Fixation of a complete scapular neck fracture in a foal using two 3.5 mm locking compression plates

This report describes the successful surgical repair of a transverse, displaced scapula fracture in a foal. A 3.5 mm locking compression plate (LCP) was used on either side of the spine of the scapula. The suprascapular nerve was apparent upon dissection as it passed directly over the fracture line and care was taken to leave it intact, although the fracture line itself caused some irritation. The foal recovered without long‐term nerve damage and is sound at 1.5 years post surgery.     

Successful surgical debridement of a cerebral Streptococcus equi equi abscess by parietal bone flap craniotomy in a 2-month-old Warmblood foal

Brain abscesses and intracranial masses have been regularly described in horses. Treatment often is difficult and unrewarding and mortality rate high. This case report describes the successful treatment of a cerebral abscess in a 2-month-old female Warmblood foal with severe neurological signs of acute onset. Computed tomography (CT) revealed a 3 × 4 × 4 cm cerebral mass in the left brain hemisphere with severe cerebral oedema. Craniotomy, using a parietal bone flap technique, allowed the abscess to be sampled, drained and lavaged. Immediately, post-surgery the foal showed significant clinical improvement. Sample culture confirmed Streptococcus equi equi infection. The foal was medically treated for 6 weeks, leading to complete clinical and radiographical recovery. Intracranial surgery in equine medicine is limited. Using a parietal bone flap instead of partial craniectomy to gain access to the cerebrum is a less invasive procedure leading to a better aesthetic result and should be considered for the treatment of cerebral masses in the horse.     

Reversed patent ductus arteriosus and multiple congenital malformations in an 8‐day‐old Arabo‐Friesian foal

An 8‐day‐old Arabo‐Friesian filly was presented with signs of severe dyspnoea, tachypnoea, coughing and cyanotic mucous membranes. On auscultation, a bilateral grade V/VI continuous heart murmur and heart rate of 155 beats/min (sinus tachycardia) were detected. Lung ultrasonography revealed pronounced comet tail artefacts indicating lung oedema. Echocardiography showed right ventricular hypertrophy, a 1.2 cm muscular ventricular septal defect with a left‐to‐right shunt, a stenotic bicuspid pulmonary valve and severe mitral and tricuspid valve regurgitation. Tricuspid regurgitation peak velocity indicated a right ventricular systolic pressure of 119 mmHg. The pulmonary artery was severely dilated and a 1 cm diameter patent ductus arteriosus was found. Colour flow Doppler showed systolic ductal flow reversal with right‐to‐left shunting through the ductus. Arterial partial oxygen pressure and saturation were lower in the metatarsal artery (25 mmHg, saturation 52.6%) than in the carotid artery (31 mmHg, saturation 64.3%). Due to the poor prognosis, the foal was subjected to euthanasia and necropsy confirmed the ultrasonographic findings. Patent ductus arteriosus is a rare condition and occurs most frequently in combination with tetralogy and pentalogy of Fallot. A genetic basis for congenital cardiac disease, especially for ventricular septal defects, in Arabians and for aortic rupture and aorto‐pulmonary fistulation in Friesians has been reported. Whether cross‐breeding leads to an increased prevalence is unknown. This is the first case report with echocardiographic visualisation of reversed ductal flow in a neonatal Arabo‐Friesian foal.     

Successful outcome after surgical correction of large colon atresia in a colt foal

This report describes successful surgical correction and long-term survival of a case of large colon atresia in a 24-h-old Warmblood colt, referred with signs of unrelenting abdominal pain and a suspicion of meconium impaction. Radiographic and ultrasonographic examination was indicative of large colon meconium impaction with secondary ileus. Due to deterioration of the foal, surgery was recommended. An atretic segment was found between the left ventral and dorsal large (ascending) colon. A band of fibrous tissue with no identifiable lumen connected the segments. Surgical correction was done by performing a stapled side-to-side anastomosis. Twelve days after surgery, the foal was discharged. Twenty-two months after discharge, the owner reported the foal developing as expected compared with its peers, but had a mild, self-limiting episode of colic at 20 months of age.     

Surgical treatment of a large congenital cavernous haemangioma on the thorax of a foal

A 3‐day‐old male foal was presented with a fluctuant 25 × 15 cm mass on the thorax. The mass had increased in size since birth. The mass did not respond to conservative treatment consisting of aspiration of serohaemorrhagic contents and compression bandages, and it was therefore surgically removed when the foal was approximately 2½ weeks. A histopathological diagnosis of cavernous haemangioma was made. Healing progressed without complications despite a large surgical wound left to heal by second intention. Recurrence was not observed during the 1.5‐year follow‐up period.     

Treatment of congenital hydrocephalus in a foal using a ventriculoperitoneal shunt

Objective: The objective of this report is to describe the presentation, diagnostic imaging findings, management, and complications of surgical shunt placement in a foal with congenital hydrocephalus. Case summary: A 3‐day‐old Quarter Horse colt was diagnosed with hydrocephalus on the basis of clinical signs and computed tomographic scan. A surgical shunt was placed from the right cerebral ventricle to the peritoneum. The foal demonstrated significant improvement in clinical signs until shunt complications occurred. New or unique information provided: To the authors' knowledge, the placement of a ventriculoperitoneal shunt to manage equine hydrocephalus has not been described. This case report provides a foundation for understanding the techniques and possible complications of surgical shunt placement in hydrocephalic foals.     

Pulmonary embolism as a complication after abdominal surgery and colitis in a foal

This report describes a fatal pulmonary embolism in a foal, as a sequela of septic thrombophlebitis of the right jugular vein and/or a generalised hypercoagulable state. The foal underwent abdominal surgery and suffered from severe and prolonged colitis. Despite intense supportive care, the colt developed venous thrombophlebitis and subsequently died suddenly 12 days after discharge from the hospital, following an initial improvement. On post‐mortem examination, a large pulmonary embolism was discovered. Pulmonary thromboembolism is a potentially fatal sequelae of thrombus formation. It is difficult to detect and therefore likely to be underdiagnosed.     

CONTRAST‐ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY FOR DIAGNOSIS OF PORTOSYSTEMIC SHUNTS IN 10 DOGS

Computed tomography angiography, sonography, scintigraphy, and portography can be used to evaluate the portal vasculature to evaluate for a portosystemic shunt (PSS). Time‐of‐flight magnetic resonance angiography (TOF‐MRA) and contrast‐enhanced MRA (CE‐MRA) are other potentially useful techniques. The aim of this study was to evaluate CE‐MRA in 10 dogs suspected of having a PSS. Noncontrast MR images of the abdomen were obtained using a Siemens Symphony MR‐scanner (1.5 T) and a T1‐weighted FLASH‐3D sequence with a very short scan time (about 20 s). After injection of contrast medium, the initial sequence was repeated five times. The sequence with the best contrast medium filling of the portal vasculature was selected subjectively, subtracted from the initial survey image series, and a maximum intensity projection (MIP) of the subtraction data, in multiple views, was created. The cross‐sectional and MIP images were evaluated for abnormal portosystemic vasculature. A single PSS was identified and confirmed at surgery in all dogs. A portocaval shunt was found in five dogs, a portophrenic shunt in three dogs, a portoazygos shunt in one, and a central divisional intrahepatic shunt in one other dog. Based on our results, CE‐MRA is a useful tool for imaging abdominal and portal vasculature and for the diagnosis of a PSS.     

Presentation,stabilisation and contrast-enhanced computed tomographic (CT) diagnosis of a left gastrocaval portosystemic shunt in a pony foal

A 2-week-old pony foal was presented for recurrence of neurological dysfunction, obtunded-comatose mentation and collapse. Signalment, history, haematological and clinical chemical measurements and response to treatment prompted a presumptive diagnosis of hepatic encephalopathy secondary to a portosystemic shunt. This case differs from previous reported cases of  congenital portosystemic shunts in horses due to the early onset of clinical signs, which usually occur at 2–6 months of age. In addition, in comparison with previously reported cases, this foal stabilised rapidly with minimal intervention. Contrast-enhanced computed tomography (CT) confirmed a left gastrocaval extrahepatic portosystemic shunt. Surgical intervention was not attempted due to financial constraints, so the foal was subjected to euthanasia, and on post-mortem examination, the anomalous vascular connection could clearly be identified.     

Portosystemic shunts: A diagnostic challenge

The case report in this issue by Woodford et al. (2017) describes the surgical management of an extrahepatic portosystemic shunt in a 5‐week old miniature foal. Only a handful of reports exist in the literature describing surgical procedures for repair of these congenital abnormalities in foals. One of the important aspects of the accompanying case report was the multidisciplinary approach taken in handling, imaging and surgical repair of the extrahepatic shunt. Small animal internal medicine specialists and surgeons diagnose portosystemic shunts much more frequently than equine veterinarians, regardless of whether they are general practitioners or specialists. It is therefore important to work as a team with small and large animal practitioners. The case described by Woodford et al. (2017) had a positive outcome.     

Successful management of multiple extrapulmonary complications associated with Rhodococcus equi pneumonia in a foal

This report describes the diagnosis and successful treatment of multiple extrapulmonary sequelae of Rhodococcus equi (R. equi) pneumonia in a 3‐month‐old filly. Bilateral uveitis and hyphaema, haemolytic anaemia and polysynovitis developed in this foal and were likely due to immune‐mediated mechanisms. The challenges associated with diagnosis and treatments of these extrapulmonary disorders are discussed. The filly was treated initially with clarithromycin and rifampin; however, a blood transfusion and immunosuppressive therapy with dexamethasone were required due to progressive haemolysis and for treatment of uveitis and polysynovitis. Bilateral hyphaema was successfully treated with intracameral injections of a recombinant tissue plasminogen activator. The development of antimicrobial resistance in R. equi was an additional challenge encountered in the management of this case and emphasises the importance of culture and in vitro antimicrobial susceptibility testing of isolates from foals with R. equi pneumonia. Extrapulmonary disorders associated with R. equi pneumonia are likely underdiagnosed and associated with a poor prognosis. This case highlights the importance of thorough and ongoing diagnostic assessment of foals with R. equi pneumonia and demonstrates that a successful outcome can be achieved with appropriate and directed treatment.     

Contrast‐enhanced ultrasonography is a feasible technique for quantifying hepatic microvascular perfusion in dogs with extrahepatic congenital portosystemic shunts

Extrahepatic‐congenital portosystemic shunt is a vascular anomaly that connects the portal vein to the systemic circulation and leads to a change in hepatic microvascular perfusion. However, an assessment of hepatic microvascular perfusion is limited by conventional diagnostic modalities. The aim of this prospective, exploratory study was to assess hepatic microvascular perfusion in dogs with extrahepatic‐congenital portosystemic shunt using contrast‐enhanced ultrasonography (CEUS) using perfluorobutane (Sonazoid^®). A total of 17 dogs were included, eight healthy dogs and nine with extrahepatic‐congenital portosystemic shunt. The time‐to‐peak (TTP), rising time (RT), and rising rate (RR) in the hepatic artery, portal vein, and hepatic parenchyma, as well as the portal vein‐to‐hepatic parenchyma transit time (ΔHP‐PV) measured from time‐intensity curve on CEUS were compared between healthy and extrahepatic‐congenital portosystemic shunt dogs. The RT of the hepatic artery in extrahepatic‐congenital portosystemic shunt dogs was significantly earlier than in healthy dogs (P = 0.0153). The TTP and RT of the hepatic parenchyma were significantly earlier in extrahepatic‐congenital portosystemic shunt dogs than in healthy dogs (P = 0.0018 and P = 0.0024, respectively). ΔHP–PV was significantly shorter in extrahepatic‐congenital portosystemic shunt dogs than in healthy dogs (P = 0.0018). CEUS effectively revealed changes in hepatic microvascular perfusion including hepatic artery, portal vein, and hepatic parenchyma simultaneously in extrahepatic‐congenital portosystemic shunt dogs. Rapid hepatic artery and hepatic parenchyma enhancements may reflect a compensatory increase in hepatic artery blood flow (arterialization) caused by a decrease in portal vein blood flow and may be used as an additional diagnostic test to distinguish extrahepatic‐congenital portosystemic shunt dogs from healthy dogs.     

Aortic rupture causing cardiac tamponade in a 24‐day‐old Friesian colt with concurrent colonic Chlamydiosis and Balantidiasis

A 24‐day‐old Friesian colt died suddenly and a physical examination the morning the foal died showed no abnormalities and serum IgG levels >8.0 g/l. Necropsy examination revealed haemopericardium and a 2 cm transverse tear at the root of the aorta. The foal was also found to have Chlamydophila spp. in the epithelium and Balantidium coli on the mucosal surface of the large colon. An aortic rupture is a novel finding in a foal, colonic Chlamydiosis has not been previously reported in horses and Balantidium coli has not been reported in equids in North America.     

Use of a Baerveldt gonioimplant for secondary glaucoma in a horse

This case report describes the surgical placement of a Baerveldt glaucoma shunt in the right eye of a 14‐year‐old Arabian gelding. The glaucomatous right eye was refractory to aggressive medical and repeated surgical therapies yet maintained functional vision. Despite the need for intensive post operative management and continued daily topical therapy, shunt placement surgery was successful at maintaining normotension and vision for a period of 402 days. This is the first report of long‐term successful glaucoma filtration surgery in this species. Further studies are warranted to evaluate long‐term success of glaucoma shunt placement in equine glaucoma cases.     

Intraoperative contrast echocardiography to verify the surgical occlusion of a single extrahepatic portosystemic shunt in a dog

This report details a bubble echocardiographic study carried out during the surgical treatment of a congenital single extrahepatic portosystemic shunt (PSS) in a Labrador Retriever. After celiotomy, agitated saline was injected through a jejunal vein and microbubbles appeared rapidly in the right cardiac chambers. The test confirmed the presence of a PSS, helping the surgeon to identify the vessel concerned and to rule out a second shunt. Successively, portography confirmed what the exploratory celiotomy had revealed before with the aid of the bubble study: a single shunt was located between the portal vein and the right renal vein. It was completely ligated, as all the criteria for this solution were met. Intraoperative contrast echocardiography (ICE) was easy to perform, helpful and undemanding. It is proposed here as an intraoperative ancillary test to diagnose all PSS and to confirm successful treatment when complete shunt closure is possible.     

Single stage urethroplasty for perineal hypospadias in a foal

The incidence of hypospadias is increasing in man, but the condition is rarely reported in horses. There are few available data regarding the surgical management of this disorder in horses, with no previous published report of urethral reconstructive surgery and only two reports documenting phallectomy procedures. This case report documents hypospadias repair, not previously reported in the horse, in a Thoroughbred foal with proximal hypospadias. The indication for surgery was contact dermatitis of the hind leg, which was impairing the foal's ambulation and had the potential to impair the foal's racing ability. Preoperative examination revealed a proximal hypospadias with a wide urethral plate. The anus was normal. The foal was otherwise thriving. A single stage urethroplasty was performed, during which the urethral plate was tubularised in two layers and the urethral meatus was successfully relocated distally to open upon the glans. The urethroplasty was covered with dartos fascia and the penile shaft skin and prepuce were reconstructed. Minor superficial dehiscence of the wound was successfully managed conservatively. Post‐operatively, urine was voided through the opening created on the glans penis, resolving the contact dermatitis. Follow‐up after 3 years confirmed that the horse continues to void through the re‐sited meatus without complication and had gone on to race successfully. In conclusion, we present the first report of reconstructive urethroplasty for the treatment of a horse for proximal hypospadias with good functionality and long‐term outcome.     

Use of transcolonic portal scintigraphy to evaluate efficacy of cellophane banding of congenital extrahepatic portosystemic shunts in 16 dogs

OBJECTIVE: To evaluate the efficacy of cellophane banding of single congenital extrahepatic portosystemic shunts in dogs using transcolonic portal scintigraphy. To investigate the portal circulation of those dogs with elevated postoperative shunt fractions to determine the cause of the persistent shunting. Further, to evaluate whether presenting signs, clinical pathology findings and liver histopathology are predictive of outcome. DESIGN: Prospective study of 16 dogs presenting with single congenital extrahepatic portosystemic shunts. PROCEDURE: Dogs with single extrahepatic portosystemic shunts attenuated by cellophane banding underwent portal scintigraphy and bile acids tolerance testing pre- and post-operatively. Dogs identified with elevated shunt fractions at 10 weeks post-operatively underwent mesenteric portovenography. Qualitative hepatic histopathology from all dogs was reviewed by a veterinary pathologist and assigned a semi-quantitative score to identify any abnormalities that may predict surgical outcome. RESULTS: At 10 weeks post cellophane banding, 10 of 16 cases (63%) had normal shunt fractions, whilst six dogs (37%) had increased shunt fractions and seven dogs (44%) had increased serum bile acids. Of these dogs, mesenteric portovenography revealed incomplete closure of the shunt in three dogs (18.6%) and multiple acquired shunts in three dogs (18.6%). Liver histopathology findings were similar for all dogs, regardless of outcome. CONCLUSIONS: Cellophane banding is an efficacious method for complete gradual occlusion of single extrahepatic shunts when the shunt vessel is attenuated to < or = 3 mm. Transcolonic portal scintigraphy is a reliable method for assessment of shunt attenuation and, unlike serum bile acids, is not influenced by other causes of liver dysfunction.     

Evaluation of a portocaval venograft and ameroid ring for the occlusion of intrahepatic portocaval shunts in dogs

OBJECTIVE:To evaluate the use of a portocaval venograft and ameroid constrictor in the surgical management of intrahepatic portosystemic shunts (PSS). STUDY DESIGN: Prospective, clinical study. Animal Population: Ten client-owned dogs with intrahepatic PSS. METHODS: Portal pressure was measured after temporary suture occlusion of the intrahepatic PSS. In dogs with an increase in portal pressure greater than 8 mm Hg, a single extrahepatic portocaval shunt was created using a jugular vein. An ameroid ring was placed around the venograft and the intrahepatic PSS was attenuated. Transcolonic pertechnetate scintigraphy was performed before surgery, 5 days after surgery, and 8 to 10 weeks after surgery. Dogs with continued portosystemic shunting were evaluated further by laparotomy or portography. Clinical outcome and complications were recorded. RESULTS: Mean (+/- SD) portal pressure increased from 6 +/- 3 to 19 +/- 6 mm Hg with PSS occlusion; in all 10 dogs, the increase in portal pressure was greater than 8 mm Hg. There were no intraoperative complications, and, after creation of the portocaval shunt, the intrahepatic PSS could be completely ligated in 8 of 10 dogs. The final portal pressure was 9 +/- 4 mm Hg. Postoperative complications included coagulopathy and death (1 dog), ascites (3 dogs), and incisional discharge (3 dogs). Five of 8 dogs had continued portosystemic shunting at 8 to 10 weeks after surgery. Multiple extrahepatic PSS were demonstrated in 4 of these dogs. Clinical outcome was excellent in all 9 surviving dogs. CONCLUSIONS AND CLINICAL SIGNIFICANCE: The surgical technique resulted in a high incidence of multiple extrahepatic PSS. Short-term clinical results were promising, but long-term outcome must be evaluated further.     

Anaphylaxis and systemic inflammatory response syndrome induced by inadvertent intravenous administration of mare's milk in a neonatal foal

Objective – To describe the diagnostic procedures, therapeutic management and successful outcome of a case of anaphylaxis induced by the inadvertent intravenous (IV) administration of mare's milk to a neonatal foal. Case Summary – A 3‐day‐old Thoroughbred colt was presented for treatment of bilateral flexural limb deformities of the forelimbs. Because the foal was unable to ambulate initially, mare's milk was administered via nasoesophageal tube feedings during treatment of the musculoskeletal disorder. Anaphylaxis resulted after unintentional administration of a bolus of 150 mL of mare's milk through a jugular catheter. Aggressive therapy for anaphylaxis and careful monitoring resulted in the successful recovery of the foal after 9 days of intensive care. New or Unique Information Provided – This case is the first published report to describe the effects of accidental IV administration of mare's milk to a neonatal foal. Medical errors are commonly reported in pediatric medicine; the intent of this report is to raise awareness of medical errors and student education in equine medicine as well as describe the therapy and outcome of anaphylaxis induced by IV administration of mare's milk in a neonatal foal.     

Ulnar osteotomy for treatment of cubital subluxation,following locking compression plate osteosynthesis of a radius fracture in a foal

A closed mid‐diaphyseal fracture in a one‐day‐old foal was treated using a 3.5 mm locking compression plate on the cranial aspect of the radius. The foal showed good fracture healing, but a radio‐ulnar synostosis developed despite the absence of transfixation by any implant into the ulna. Four months after surgery the radiographs revealed a cubital subluxation, which was managed by an osteotomy of the ulna at the time of plate removal, allowing the ulna to adjust into a normal position. One year after surgery the foal was clinically sound; the radiographs showed good healing of the osteotomy gap as well as good remodelling of the radius; however, a slight elbow subluxation was present.