Chronic ileocecal intussusception in horses

Ten young horses with signs of simple partial obstruction of the small intestine were found upon surgical exploration of the abdomen to have chronic intussusception of the distal ileum into the cecum. Poor general physical condition, intermittent or continual abdominal pain of varying degree, depression, and poor appetite were consistent clinical findings. Rectal palpation in eight animals was suggestive of an incomplete or intermittent obstruction of the small intestine. Laboratory determinations were not helpful in making a diagnosis. Dilatation and hypertrophy of the distal jejunum and ileum were associated surgical findings indicating chronicity of the problem. Surgical correction utilizing an end-to-side or a side-to-side anastomosis of small intestine to cecum resulted in recovery in 7 of 8 cases which could be followed long term. Failure to resect the abnormal segment of small intestine did not affect the outcome.     

Intussusception in dogs and cats: A review of 36 cases

Intussusception is recognized as a common cause of bowel obstruction in small animals. This study documents the clinical and surgical findings in nine cats and 27 dogs diagnosed as having intussusception. The main purposes of the study were to define the predisposing causes and clinical signs of intussusception and to evaluate various surgical techniques commonly employed in its treatment. No common predisposing cause could be established. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass. The majority of the intussusceptions involved the enterocolic junction. Formation of adhesions was more frequent in cats. Surgical treatments included simple reduction, manual reduction with plication, intestinal resection/anastomosis, and intestinal resection/anastamosis with plication. There was no statistically significant difference (p>0.05) in the recurrence rate of the intussusceptions when the various surgical techniques were compared. Recurrence of an intussusception was not related to either the bowel segment involved or whether a simple reduction, bowel resection, or intestinal plication was performed at the initial surgery.     

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.     

Obstruction of the cecocolic orifice by ileocecocolic intussusception following jejunocecostomy in a horse

A 4-year-old Thoroughbred stallion was referred for signs of mild to moderate colic, anorexia, and decreased water intake of 3 weeks' duration. Ultrasonographic examination revealed an intussusception, the most common of which would be a cecal inversion or ileocecal intussusception. Surgical exploration identified an ileocecocolic intussusception with extension of the intussusceptum into the right ventral colon; however, the cause of the intussusception could not be identified. The intussusception could not be surgically corrected, and the horse was euthanatized. A side-to-side jejunocecostomy that had been performed previously was identified at necropsy. The ileal stump had intussuscepted into the right ventral colon and become hypertrophied, causing partial obstruction of the cecocolic orifice and clinical signs of colic. In horses requiring an ileocecal or jejunocecal anastomosis, the ileal stump may be left to slough within the cecum as part of the treatment for an irreducible ileocecal intussusception or intentionally inverted into the cecum when the ileal stump is necrotic and cannot be exteriorized and resected. Efforts should be made to minimize the size of the ileal stump to reduce the liklihood of intussusception.     

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.     

Small colon obstruction by an ovarian pedicle as an acquired condition in a foal

This report describes the clinical course and the surgical findings in a 7‐day‐old foal referred for signs of abdominal pain. The foal underwent abdominal celiotomy due to the degree of pain unresponsive to medical treatment and, upon exploration, an ovarian pedicle was found to be wrapped around the small colon. The lesion was corrected, the foal recovered well from anaesthesia, and a 4 month follow‐up revealed no other signs of abdominal pain or complications.     

Cecocolic Anastomosis for the Surgical Management of Cecal Impaction in Horses

Fourteen horses with cecal impaction were treated by cecocolic anastomosis. In nine horses, the anastomosis followed enterotomy and evacuation of the cecal contents, and in two horses it followed saline infusion and massage of the cecum. In three horses, the anastomosis was the only surgical procedure performed. Cecocolic anastomosis was performed between the lateral and dorsal cecal teniae, and the lateral and medial free teniae of the right ventral colon. The anastomosis was hand sutured in five horses. In all other horses, the GIA surgical stapling instrument was used in combination with hand sutured seromuscular layer closures and became the preferred surgical technique. The anastomosis allowed an alternative route for the transit of ingesta from the cecum to the right ventral colon.
Twelve of the 14 horses survived 2 months or longer after surgery (short-term survival rate, 86%) and 10 horses survived 12 months or longer after surgery (long-term survival rate, 71%). Early postoperative complications included mild abdominal pain (6 horses), wound infections (3 horses), fatal peritonitis (2 horses), and large colon distention necessitating reoperation (2 horses).     

Surgery of the bovine small intestine

Cattle require surgery for small-intestinal problems less frequently than they do for abomasal, forestomach, or large-intestinal problems. Close attention to local vascular anatomy is critical to success when intestinal resection is required. Cows with signs of severe abdominal pain may make rapid recoveries following prompt surgical treatment. This article discusses relevant anatomy of the small intestine and the diagnosis and treatment of intussusception, volvulus, obstruction by incarceration or entrapment, and duodenal obstruction.     

Caeco-caecal and caeco-colic intussusception in two half-sibling Standardbred horses

This report describes caecal intussusception in two young half-sibling Standardbred horses. Both horses presented showing signs of low-grade abdominal pain. The horses remained haemodynamically stable despite signs of abdominal pain and associated tachycardia. Exploratory celiotomy was undertaken in both horses due to persistent abdominal pain and a poor response to administration of analgesic medications. Exploration of the abdomen revealed caeco-caecal intussusception in one horse and caeco-colic intussusception in the other horse. An underlying cause for caecal dysfunction and subsequent intussusception was not identified in either patient. Manual reduction of the intussusception was successful in both cases. The horses recovered uneventfully from surgery.     

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)     

Caecal intussusception in two ponies

One case of caecocaecal intussusception (case 1) and one case of caecocolic intussusception (case 2) in ponies are described. Case 1 showed mild abdominal discomfort for seven days followed by sudden death whereas case 2 showed continuous moderate pain for three weeks. At post mortem examination, case 1 showed intussusception of the base of the caecum into the body whereas in case 2, the entire caecum had invaginated into the right ventral colon. Histopathological examination showed that the lesions in both animals had been present for a long time.     

T-shaped malformation of the ventral colon in a Thoroughbred filly with colic

A 4-month-old Thoroughbred filly presented for abdominal pain was diagnosed with a T-shaped malformation of the ventral colon at exploratory laparotomy. Following resection and anastomosis of the large colon, no further episodes of abdominal pain occurred during a 12-month follow-up. Acute dehiscence of the linea alba occurred as a complication of the initial laparotomy, but was successfully managed following additional surgical repair. T-shaped malformation of the ventral colon has not previously been reported and is considered a congenital malformation of mesocolon formation.     

Ileal intussusception in 16 young thoroughbreds.

The paper describes the outcome of 16 cases of short-ileal-ileal intussusception in young Thoroughbred horses. The intussusception was often associated with chronic or intermittent low grade abdominal pain. At laparotomy, only the intussusception was reduced in one horse; in another, a myotomy of the thickened stenosed intussusception was carried out after reduction. In 11 cases as ileocaecal bypass anastomosis was performed proximal to the intussusception after its reduction. One horse was subjected to euthanasia during operation because of irreversible intestinal wall damage and another because of intestinal rupture. One foal had a cardiac arrest following reduction of the intussusception. One horse was subjected to euthanasia 4 months post-operatively because of intractable abdominal pain caused by intestinal adhesions. Although several horses suffered episodes of post-operative abdominal pain, and 2 were subjected to a second laparotomy, 12 horses made an eventual complete recovery.     

Fecalith impaction in four miniature foals.

Four miniature foals admitted with signs of progressive nonresponsive abdominal pain and no fecal production had fecalith impaction of the small colon. Duration of clinical signs ranged from 10 hours to 5 days. Removal of the fecalith via small colon enterotomy was a successful treatment in all 4 cases. Miniature foals may be predisposed to fecalith impaction of the small colon. If a miniature foal has signs of progressive nonresponsive abdominal pain, fecalith impaction needs to be considered. Surgical correction may be required.     

Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion

Colonic torsion is a life‐threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed. Fourteen dogs met inclusion criteria. Of these, nine dogs had colonic torsion confirmed at surgery, with five dogs having surgical confirmation of colonic congestion or mesenteric torsion. Radiographic findings included segmental distention of the colon (14/14), focal narrowing of the colon (11/14), displacement of cecum (11/14), displacement of descending colon (14/14), and mild to no small intestinal distention (14/14). In cases where barium enema was performed, focal narrowing of the colon and longitudinal striations that course in a helical pattern were identified, termed the “torsion sign.” Vomiting was the most common clinical sign observed (12/14), followed by abdominal pain in a small majority of cases (8/14). Severe abdominal pain and hypovolemic shock were uncommon in the patients reported (3/14). Colonic torsion should be considered as a differential diagnosis for dogs with radiographic segmental colonic distention with displacement of the descending colon and cecum. Barium enema is recommended for more definitive diagnosis.     

Surgical management of intussusception in the horse

During a 14 year period, 27 of 310 horses undergoing laparotomy because of abdominal pain were found to have an intussusception involving the small intestine (16 cases) or caecum (11 cases). The clinical signs, operative findings and techniques adopted to overcome the obstruction are described. An evaluation of possible predisposing factors provided further evidence of the important role of the tapeworm Anoplocephala perfoliata in initiating intussusception involving the ileum and caecum.     

A case of a colocolic intussusception in a horse

The purpose of this report is to describe the clinical course and pathological findings in a horse admitted to the emergency service of the University of Georgia Large Animal Teaching Hospital for evaluation of colic, fever and diarrhoea of several days' duration. A presumptive historical diagnosis of colitis was made initially, but, due to the lack of faecal output during the first 12 h of hospitalisation and subsequent examination findings, an impaction of the ascending colon was suspected. Initial therapy consisted of rehydration with oral fluids and management of the abdominal pain with analgesic therapy. The horse did not respond to medical therapy and because of signs of persistent abdominal pain and financial constraints, the owner elected euthanasia after several days of supportive care. At necropsy, the horse was diagnosed with a colocolic intussusception.     

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.     

Bilateral Morgagni hernia in a donkey

This case report describes the clinical presentation and management of a donkey admitted with acute signs of abdominal pain that was diagnosed with a bilateral Morgagni hernia, a rare type of congenital diaphragmatic hernia. For more than 8 months before presentation, the donkey had been showing signs of recurrent mild abdominal pain that responded favourably to medical treatment. On admission, the donkey had mild tachycardia and tachypnoea. Radiography and ultrasound of the thorax and abdomen showed thoracic herniation of the large colon. Exploratory laparotomy was performed, and the sternal and diaphragmatic flexures of the large colon, as well as the left hepatic lobe, were found incarcerated in a bilateral Morgagni hernia. Intestine and liver were removed from the hernia, and the large colon was exteriorised. The defect in the diaphragm was repaired by stapling a polyester mesh circumferentially around the hernia ring and covering the mesh with an excised section of the greater omentum. No further complications and no recurrence of colic were observed during an 8-month follow-up period.     

DORSAL DISPLACEMENT OF THE LEFT VENTRAL AND DORSAL COLON IN TWO HORSES

This paper describes the clinical signs and surgical treatment of 2 cases of dorsal displacement of the left ventral and dorsal colon. The condition, in which the colon becomes enclosed in the space bounded by the base of the spleen, the dorsal aspect of the suspensory ligament of the spleen (phrenicosplenic ligament), the left kidney and the adjacent body wall, is characterised by moderate to severe pain, minimal signs of shock, no response to medical therapy and a tendency for a ventral midline abdominal paracentesis to enter the spleen. Both horses recovered after surgical replacement of the colon, one case requiring a second laparotomy because of a recurrence of the displacement.