Association between cribbing and entrapment of the small intestine in the epiploic foramen in horses: 68 cases (1991-2002)

OBJECTIVE: To determine whether there was an association between a history of cribbing and epiploic foramen entrapment (EFE) of the small intestine in horses. DESIGN: Retrospective study. ANIMALS: 68 horses examined at the University of Illinois or the University of Liverpool veterinary teaching hospitals. PROCEDURE: For horses examined at the University of Illinois that underwent surgery because of strangulating small intestine lesions, information about cribbing was obtained through telephone calls with owners. For horses examined at the University of Liverpool that underwent surgery for colic for any reason, information about cribbing was obtained through a preoperative questionnaire. RESULTS: 13 of 19 (68%) horses with EFE examined at the University of Illinois had a history of cribbing, compared with only 2 of 34 (6%) horses with other strangulating small intestine lesions (odds ratio, 34.7; 95% confidence interval, 6.2 to 194.6). Similarly, 24 of 49 (49%) horses with EFE examined at the University of Liverpool had a history of cribbing, compared with 72 of 687 (10.5%) horses with colic caused by other lesions (odds ratio, 8.2; 95% confidence interval, 4.5 to 15.1). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that there may be an association between cribbing and EFE in horses, with horses with a history of cribbing more likely to have EFE than horses without such a history.     

Incarceration of the small intestine by the epiploic foramen in fifteen horses

In 15 horses with acute abdominal disease, a diagnosis of incarceration of small intestine through the epiploic foramen was made, either at the time of exploratory celiotomy or at necropsy.     

Age distributions of horses with strangulation of the small intestine by a lipoma or in the epiploic foramen: 46 cases (1994-2000).

OBJECTIVE: To test the hypothesis that strangulation of the small intestine by a lipoma or in the epiploic foramen is more common in older horses. DESIGN: Retrospective study. ANIMALS: 46 horses. PROCEDURE: Ages of horses with strangulation of the small intestine by a lipoma (n = 29) or in the epiploic foramen (17) were compared with ages of 79 horses with miscellaneous small intestinal lesions. Effects of increasing age on risk of the diseases of interest were examined by use of logistic regression and a 1-sided trend test for binomial proportions. RESULTS: Mean age of the horses with strangulation in the epiploic foramen (9.6 years) was the same as that for the horses with miscellaneous small intestinal lesions (7.7), but mean age of the horses with strangulation by a lipoma (19.2) was significantly greater than that for the other groups. The proportion of horses with lipoma increased significantly with increasing age, but the proportion with strangulation in the epiploic foramen did not. CONCLUSIONS AND CLINICAL RELEVANCE: Results refute the current suggestion that increasing age predisposes horses for strangulation of the small intestine in the epiploic foramen but support the suggestion that the risk of strangulation of the small intestine by a lipoma increases with age.     

Short-term survival after surgery for epiploic foramen entrapment compared with other strangulating diseases of the small intestine in horses

REASONS FOR PERFORMING STUDY: Epiploic foramen entrapment (EFE) is one of the more common causes of colic in horses, but recent reports suggest a poor prognosis after surgical treatment. HYPOTHESIS: That EFE has a good prognosis compared with other small intestinal strangulating lesions. METHODS: Surgical findings, surgical procedures and short-term outcome were recorded for 157 horses that underwent surgery for strangulating lesions of the small intestine at the University of Illinois from 1994 to 2003. Horses were assigned to 3 groups for comparison; those with EFE, strangulation by lipoma and miscellaneous strangulating lesions. A logistic regression model and Monte Carlo tests of the binomial proportions were used to examine survival rates. The Kruskal-Wallis test was used to determine differences in usage of surgical treatments. Measurements of length and viability indices were analysed using a one-way analysis of variance followed by Tukey's HSD test, and viability scores were analysed using an exact Kruskal-Wallis test. Significance was set at P < 0.05. RESULTS: Horses with EFE were significantly more likely to be discharged (95%) than those with the other conditions (P < 0.05). The proportion of horses with ileal involvement was greater in horses with EFE than in the other 2 groups (P < 0.05), although this did not affect outcome. The distributions of viability grades for EFE and lipoma differed significantly (P < 0.05). CONCLUSIONS: The prognosis for horses that had surgery at this hospital for EFE was better than for those with the other conditions, although the greater proportion of horses with EFE with ileal involvement could influence outcome. Therefore, surgeons must consider ways of improving jejunocaecostomy and determining when bowel is viable, the latter to avoid jejunocaecostomy.     

Hypercalcemia in cats: a retrospective study of 71 cases (1991-1997)

A retrospective study was conducted to characterize the diseases, clinical findings, and clinicopathologic and ultrasonographic findings associated with hypercalcemia (serum calcium concentration >11 mg/dL) in 71 cats presented to North Carolina State University Veterinary Teaching Hospital. The 3 most common diagnoses were neoplasia (n = 21), renal failure (n = 18), and urolithiasis (n = 11). Primary hyperparathyroidism was diagnosed in 4 cats. Lymphoma and squamous cell carcinoma were the most frequently diagnosed tumors. Calcium oxalate uroliths were diagnosed in 8 of 11 cats with urolithiasis. Cats with neoplasia had a higher serum calcium concentration (13.5 ± 2.5 mg/dL) than cats with renal failure or urolithiasis and renal failure (11.5 ± 0.4 mg/dL; P <.03). Serum phosphorus concentration was higher in cats with renal failure than in cats with neoplasia ( P < .004). Despite the fact that the majority of cats with uroliths were azotemic, their serum urea nitrogen and creatinine concentrations and urine specific gravity differed from that of cats with renal failure. Additional studies are warranted to determine the underlying disease mechanism in the cats we identified with hypercalcemia and urolithiasis. We also identified a small number of cats with diseases that are not commonly reported with hypercalcemia. Further studies are needed to determine whether an association exists between these diseases and hypercalcemia, as well as to characterize the underlying pathophysiologic mechanism for each disease process.     

Hypoglycemia and hepatic ischemic necrosis after small intestinal incarceration through the epiploic foramen in a horse.

A 16-year-old stallion was presented to the Louisiana State University Veterinary Teaching Hospital for evaluation of acute abdominal pain. Physical examination and diagnostic procedures indicated a strangulating obstruction of the small intestine. At exploratory celiotomy, a strangulating incarceration of the jejunum through the epiploic foramen was found. The incarcerated small intestine was reduced, then resection of the nonviable bowel and anastomosis performed. After surgery, the horse exhibited clinical signs and laboratory findings associated with hypoglycemia and died in spite of emergency treatment. On post-mortem examination, a large thrombus was present in the portal vein at the level of the epiploic foramen and the liver had multiple large infarcted areas. The post-operative signs of hypoglycemia and necropsy findings of widespread hepatic ischemic necrosis are complications of epiploic foramen incarceration of the small intestine not previously reported and may in part explain the high mortality rate described for this lesion.     

Haemoperitoneum in horses: a retrospective review of 54 cases

This retrospective study was conducted in the UK and identifies the most frequent causes, diagnoses, treatment and prognoses for short- and long-term survival in 54 cases of horses with haemoperitoneum. Clinical signs of haemorrhagic shock and colic were common, and abdominal ultrasound was very useful for the identification of haemoperitoneum. Causes of haemoperitoneum included uterine injury (22 per cent), involvement of specific blood vessels (20 per cent), splenic injury (19 per cent), neoplasia (13 per cent) and other (4 per cent). No source was identified in 22 per cent of cases. Fifty-seven per cent of cases underwent exploratory laparotomy. Of the surgical cases, a diagnosis was made in 65 per cent, with 42 per cent surviving to discharge. It was felt that exploratory laparotomy had both diagnostic and therapeutic implications. Twenty-eight per cent of cases died, and 33 per cent were euthanased, whereas 39 per cent survived to be discharged from the hospital, with 35 per cent of these surviving in the long term. Idiopathic haemoperitoneum was associated with the best outcome for long-term survival.     

Correlation of epiploic foramen length to height,weight, breed,gender and age in horses

Epiploic foramen entrapment (EFE) is one of the most common causes of small intestinal strangulation in horses. Cribbing and previous episodes of colic are suggested as risk factors for its occurrence. The aim of this study was to correlate the height, weight, breed, gender and age to the epiploic foramen (EF) length. Forty-three horses were submitted to post-mortem measurement of epiploic foramen with abdominal and thoracic organs positioned in situ. After data collection, linear regression between EF length and the explanatory variables was performed. None of the post-mortem physical variables was associated with EF length, supporting the hypothesis that there is no association between EF length and age, and that increased intra-abdominal pressure is the most important factor predisposing to EFE recurrence.     

Esophageal obstruction in horses: a retrospective study of 34 cases

The major purpose of this investigation was to describe the causes, possible complications, and prognoses of horses with esophageal obstruction. Of 34 cases presenting with esophageal obstruction, 28 cases were due to impaction of ingesta. Obstruction due to pre-existing esophageal disease occurred in 4 horses with megaesophagus, in 1 horse with stricture in the upper third of the esophagus, and in 1 horse with esophageal diverticulum. There was no significant difference in the contamination of the trachea between horses that subsequently developed aspiration pneumonia and those that did not. The duration of esophageal obstruction prior to admission was significantly longer in horses that developed aspiration pneumonia (median 18, range 2-48 h) than in those horses that did not (median 4, range 0.5-48 h). Although the obstruction was relieved in all 34 horses, 4 were euthanized because of recurring obstruction due to megaesophagus (n = 2), esophageal diverticulum (n = 1), and esophageal stricture (n = 1).     

Idiopathic muscular hypertrophy of the equine small intestine: 11 cases (1980-1991).

The medical records of 11 horses with idiopathic muscular hypertrophy (MH) of the small intestine were reviewed to determine the clinical and pathological features of the disease. The median age of affected horses was 10.0 years (range 5-18 years). No breed or sex predisposition was apparent. Ten horses (91%) had chronic (23 days to 2.4 years) signs of mild, intermittent colic, and 1 horse had signs of severe colic of only 3 days' duration. Partial anorexia and chronic weight loss of variable duration (1-6 months) were prominent historical findings in 5 (45%) horses. Diagnostic tests, with the exception of exploratory caeliotomy, were ineffective for definitive diagnosis of intestinal MH as a cause of colic. In 2 horses, however, a thickened, rigid ileum was detected by palpation per rectum, and in 5 horses, multiple loops of distended small intestine were detected by palpation per rectum. Hypertrophy of both the circular and longitudinal layers of muscularis was determined as the cause of intestinal thickening in all horses. Muscular hypertrophy of the ileum was present in 9 (82%) horses. Two horses (18%) had MH of a section of jejunum only, and 4 (36%) horses had MH of the ileum in combination with MH of other sections of small intestine. Two (18%) horses had MH of the entire small intestine. In 9 (82%) horses, intestinal MH resulted in narrowing of the luminal diameter at the site of MH. Small diverticula were present on the mesenteric border of the hypertrophied ileum of 5 (45%) horses. Five linear (up to 150-cm) diverticula were present in the hypertrophied jejunum of 1 (9%) horse. Haemomelasma ilei was present on the antimesenteric serosal surface of affected intestine of 8 (73%) horses. Full-thickness rupture of the ileum with subsequent diffuse, septic peritonitis occurred in 3 (27%) horses.     

Microvascular circulation of the small intestine in horses.

The microvascular anatomic features of the small intestine was described by correlating results of microangiography, light microscopy, gross studies, and scanning electron microscopy of vascular replicas in 14 horses. After heparinization, the horses were euthanatized, a length of jejunum was transected, and blood was flushed free of the circulation, using isotonic NaCl solution. In six horses, the circulatory system was perfused with a modified radiopaque medium and evaluated radiographically. These sections were then evaluated by standard histologic methods. Sections from 8 horses were perfused with 1 of 2 types of plastics and studied grossly or by scanning electron microscopy. The marginal arterial arcade gives rise to vessels that enter the jejunum at the mesenteric angle. These vessels penetrated either directly, by branching and entering on both sides of the mesenteric angle, or supplying only 1 side of the mesenteric angle. All these vessels continued in the submucosa branching extensively, forming a submucosal plexus. This submucosal plexus supplied the tunica muscularis, tunica serosa, and the mucosa. Vessels within the 2 muscle layers ran parallel to the muscle fibers and, consequently, perpendicular to each other. The arterial supply to the mucosa penetrated the muscularis mucosae and branched to supply 2 mucosal capillary networks. An eccentrically placed arteriole penetrated the base of the villus and spiralled to the tip where it "fountained" into a mesh-like capillary network, which descended peripherally in the villus to drain via 1 to 3, but most commonly 2 venules. Venules from adjacent villi united and drained via the submucosal veins.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-and long-term evaluation of surgical treatment of strangulating obstructions of the small intestine in horses: a review of 224 cases

A retrospective study was carried out of 224 horses operated for strangulating small intestine obstructions. Fifty-four horses were euthanized and 5 horses died during surgery which means that 165 (73%) were allowed to recover. Of these, 53 horses were euthanized or died in the clinic and 112 (50%) were discharged from the hospital. Of 90 horses available for follow-up 1 year postoperatively, 76 (84%) were still alive. The most important causes of death or reasons for euthanasia in the direct post-operative period were post-operative paralytic ileus, (adhesive) peritonitis and intra-abdominal haemorrhage. After discharge from the hospital the reasons were (adhesive) peritonitis and (recurrent) colic. Of the horses which survived for at least 1 year, 16% sometimes suffered from colic, 12% experienced problems with incisional woundhealing and 4% suffered from jugular vein thrombosis. All were in good or reasonable condition and 88% performed at (approximately) the same level as before the operation. The type of surgical intervention (i.e. enterotomy, enterectomy) did not significantly influence the outcome of surgery, whereas the type of anastomosis did. End-to-end jejunojejunostomy had a better prognosis than side-to-side jejunocaecostomy. It was concluded that strangulating obstructions of the small intestine still carry a poor to guarded prognosis. Mortality was highest in the direct peri-operative period. Once discharged from hospital, prognosis can be considered to be fair to good. Attempts to improve outcome should be directed at a better handling of the ileal stump during surgery and at the prevention of post-operative ileus and the formation of adhesions.     

Jejunoileal anastomosis following small intestinal resection in horses: seven cases (1999-2001)

OBJECTIVE: To report the postoperative outcome in horses undergoing jejunoileal anastomosis performed with a 2-layer simple continuous technique. DESIGN: Retrospective study. ANIMALS: 7 horses. PROCEDURE: Information regarding signalment, clinical signs, findings at surgery, and postoperative complications was obtained from medical records of horses that underwent exploratory ventral midline celiotomy, small intestinal resection, and jejunoileal anastomosis to correct various small intestinal strangulating lesions. Follow-up information was obtained via telephone conversations with owners or trainers. RESULTS: Six males and 1 female of various breeds aged 10 months to 27 years and weighing 312 to 785 kg (686.4 to 1,727 lb) were included. The most common complications were mild to moderate tachycardia and mild to moderate signs of abdominal pain. Two horses developed incisional infections and soft, fluctuant swelling at the incision site following resolution of the infection. Follow-up time ranged from 7 to 17 months after surgery. Owners reported no further colic episodes and no diet change necessary following surgery. All horses had returned to their intended level of use. CONCLUSIONS AND CLINICAL RELEVANCE: Advantages to the jejunoileal technique include maintaining the normal ileocecal valve and a postoperative recovery period similar to that described following other small intestinal anastomoses. Jejunoileal anastomosis is a viable alternative to ileal bypass. This technique appears to result in a postoperative complication rate similar to that reported following jejunojejunostomy procedures.     

Acute nontraumatic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001)

The medical records of 39 dogs with acute nontraumatic hemoabdomen were identified and reviewed. Anemia and hypoalbuminemia were identified in 36/37 (97%) and 25/33 (76%) dogs, respectively. Coagulopathies were identified in 26/31 (84%) dogs. When a definitive diagnosis was obtained, malignant neoplasia was diagnosed most frequently and occurred in 24/30 (80%) dogs. Hemangiosarcoma accounted for 21/30 (70%) diagnoses. Sixteen dogs underwent exploratory laparotomy, of which seven (44%) survived the perioperative period. Of the dogs that did not undergo surgery, 9/23 (39%) survived to be discharged from the hospital.     

Preliminary study of capsule endoscopy in the small intestine of horses

Objective To evaluate the visibility of various portions of the small intestine in healthy horses using capsule endoscopy. Procedure Six healthy, conscious adult Thoroughbreds were restrained and an endoscopic capsule (PillCam® SB capsule) was inserted into the oesophagus using an intranasal catheter aided by a guide wire. Water (500 mL) flushed the capsule down the gastrointestinal tract. Data were collected and stored in the recorder of the endoscopic system for 6 hours after capsule insertion and the images were evaluated using an image reader and scored using a visual analogue scale. Results Capsule endoscopy enabled observation of the distinct mucosal shape, colour, and villus structure of the intestinal lumen from the duodenum through the proximal jejunum. At 4 h after passing the pylorus, the endoscopic capsule started transmitting increasingly dark images in the distal jejunum as the lumen circumference increased. Means of the visual analogue scale in the duodenum, proximal jejunum, and distal jejunum were 93.8 ± 1.3%, 86.2 ± 2.5% and 48.8 ± 6.3%, respectively. Differences among these values were statistically significant (P < 0.05). Conclusions and Clinical Relevance Capsule endoscopy enables observation of the distinct mucosal shape, colour and villus structure of the proximal and mid-small intestine in healthy horses.     

Idiopathic perforating ulceration of the small intestine in five adult horses

Perforating ulceration of the small intestine was diagnosed in 5 adult horses. Affected horses presented with signs of low‐grade colic, depression and inappetance. Abdominal paracentesis yielded abnormal peritoneal fluid in all cases. Perforating ulcers were located at the mesenteric border in 4 horses and the ileum in one horse. All horses had diffuse septic peritonitis. The aetiology of the condition is unknown.     

End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study

REASONS FOR PERFORMING STUDY: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. HYPOTHESIS: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). METHODS: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to- end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. RESULTS: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. CONCLUSION: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. POTENTIAL RELEVANCE: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers.