANCE: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection seemed to offer 2 potential advantages over traditional surgical techniques for treating this condition. The risk of abdominal contamination was far less than with techniques in which the colotomy is needed to enable resection of the cecum or techniques in which the ileum is transected. Also, it was technically simpler to perform because there was no need to transect the ileum, oversew the ileal stump, perform cecal resection, or close the mesenteric space created by relocating the jejunal stump to the right ventral colon.     

The venous supply of the cecum, ileum, and the proximal loop of the ascending colon in the ox

The present study describes in detail the venous supply to the bovine cecum, ileum, and the proximal loop of the ascending colon. The cecum was supplied by branches from the cecal and accessory cecal veins. The accessory cecal vein was observed in the majority of the specimens examined. The cecal and accessory cecal veins were joined by 7–10 short oblique anastomoses. The ileum was supplied by the ileal branches of the cecal vein, and from the mesenteric ileal and first ileal (cranial mesenteric) veins. The ileal branches of the cecal vein formed a row of antimesenteric ileal arches in the ileal part of the ileocecal fold. The mesenteric ileal vein, in some cases, detached a collateral branch. The first ileal and the mesenteric ileal veins anastomosed on the ventral surface of the ileum. The initial loop of colon was supplied by branches from the ileocolic vein. In the majority of specimens, the common colic, a branch of the cranial mesenteric vein, supplied the first colic branch to the third part of the initial colon. In such cases, the ileocolic vein gave off only the second and third colic branches. However, in one case, the proximal loop of the ascending colon was supplied by three colic branches of the ileocolic vein and by the first colic branch of the common colic vein. In specimens in which the common colic vein was absent, the colic branches to the initial colon were all given off by the ileocolic vein. The third (or fourth) colic branch of the ileocolic vein and the first cecal branch of the cecal vein united on the lateral surface of the ileocecocolic junction to form an ileocecocolic arch. The veins on the medial surface of the ileocecocolic junction did not form an arch. The colic and ileal lymph nodes were supplied by twigs from the colic branches of the ileocolic vein and first ileal vein of the cranial mesenteric, respectively. The small cecal lymph nodes seen only in the specimen from the calf were supplied by fine branches from the cecal vein.     

Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses

OBJECTIVES: To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses. STUDY DESIGN: Retrospective study. ANIMALS: Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy. METHODS: Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern. RESULTS: The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function. CLINICAL RELEVANCE: Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.     

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.     

The Arterial Supply to the Ileum, Cecum and Proximal Loop of the Ascending Colon in the Ox*

This study describes in detail the arteries supplying the ileum, cecum and proximal loop of the ascending colon in the ox important to the veterinary surgeon treating disorders of these segments of the intestinal tract. The ileum was vascularized by the mesenteric ileal artery (from the ileocolic), the first ileal artery (from the cranial mesenteric) and by the ileal branches of the cecal artery which, by means of their anastomoses, form a row of antimesenteric arches in the ileal part of the ileocecal fold. The termination of the ileum was also supplied by twigs from the ileocecocolic arch. The ileum appears to be the most vascular part of the small intestine. The cecum was supplied mainly by the cecal branches of the cecal artery. The proximal end of the cecum was also vascularized by branches from the ileocecocolic arch. The proximal loop of the colon was vascularized by the three colic branches of the ileocolic. The first colic branch supplied the third part of the loop, the second colic branch supplied the first and the second parts of the loop and the third colic branch supplied the first part and, together with the first cecal branch of the cecal artery, formed the ileocecocolic arch at the dorsolateral surface of the ileocecocolic junction. The terminal branches of the arteries to the ileum, cecum and proximal loop of the colon detached lateral branches in the tunica muscularis which anastomosed with similar branches from neighboring arteries in an arcuate manner in the tunica submucosa. The terminal branches from both sides terminated in the free border, releasing branches which anastomosed with each other in the tunica submucosa. The colic lymph nodes were supplied by the colic branches of the ileocolic artery, die two largest nodes being perforated by some of the branches of the first two colic branches. The ileal lymph nodes were supplied by the ileal arteries of the cranial mesenteric. They were also perforated by these arteries. Cecal lymph nodes were seen only in the specimen from the calf. They were much smaller than the colic and ileal nodes and were supplied by the first two or three cecal branches of the cecal artery and also by twigs arising directly from the cecal artery.     

USE OF COMPUTED TOMOGRAPHY TO EVALUATE THE INTESTINAL TRACT OF ADULT LLAMAS

In the llama, signs of colic are obscure and may be exhibited as persistent sternal recumbency and anorexia even in the presence of a surgical lesion. Diagnostic methods for evaluation of abdominal disorders are limited. As a result, surgical intervention may be prolonged and increase the risk of mortality and postoperative complications. The objective of this study was to determine the feasibility of computed tomography to evaluate the llama intestinal tract. Eighteen hours prior to the computed tomography scan, six llamas were given barium sulfate (15%) via an orogastric tube. Following induction of general anesthesia, the llamas were positioned in sternal recumbency, and 10 mm contiguous slices were obtained from the diaphragm to the tuber ischiadicum. Structures that were consistently identified included the first, second, and third compartments (C1, 2, and 3), small intestine, spiral colon, and ascending colon. C1 was easily identified in the cranial aspect of the abdomen due to its large size relative to the other compartments and characteristic saccules. C2 was located cranial, ventral, and to the right of Cl, while C3 was visualized as a tubular structure to the right and ventral to C1 and C2, C3 was traced caudally until it turned dorsally and continued cranially to a dilated ampulla in the right cranial abdomen delineating the entrance to the small intestine. The spiral colon was identified consistently in the left ventral caudal abdomen. Structures that could not be conclusively identified included the cecum and mesenteric lymph nodes. Computed tomography allowed a consistent evaluation of the major intestinal structures associated with colic in the llama. Thus, computed tomography is a potentially valuable noninvasive diagnostic tool to effectively evaluate the abdominal cavity and differentiate medical from surgical lesions in the llama.     

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.     

Ileocecocolic intussusception as a sequel to jejunocecostomy in a mare

An excessively long ileal stump, the result of a previous jejunocecostomy, had intussuscepted into the cecum and subsequently obstructed the cecocolic orifice of a 12-year-old Quarter Horse mare. Clinical signs were dehydration, ileus, and endotoxemia. The diagnosis was made at necropsy.     

Intussusception Involving the Spiral Colon in a Calf

Clinical examination of a ten month old Holstein heifer with a history of colic and anorexia revealed a distended viscus in the midline and a hard, sausage-shaped mass in the right lower posterior quadrant of the abdomen. At surgery, the mass was exteriorized and found to be an intussusception of the colon into the spiral colon. The intussusception was reduced by traction and the animal made an uneventful recovery.     

Surgical diseases of the equine cecum

Cecal impaction and cecal perforation, the two most common equine cecal diseases, are thought to develop after slowing or interruption of a single progressive motility pattern, which begins in a pacemaker area near the apex, occurs once every 3 minutes, and propels ingesta from the cecum to the right ventral colon. Rectal examination in horses with cecal impaction is the most useful technique to grade the severity of the condition. Medical treatment is undertaken if the impaction is judged to be mild to moderate. Surgical correction of cecal impaction in severe cases requires a ventral midline celiotomy, and exploration reveals a large ingesta-filled cecum and relatively empty large colon. Currently, the techniques of typhlotomy with manual evacuation of ingesta, combined with a complete bypass of the cecum by use of a jejunocolostomy, is the preferred method of surgical management. The use of a cecocolic anastomosis remains a viable alternative surgical procedure. Cecal perforation (CP), a uniformly fatal disease of horses, most often develops when the subtle signs of cecal impaction are missed or are masked by the administration of nonsteroidal antiinflammatory agents. CP can occur in mares around the time of foaling and, in this form, is not associated with cecal outflow dysfunction. Surgical management of cecocecal or cecocolic intussusception is required and involves resection of the diseased portion of cecum, either with extra- or intraluminal techniques. Both the side-to-side and end-to-side jejunocecal anastomoses are useful and successful techniques for bypass of simple or strangulating lesions of the ileum.     

Ileocecal intussusception in horses: 26 cases (1981-1988)

The case records of 26 horses with ileocecal intussusception over a 7-year period were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with ileocecal intussusception was 1 year and ranged from 2 weeks to 19 years. There was no apparent gender or breed predisposition to this disease. An acute form of ileocecal intussusception was diagnosed in 19 horses with signs of moderate to severe abdominal pain of less than or equal to 24 hours' duration, and a chronic form was diagnosed in 7 horses with signs of intermittent, mild to moderate abdominal pain of more than 3 days' duration. Horses with chronic ileocecal intussusception had a history of weight loss or failure to gain weight, slow growth, poor appetite, low-grade pyrexia, and postprandial signs of abdominal pain. At surgery, the involved segments of intestine (intussusceptum and intussuscipiens) in chronic cases were 2 to 10 cm long, and the ileum and much of the distal portion of the jejunum were flaccid, dilated, and thick walled. In the acute cases, the length of involved intestine ranged from 6 to 457 cm. Whereas only 1 of 7 chronic intussusceptions (14%) could be reduced, 9 of 19 (47%) acute intussusceptions were reducible. Surgical treatment included resection and jejunocecostomy (6 horses), partial resection through a cecotomy and a side-to-side jejunocecostomy (2 horses), and a side-to-side ileocecostomy or jejunocecostomy without resection (12 horses, 7 of which had chronic intussusception). Six horses with acute intussusception were euthanatized before or during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital retrosternal (Morgagni) diaphragmatic hernias in three horses

CASE DESCRIPTION: 3 Horses were examined and treated because of sudden onset of signs of abdominal pain. CLINICAL FINDINGS: All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac. TREATMENT AND OUTCOME: Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correction, no major postoperative complications developed, and all 3 horses have been free of signs of abdominal pain. CLINICAL RELEVANCE: Horses with retrosternal hernias involving the diaphragm can develop clinical signs of intermittent obstruction of the large colon and chronic colic. In horses, retrosternal diaphragmatic hernias appear to develop exclusively in the right ventral aspect of the diaphragm and could represent an embryologic defect of diaphragm formation. Affected horses can be successfully treated with mesh herniorrhaphy or, in some instances, with conservative management.     

A novel use for polyamide tie‐wraps in the surgical resolution of caecocolic intussusception in a horse

Caecocolic intussusception is an uncommon cause of colic in the horse. Surgical correction presents its own set of challenges. The affected tissue is often markedly oedematous and a partial typhlectomy through an enterotomy incision in the right ventral colon can be the only method of successfully reducing the intussusceptum. Suture ligation of the nonviable portion of caecum can result in cut through of tissue, which can lead to an insecure ligation. In addition, a right ventral colon enterotomy can result in life‐threatening peritoneal contamination. This report describes the novel use of polyamide tie‐wraps to ligate the inverted caecum, allowing for partial typhlectomy and reduction of the intussusceptum, as well as a method to minimise potential abdominal contamination. To the author's knowledge, this is the first report of the use of polyamide tie‐wraps in the gastrointestinal tract of the horse.     

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.     

Intermittent Colic and Intussusception Due to a Cecal Polyp in a Rabbit

A 9-year-old male rabbit was presented for chronic intermittent anorexia and colic. A small abdominal mass was evident on palpation, and ultrasonography demonstrated a luminal mass and small intussusception in the distal cecum. Surgical resection of the distal third of the cecum was performed and histologic examination yielded a diagnosis of an inflammatory fibroid polyp. Although reported as causing intussusception in humans and other animals, the authors are unaware of any reports in pet or laboratory rabbits. The etiology and histogenesis of inflammatory fibroid polyps are still unclear.     

Gastric ulceration in horses: 91 cases (1987-1990).

Gastroendoscopy was performed on 111 horses (1 to 22 years old) that had signs of abdominal discomfort of variable duration and severity. At least 1 episode of colic had been observed within 48 hours of examination in 31 horses. Recurrent episodes of colic were observed in 28 horses within 2 to 10 days of examination, 31 horses within 11 to 30 days, 12 horses within 31 to 60 days, and in 9 horses at more than 60 days after the initial examination. Gastric ulceration was found in 91 of 111 horses examined. Other abnormalities involving the gastrointestinal tract or other abdominal viscera were not found on examination in 57 of 91 horses with gastric ulcers. The most frequent concurrent abnormalities found in the remaining 34 horses with gastric ulcers were impaction of the large colon (n = 6), colonic tympany (n = 6), peritonitis (n = 6), gastric impaction (n = 4), ileocecal intussusception (n = 3), small-colon impaction (n = 4), and proximal enteritis (n = 2). Thirteen horses with gastric ulceration underwent abdominal surgery, and in 5 horses, lesions were not found at surgery. Gastric ulceration was determined to be the primary cause of colic in 31 horses on the basis of the lack of other abnormalities, clinical response to treatment with histamine type-2 receptor (H2) antagonists, and confirmation of improvement or resolution of gastric ulceration via endoscopy. Gastric ulceration was the suspected cause of colic in 26 other horses on the basis of the lack of other abnormalities, severity of lesions, and clinical response to treatment with H2 antagonists.(ABSTRACT TRUNCATED AT 250 WORDS)     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Jejunal myxoma as a cause for jejunoileo‐caecal intussusception in a horse

A 17‐year‐old gelding was presented with mild to moderate signs of colic. Exploratory laparotomy revealed an intussusception of ileum and jejunum into the caecum. The starting point of the intussusception was an intramural mass in the jejunum. Half a metre of jejunum was resected and the horse recovered without complications. Histopathology and immunohistochemistry revealed a myxoma with no myogenic or neurogenic origin.     

Simultaneous cecostomy and ileal cannulation with a modified flexible T cannula in gilts

A surgical procedure was developed for the simultaneous cannulation of the ileum and fistulation of the cecum in breeding-age gilts to study the effects of enteric microflora on the nutritional requirements and/or status of the pig. Flexible T-shaped cannulae were made from plastic tubing, placed surgically in the caudal part of the ileum, and exteriorized in the right paralumbar fossa. After the exteriorization of the cecal apex in the right flank area, a cecal fistual was made caudoventral to the ileal cannula. Prececocolonic contents could be collected from the ileal cannulae and/or substances could be infused into the cecum. The flexible cannulae were light weight (35 g), were easily replaced when dislodged with minimal tissue trauma and minimal discomfort to the animal, and had good animal tolerance and patency in long-term experiments. The cecal fistulae allowed the direct introduction of various substances into the cecum. There was little external projection from the abdominal wall, and the fistulae were subject to minimal leakage. The procedure did not adversely affect the subsequent health or performance of the 43 gilts used in the experiment. Postmortem examination of gilts euthanatized 12 to 26 weeks postoperatively revealed normal tissue adhesions around the surgical sites with no detrimental effects on the gastrointestinal tract.