Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.     

Long-term management of sabulous cystitis in five horses

Five horses with sabulous cystitis were managed for up to three years. They were treated by emptying the bladder through a urinary catheter and saline lavage with cytoscopic guidance to remove residual sabulous material. The cystitis was treated with antimicrobial and anti-inflammatory medications, and bethanechol chloride was also administered. Frequent catheterisation and emptying of the bladder was an alternative to regular cystoscopic examination with saline lavage but it resulted in the development of a urethral stricture in one case. Four of the horses returned to work and one was retired owing to persistent incontinence.     

Use of an active intra-abdominal drain in 67 horses

OBJECTIVE: To describe the insertion technique, efficacy, and complications associated with the use of an active (closed-suction) abdominal drain in horses. STUDY DESIGN: Retrospective study. Animals-Sixty-seven horses with abdominal contamination treated by abdominal lavage and use of a closed-suction abdominal drain. METHODS: Medical records of horses (1989-1996) that had a closed-suction abdominal drain were reviewed. Follow-up information was obtained by telephone interviews with owners. RESULTS: Sixty-eight closed-suction abdominal drains were used in 67 horses that had abdominal contamination, peritonitis, or to prevent adhesion formation. The drain was placed under general anesthesia (62 horses) or in a standing position (6 horses). Abdominal lavage was performed every 4 to 12 hours and about 83% of the peritoneal lavage solution was retrieved. Minor complications associated with drain use occurred in 49% of the horses and included obstruction or slow passage of fluid through the drain in 18 horses (26%), leakage of fluid around the drain in 11 horses (16%), and subcutaneous fluid accumulation around the drain in 8 horses (12%). Incisional suppuration developed in 20 of 62 (32%) and incisional herniation in 5 of 46 (11%) horses. CONCLUSIONS: A closed-suction drain system was easily placed and was associated with only minor complications in most horses. CLINICAL RELEVANCE: Active abdominal drainage and lavage is a useful adjunct in the treatment of peritonitis or as a prophylactic procedure in horses at risk of developing septic peritonitis and abdominal adhesions. Clinicians should be aware of the high incidence of minor complications.     

Ten cases of bladder paralysis associated with sabulous urolithiasis in horses

Bladder paralysis and sabulous urolithiasis were diagnosed in 10 horses with urinary incontinence. Additional neurological deficits in the hindquarters were detected in five of them. Treatment by catheter drainage and bladder lavage was unsuccessful, and all the horses were destroyed within 14 months of presentation. Neuritis of the cauda equina was diagnosed post mortem in one horse, but the cause of the paralysis was not identified in the others, although radiography revealed abnormal lumbosacral vertebral angulation in one case.     

Antimicrobial delivery by intrasynovial catheterisation with systemic administration for equine synovial trauma and sepsis

Objective To present the technique for intra-articular catheter placement and report the clinical outcomes of 38 cases of equine synovial trauma and/or infection treated with broad-spectrum antimicrobials administered via an intrasynovial catheter (ISC). Design Retrospective study. Procedure Medical records of 38 horses treated for synovial trauma and sepsis with frequent antimicrobial administration through an ISC from 1995 to 2008 were reviewed. Follow-up information was obtained via clinical re-evaluation or telephone contact with the owners. Results The majority of horses (84%) received amikacin and Timentin® four times daily. In addition, synovial lavage through the ISC was carried out in 27 horses (71%). Only radiological evidence of osteolysis had a significant negative impact on both lameness at the time of hospital discharge and the long-term outcome. In total, 92% of horses treated with frequent antimicrobial administration through an ISC had clinical resolution of infection. Catheter obstruction occurred in three cases, necessitating replacement or removal, and two synovial fistulae developed at sites of open drainage. The majority of horses treated had a favourable outcome, with 86% being at least pasture sound and 43% returned to riding. Conclusion Septic synovial structures treated with frequent antimicrobial administration through an ISC had a good prognosis for survival and 43% returned to riding, which is consistent with the results of other studies. The use of a simple ISC should be considered when broad-spectrum intrasynovial antimicrobial administration and lavage of a septic synovial structure are indicated.     

Mononuclear phagocytes of transport-stressed horses with viral respiratory tract infection

Twelve horses comprised 3 treatment groups; all horses in 2 of the groups had recently been transported and had clinical and laboratory evidence of respiratory tract infection, with equine influenza type 2 virus being the principal pathogen. Mononuclear phagocytes and other leukocytes from blood, lung, and peritoneal cavity were studied in phagocytosis and erythrocyte-antibody (EA) rosette assays. Total numbers of pulmonary alveolar macrophages were increased over control values in bronchoalveolar lavage (BAL) fluid of group 3 horses after recovery from influenza (P less than 0.02), whereas the increase in neutrophils in the fluid of those horses approached significance. Lymphocytes in BAL fluid of group 3 horses (after recovery from influenza) were in larger proportion than those in fluid of group 1 horses during acute influenza (P less than 0.05). Pulmonary alveolar macrophages of group 1 horses formed a lower percentage of EA rosettes than did those of controls (P less than 0.01) or group 3 horses (P less than 0.02). The differential counts of peritoneal macrophages and neutrophils in horses of groups 1 and 3 were virtually identical at the first collection, but differed from controls at the second collection 4 weeks later; peritoneal macrophages were reduced (P less than 0.01), whereas peritoneal neutrophils were increased (P less than 0.01). Peritoneal macrophages and peritoneal neutrophils of horses with acute influenza were phagocytic in larger proportion than were those in controls at both collection times (P less than 0.01 and P less than 0.01 for peritoneal macrophages, and P less than 0.01 and P less than 0.05 for peritoneal neutrophils, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Peritoneal Lavage and Drainage with Fenestrated Balloon Catheters in Standing Horses: A Comparative Study

This experimental study compares the efficiency of two fenestrated balloon catheters in allowing drainage of fluid during abdominal lavage in 12 healthy horses. Catheter A (with multiple side holes) or catheter B (with a single side hole) was placed in the ventral abdominal wall. Lactated Ringer's solution was instilled through a catheter in each paralumbar fossa of the standing horse. Drainage was performed through two catheters A in group 1, one catheter A in group 2, and one catheter B in group 3. Drainage was not significantly faster when using two, as compared with one, catheters A (P = 1). Amount of fluids recovered was greater using catheter A compared with catheter B (P = .004). Abdominal fluid analysis on day 30 was significantly higher (P = .008) for total protein in individuals with catheter B compared with catheter A. Use of one multiple fenestrated balloon catheter may be justified in clinical cases that need abdominal lavage and drainage.     

Diagnostic abdominal paracentesis and lavage: experimental and clinical evaluations in the dog.

Diagnostic abdominal paracentesis and saline lavage, using a peritoneal dialysis catheter, was evaluated experimentally and clinically in dogs. Use of the catheter enabled detection of abdominal fluid in volumes as low as 0.2 ml/kg of body weight. In paracentesis, the catheter proved to be a more reliable means of detecting hemoperitoneum than did a needle. In 14 clinical cases of blunt trauma, use of the catheter provided reliable evidence of intraabdominal injury.     

Bronchoalveolar lavage fluid cytologic findings in horses with pneumonia or pleuropneumonia

Bronchoalveolar lavage was performed in 22 horses with pneumonia or pleuropneumonia. All horses had clinical evidence of pneumonia or pleuropneumonia on the basis of physical, radiographic, ultrasonographic, tracheobronchial aspirate or post-mortem findings. Results of lavage fluid analysis were normal in 9 horses, equivocal in 3 horses, and abnormal in 10 horses. Abnormal lavage fluid had increased total cell count, increased relative and absolute neutrophil counts, degenerative neutrophils, and decreased relative and absolute macrophage and lymphocyte counts.     

Use of free conjunctival grafts in horses: ten cases

OBJECTIVE: To assess the effectiveness of free conjunctival grafts in the treatment of horses with a range of keratopathies. DESIGN: A retrospective clinical study of ten client-owned horses treated at Murdoch University Veterinary Hospital from May 1996 to September 2001. PROCEDURE: The suitability of patients for the surgical procedure was assessed using a slit lamp biomicroscope and by direct and indirect ophthalmoscopy. Surgery was performed with the aid of an operating microscope, under general anaesthesia. A subpalpebral ocular lavage catheter was used for administration of topical atropine and antibiotics postoperatively. RESULTS: In all ten horses the affected globe was saved. In nine of the horses vision in the eye was satisfactory 6 months after surgery, and in one horse the eye was blind. Complications included further corneal ulceration or eyelid abscessation and some loss of sutures, although these did not preclude a successful outcome. CONCLUSION: Free conjunctival grafts were successful in treating a range of keratopathies in the horse, and the technique offers a number of advantages over other forms of surgical intervention.     

Use of a protected catheter brush for culture of the lower respiratory tract in horses with small airway disease.

A protected catheter brush introduced by fiberoptic bronchoscopy was used to sample the tracheai and bronchial mucosa in 28 horses with small airway disease. Tracheal and bronchial brushings were examined for the presence of fungi, aerobic and anaerobic bacteria, and a cytoiogical evaluation was also done on fluid collected by the bronchoalveolar lavage (BAL) technique. Microorganisms (bacteria and fungi) were isolated more often in tracheal brushings (53.6%) than in bronchial brushings (10.7%). Anaerobic bacteria were not isolated. Results of this study indicate that fiberoptic bronchoscopy using a protected catheter brush is an easy and practical technique to obtain minimally contaminated samples for isolation of microorganisms from the lower respiratory tract of horses. However, no association was observed between isolation of high numbers of microorganisms from the bronchi and severity of small airway disease.     

Pericarditis in horses: six cases (1982-1986)

Records of 6 horses with pericarditis were reviewed. Septic pericarditis was suspected in all horses, based on historic and clinical findings. In horses 1, 2, and 4, cytologic examination of the pericardial effusion revealed acute inflammation with severe neutrophil degeneration. In horses 3 and 5, cytologic examination of pericardial fluid revealed subacute inflammation with degenerated neutrophils, and in horse 6, chronic active inflammation, with well preserved neutrophils. In horses 1 and 3, bacteria were identified on cytologic examination of pericardial fluid. Results of microbiologic cultures of pericardial fluid were positive in horse 3. All horses were treated with broad-spectrum antibiotics. An indwelling pericardial catheter was used to lavage and directly administer antibiotics into the pericardial sac. Horses 1, 4, 5, and 6 survived, horse 2 died of unrelated causes, and horse 3 was euthanatized at the owner's request. Surviving horses returned to athletic performance.     

Tumor Necrosis Factor and Interleukin-6 Activity and Endotoxin Concentration in Peritoneal Fluid and Blood of Horses with Acute Abdominal Disease

The purpose of this study was to evaluate the diagnostic and prognostic significance of tumor necrosis factor-alpha (TNF) and interleukin-6 (IL-6) activities and endotoxin concentration in blood and peritoneal fluid of 155 adult horses with acute abdominal disease (colic). Samples also were obtained from 20 healthy adult horses. Blood and peritoneal fluid supernatant TNF and IL-6 activities and endotoxin concentration were significantly greater in horses with colic, compared with healthy horses. In horses with colic, the peritoneal fluid endotoxin concentration and TNF and IL-6 activities were significantly greater than those in blood. Within the colic group, peritoneal fluid IL-6 activity was the analyte that was most frequently increased. Blood and peritoneal fluid supernatant TNF and IL-6 activities were significantly greater when endotoxin was detected in the same sample. Blood and peritoneal fluid IL-6 activity was significantly greater in horses with inflammatory or strangulating lesions, compared with horses having nonstrangulating or noninflammatory lesions. Compared with all other data categories, diagnostic accuracy for nonsurvival was greatest (80%) when blood IL-6 activity exceeded 60 units/mL. The results of this study indicate that endotoxin was present in the peritoneal cavity of at least one third of horses with any acute disease of the abdomen. In horses presented for colic, blood or peritoneal fluid IL-6 activity was more useful than either TNF activity or endotoxin concentration for distinguishing lesion type. Although diagnostic accuracy for the prediction of nonsurvival was good for all of the analytes, negative values were more useful in the prediction of a favorable outcome than were abnormally increased values in the prediction of mortality.     

Arthroscopic treatment of temporomandibular joint sepsis in a horse

OBJECTIVE: To report arthroscopic debridement and lavage of a septic temporomandibular joint (TMJ) in a horse. DESIGN: Clinical case report. ANIMALS: A 12-year-old Thoroughbred mare. METHODS: Arthroscopic investigation of the dorsal joint pouch of the right TMJ was made through a stab incision into the dorsocaudal compartment. Mechanized resection of synovium and fibrinous debris combined with copious lavage, and intra-articular and systemic antibiotic administration was used to treat the septic TMJ. RESULTS: Arthroscopic debridement and lavage of the TMJ, in combination with intra-articular and systemic antimicrobials resulted in resolution of sepsis. Eight months post-operatively, there was no clinical evidence of degenerative joint disease or ankylosis of the TMJ. CONCLUSION: TMJ sepsis is rare in horses, however, standard arthroscopic equipment can be used in the management of this condition with minimal complications. CLINICAL RELEVANCE: Arthroscopic debridement and lavage should be considered for evaluation and initial treatment of TMJ sepsis in horses.     

Open drainage, intra-articular and systemic antibiotics in the treatment of septic arthritis/tenosynovitis in horses.

Open drainage was used to treat 26 horses with persistent or severe septic arthritis/tenosynovitis. Infected synovial structures were drained through a small (3 cm) arthrotomy incision that was left open and protected by a sterile bandage. Joint lavage was performed in all 26 horses. In addition to systemic antibiotics, 23 of these horses were also treated with intra-articular antibiotics; amikacin (17 horses), gentamycin (2 horses), cefazolin (2 horses), and 2 horses were injected at different times with gentamycin and amikacin. The infection was eliminated from the involved synovial structures in 25 of 26 horses; 24 survived and were released from the hospital. The arthrotomy incisions healed by granulation in 16 horses; in 9 horses the arthrotomy incision was sutured closed once the infection was eliminated. Seventeen horses returned to soundness and resumed athletic function. Open drainage was an effective method of achieving chronic drainage from a joint or tendon sheath. It is indicated in horses that have established intra-synovial infections or in horses that do not respond to joint lavage through needles.     

Intermittent peritoneal dialysis for the treatment of acute renal failure in two horses

Acute renal failure (ARF) in the horse is most commonly due to decreased renal perfusion or a nephrotoxic insult. Conventional therapy includes the administration of i.v. fluids, frusemide, mannitol and/or dopamine, as well as general supportive care. However, not all horses with ARF will respond to these treatments. In these cases, peritoneal dialysis is a viable therapeutic option. This case report describes 2 horses with ARF that was refractory to conventional therapy. Intermittent peritoneal dialysis was used effectively in both cases for treatment of the ARF. Dialysis was easy to perform and associated only with minor complications. To the authors' knowledge, this is the first report describing the successful use of intermittent peritoneal dialysis in the treatment of ARF in the horse.     

Prevention and treatment of gastrointestinal adhesions.

As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, minimizing the propensity for adhesion formation between apposing adynamic segments of intestine. Mechanical separation of potentially adhesiogenic serosal and peritoneal surfaces is commonly achieved with use of abdominal lavage, protective coating solutions, and barrier membranes. Ongoing and future research is directed toward a better understanding of the local effects of intestinal trauma and the corresponding response of the fibrinolytic system. Recognition of horses at high risk for adhesion formation helps to guide the equine surgeon to an appropriate perioperative and intraoperative plan for adhesion prevention, including good surgical technique and a combination of adjunct therapies.     

Peritoneal d-Dimer Concentration for Assessing Peritoneal Fibrinolytic Activity in Horses with Colic

Background: Plasma d -dimer concentration is a useful marker to assess systemic coagulation and fibrinolytic activities in humans, dogs, and horses. Peritoneal fibrinolytic activity increases in horses with colic, especially in horses with endotoxin in the peritoneal fluid.
Hypothesis/Objectives: Peritoneal d -dimer concentration can be used to assess peritoneal fibrinolytic activity in horses with severe gastrointestinal (GI) disorders and altered peritoneal fluid.
Animals: Two hundred and twenty-one colic horses and 15 control horses.
Methods: Prospective observational clinical study. Blood and peritoneal fluid were collected on admission. Horses were grouped according to diagnosis, peritoneal fluid analysis, and outcome. Peritoneal d -dimer concentration was determined, together with peritoneal tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) activities. Plasma d -dimer concentration also was measured.
Results: Peritoneal d -dimer concentration was significantly higher in all colic groups compared with controls, and in horses with enteritis, peritonitis, and ischemic disorders compared with horses with large intestinal obstructions. Peritoneal d -dimer concentration was significantly higher in horses with altered peritoneal fluid (modified transudate and exudate) compared with horses with normal peritoneal fluid analysis. Plasma d -dimer concentration also was significantly higher in the peritonitis group, and in horses with altered peritoneal fluid analysis. Peritoneal and plasma d -dimer concentrations also were significantly higher in nonsurvivors. Peritoneal d -dimer concentration was significantly correlated with decreased peritoneal t-PA activity and increased peritoneal PAI-1 activity.
Conclusions and Clinical Importance: Peritoneal d -dimer concentration is markedly higher in severe GI disorders, and it can be used to assess peritoneal fibrinolytic activity in horses with colic.     

Standing laparoscopic abdominal lavage using a suction-irrigation device in 2 horses with primary suppurative peritonitis

The use of a laparoscopic suction-irrigation device in 2 standing horses for lavage of the abdomen for the treatment of primary suppurative peritonitis is reported. Two horses were presented with a 1- to 2-week history of weight loss. Abdominocentesis revealed highly elevated total nucleated cell count. Peritoneal lavage systems were placed in both horses, but complications prevented adequate lavage. Both horses underwent standing laparoscopy; the dorsal abdomen was explored and the abdomen was profusely lavaged, using a suction-irrigation device. The procedure was efficient and allowed adequate visualization of the dorsal abdomen and lavage. A successful outcome was achieved in both cases.Key clinical message:Lavage of the abdomen of horses with peritonitis can be achieved under standing sedation, using a laparoscopic technique. In appropriately selected cases, this allows for adequate visualization of the dorsal abdomen and efficacious abdominal lavage.     

Closed Suction Drainage in the Treatment of Infectious Arthritis of the Equine Tarsocrural Joint

Infectious arthritis of the tarsocrural joint was treated in 13 horses with closed suction drainage through a flat, fenestrated, latex (Jackson-Pratt) drain, broad-spectrum antimicrobial agents, nonsteroidal anti-inflammatory drugs, and bandage immobilization. In 11 horses, arthroscopic lavage and debridement were also performed. Ingress drains were placed for lavage in six horses. Ten horses returned to their previous level of competition or were sound. One horse raced but had lameness of the affected tarsocrural joint and dropped in racing class; one horse was euthanatized because of laminitis in the supporting limb; and one horse was lame, but useful as a breeding animal. Closed suction drainage appeared to be a useful treatment in horses with infectious arthritis. Although arthroscopy was not necessary, it facilitated fibrin removal, lavage, and partial synovectomy. Because of the development of Pseudomonas superinfection in one horse, the use of simultaneous ingress catheters was not recommended.