Topic:Adhesions
Morphologic study of repair of induced osteochondral defects of the distal portion of the radial carpal bone in horses by use of glued periosteal autografts [corrected]. The use of periosteal autografts to resurface osteochondral defects was investigated in 10 horses (2 to 3 years old), and the repair tissue was characterized morphologically. Middle carpal joint arthrotomies were made, and osteochondral defects were induced bilaterally on the distal articular surface of each radial carpal bone. Each defect measured approximately 1 cm2 and extended 3 mm into the subchondral bone plate. Residual subchondral bone plate of control and principal defects was perforated by drilling. A sterile fibrin adhesive was made by mixing a fibrinogen component and a thrombin co...
Evaluation of sodium carboxymethylcellulose for prevention of experimentally induced abdominal adhesions in ponies. Twelve ponies were used to evaluate the reliability of an abdominal adhesion model and the efficacy of intraperitoneal infusion of sodium carboxymethylcellulose in preventing abdominal adhesions. A celiotomy was performed on each of the 12 ponies and the serosa of the distal portion of the jejunum was abraded with a dry gauze sponge at 5 locations. In addition to the serosal damage, a single 2-0 chromic gut suture was placed through the seromuscular layer of the jejunum in the center of the abraded area. After closure of the celiotomy, a 1% solution of sodium carboxymethylcellulose (7 ml/kg of...
Modulation of an adhesion-related surface antigen on equine neutrophils by bacterial lipopolysaccharide and antiinflammatory drugs. The essential role of the CD11/CD18 family of leukocyte adhesion molecules (LeuCams) in neutrophil-substrate adhesion is well documented. We have found that a monoclonal antibody designated 60.3 (MoAb 60.3) that recognizes the common beta-subunit (CD18) on human neutrophils (PMN) also recognizes a surface antigen on equine PMN. Antigen expression as assessed by immunofluorescence flow cytometry was enhanced by zymosan-activated serum (ZAS) or phorbol 12-myristate 13-acetate (PMA) stimulation. Pretreatment of equine PMN with MoAb 60.3 inhibited ZAS-stimulated aggregation, indicating that the mo...
Surgical treatment of tarsal sheath effusion associated with an exostosis on the calcaneus of a horse. A 2-year-old Thoroughbred colt was referred for evaluation of effusion within the tarsal sheath and associated lameness of the right hind limb. Conservative treatment consisting of needle aspiration and pressure bandaging had been unsuccessful. Radiography of the right tarsus revealed proliferative periosteal reaction along the distal caudal border of the sustentaculum tali and medial aspect of the calcaneus. The owners elected conservative treatment, using a local injection of corticosteroid and pressure bandaging the tarsus. Five months later, the severity of the effusion and lameness had in...
Retrospective evaluation of repeat celiotomy in 53 horses with acute gastrointestinal disease. Fifty-three of 648 horses (8.2%) treated surgically for acute gastrointestinal obstruction were subjected to repeat celiotomy. Forty horses (75%) recovered from anesthesia after repeat celiotomy, and 26 horses (49%) were discharged from the clinic. Excluding two horses lost to follow-up, 10 of 51 horses (20%) survived long term. Horses subjected to repeat celiotomy had a significantly lower long-term survival rate than horses subjected to a single celiotomy. Twenty-eight horses had mechanical obstructions, and 22 had functional obstructions at the second surgery. Significantly more horses with...
Abdominal adhesions after small intestinal surgery in the horse. One hundred thirteen of 172 horses (66%) undergoing exploratory celiotomy for a small intestinal lesion survived 4 or more days after surgery. Intra-abdominal adhesions causing clinical problems requiring additional surgery or euthanasia were documented in 25 horses (22.1%). Problems developed in significantly more males than females. The most common initial small bowel lesion was ileal impaction (12 horses); 21 horses underwent small intestinal resection or bypass. However, there was no significant difference in the incidence of intra-abdominal adhesions between horses that underwent intestin...
Induction of peritoneal adhesions with small intestinal ischaemia and distention in the foal. Twenty-two foals were divided into groups of intestinal distension and intestinal ischaemia as methods to induce peritoneal adhesions. In the first group, the lumen of a segment of distal small intestine was occluded without extramural vascular compromise and distended with lactated Ringer's solution to a constant pressure of 25 cm H2O for 2 h within the abdomen. The ischaemic group underwent 70 mins total vascular occlusion of identical segments of bowel. Serosal biopsies were obtained before and after each experimental procedure and following 60 mins of reperfusion. Similar biopsies were har...
Intestinal healing and methods of anastomosis. Optimal intestinal healing occurs when like layers of the intestinal wall are aligned. Hand-sewn, double-layer, end-to-end anastomosis that apposes the mucosa and produces slight inversion of the seromuscular layer is recommended to minimize adhesion formation and provide reasonable alignment of the intestinal layers. Stapled, everted, triangulated, end-to-end anastomosis is not recommended because of extensive adhesion formation and poor healing of the intestinal layers. The preferred stapled techniques create an inverting, side-to-side stoma between the bowel segments.
Use of a linear stapling device to construct an inverted, triangulated, end-to-end anastomosis of the equine jejunum. An inverting, triangulated, stapled, end-to-end anastomosis technique was evaluated in the jejunum of four horses. None of the horses showed evidence of gastrointestinal disturbance after surgery; however, stricture and adhesion formation were pronounced in three animals examined 10 days, one month, and two months after surgery. The animal examined four months after surgery had no adhesions present at the anastomosis, and only mild narrowing of the intestinal lumen. Histologic examination of the anastomoses showed lack of a normal mucosal lining in some examined sections up to two months posts...
Enterotomy technique in the descending colon of the horse. Effect of location and suture pattern. To compare the effects of placing enterotomy incisions on or off the antimesenteric teniae and closing the intestinal mucosa as a separate layer, four longitudinal enterotomies were performed in the descending colon of each of six horses by the following techniques: incision through the antimesenteric teniae with one- and two-layer closure, and incision adjacent to the teniae with one- and two-layer closure. The horses were necropsied at day 33 for evidence of obstruction, adhesions, and ultrasonographic determination of the percent reduction in lumen diameter. Histologic and histomorphometric...
Clinical uses of hyaluronan. The availability of elastoviscous solutions of highly purified hyaluronan has created two new therapeutic methods in human and veterinary medicine: viscosurgery and viscosupplementation. Viscosurgical tools and implants are widely used in ophthalmology and have been suggested for use in otology. Visco-supplementation of joint fluid using elastoviscous hyaluronan solutions is widely used in the treatment of equine traumatic arthritis. It was also suggested for use in idiopathic osteoarthritis in humans, but this application has not received wide acceptance. Cross-linked forms of hyaluronan have...
Lymphocytic enteritis in a filly. A yearling Hanoverian filly had intermittent colic for 6 weeks, chylous peritoneal effusion, and a firm mass palpable per rectum. Exploratory laparotomy revealed mesenteric lymphadenopathy, adhesion of the mesenteric root to the duodenum and jejunum, distention of the mesenteric veins and lymphatic vessels, and increased jejunal venous pressure. Lesions in the duodenum, jejunum, and colon included infiltration of lymphocytes and plasma cells in the lamina propria.
A comparison of enterotomies through the antimesenteric band and the sacculation of the small (descending) colon of ponies. Three pairs of longitudinal enterotomies were performed in the small colon of 10 ponies. Each pair consisted of one enterotomy through the antimesenteric band and one through the sacculation. The ponies were destroyed 96 h after surgery. The enterotomies in the two sites were compared for: speed of surgery, adhesions, bursting wall tension, neovascularisation by micro-angiography, and histological reaction. Enterotomies made through the antimesenteric band were superior because they were quicker to perform, stronger, more accurately apposed, and had less inflammation than those made through th...
A comparison of three methods of end-to-end anastomosis in the equine small colon. Six animals were used to compare simple interrupted, simple continuous, and stapled techniques for end-to-end rotated small colon anastomoses. Three ponies were evaluated three days after surgery for adhesion formation and luminal diameter at each anastomosis site. Two ponies and one horse were evaluated 14 days after surgery for adhesion formation. All anastomosis sites were examined histologically for alignment of tissue planes, and evidence of inflammation. No single technique was superior in all areas examined. While only three of the nine anastomoses had mild fibrinous adhesions at three ...
Comparison of staple and suture techniques for end-to-end anastomosis of the small colon in horses. Two techniques for end-to-end anastomosis of the small colon were evaluated in each of 6 horses. A simple interrupted suture pattern that excluded the mucosa and was oversewn with an inverting suture was compared with a triangulated double-row pattern of stainless steel staples. Anastomotic sites were evaluated at 2 weeks, 2 months, and 6 months for extent of abdominal adhesions, lumen diameter at anastomotic sites, bursting pressures, and healing response. Clinical postoperative complications were not associated with either technique. At postmortem examination, there was extensive adhesion fo...
Evaluation of three techniques for end-to end anastomosis of the small colon in horses. In an attempt to determine the best method for surgical removal of devitalized small colon lesions, 12 horses underwent a double small colon resection and end-to-end anastomosis. In 4 horses (study 1), an appositional single-layer (APP-1) suture pattern was compared with an inverting 2-layer (INV-2) suture pattern. In 8 horses (study 2), an appositional 2-layer (APP-2) suture pattern was compared with the INV-2 suture technique. Polydioxanone suture (size 1-0), was used. Horses were evaluated at necropsy 3, 10, 14, 28, or 56 days after surgery. Postoperative complications (peritonitis, impacti...
Prevention and management of peritonitis in horses. Peritonitis and adhesions in the horse are best managed through prevention. Perioperative antimicrobial therapy, nonsteroidal anti-inflammatory therapy, experienced personnel, and good surgical techniques should minimize complications after surgery. Despite preventative measures, some horses still develop peritonitis after surgery. Immediate, intensive treatment is necessary to enhance their chances for survival.
Intramural hematoma in the jejunum of a mare. An intramural hematoma involving a 40-cm segment of the distal portion of the jejunum caused intestinal obstruction and colic in a mature mare. The involved intestine was resected, and an end-to-end anastomosis was performed. The mare recovered completely, but 4 years later had colic caused by incarceration and volvulus of the distal portion of the jejunum, involving fibrous abdominal adhesions. The cause of hematoma was not identified; however, rupture of an intramural vessel after migration of Strongylus vulgaris larvae was considered a possibility because of the histologic observation of an...
Colopexy of the equine large colon: comparison of two techniques. A study was designed to evaluate 2 colopexy techniques (A and B) in 8 clinically normal horses to determine which technique would prevent recurrence of large-colon displacement and/or volvulus. For technique A, 35 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. For technique B, the medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon, and 8 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. ...
Prevention of intraabdominal adhesions in ponies by low-dose heparin therapy. An ischemic bowel model was used to stimulate adhesion formation in eight ponies. Heparin (40 USP u/kg) or saline was administered intravenously at surgery and was continued subcutaneously every 12 hours for 48 hours to evaluate the efficacy of heparin in preventing intraabdominal adhesions. Ponies were euthanatized after 6 weeks, and postmortem examinations were performed. A statistically significant difference was found between the heparin-treated and the control groups. Adhesions developed in three of four control ponies, and adhesions did not develop in three of four heparin-treated ponies...
Extension large colon resection in 12 horses. Extensive resection (50-75%) of the large colon was performed in 12 horses. Indications for resection were: loss of viability due to large colon volvulus (seven), thromboembolic episode (three), impairment of flow of ingesta due to adhesions (one), or congenital abnormalities (one). The time required to correct the primary cause of abdominal pain and complete the resection ranged from 2.5 to 4.75 hours. Three horses had severe musculoskeletal problems postoperatively and were euthanized in the recovery stall. Four other horses were euthanized early in the postoperative period because of: furth...
Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium. The risk of repeat sternotomy is higher than that of the initial sternotomy, especially if the pericardial sac was left open at the first intervention. In 200 consecutive patients with a pericardial defect after open heart operations, the pericardium was closed with a glutaraldehyde-preserved equine pericardial patch. Precardiac adhesions at reoperation were assessed in four groups of patients on a scale of 6, ranging from 0 (no adhesions) to 5 (calcified or ossified adhesions). Group I comprised 13 patients in whom the pericardium was left open at the first operation and an equine pericardial...
Acquired incarcerated inguinal hernia: a review of 13 horses. The case records of 13 horses with acquired incarcerated inguinal hernia in January-August 1983, were reviewed. Nine cases were in stallions. The remaining four involved eventration 5-48 hours following castration. Ages ranged from 1-17 years. Horses showed a variable degree of colic. Bowel was felt to pass through the internal inguinal ring on rectal examination in most cases. The physical features of the scrotum varied considerably. Resection of ischemic jejunum and/or ileum was necessary in three horses. Two horses were euthanized at surgery (one with bilateral ischemic jejunum, one with bo...
Experimental large colon resection at the cecocolic ligament in the horse. Ten normal horses had approximately 95% of the length of the large colon resected with a side-to-side anastomosis between right ventral and right dorsal colon performed with surgical stapling equipment. Four horses died shortly after surgery of colitis (1 horse) or failure of the TA 90 transection staple line (3 horses). Another horse died 4 months after surgery from disseminated streptococcal infection but had recovered well from the colon resection. Five horses survived long term (18 months) with no clinical evidence of adverse effects of the resection. Surviving horses had weight loss and s...
Use of contrast radiography in the investigation of tenosynovitis and bursitis in horses. Contrast radiography, using a 25 per cent solution of sodium diatrizoate, has been used for the investigation of tenosynovitis and bursitis in horses. The procedure was undertaken on a series of 32 clinical cases and on specimens obtained at autopsy. Lesions affecting the extensor tendon sheaths at the carpus, the digital sheath, the tarsal sheath and the bursae at the elbow, hock and fetlock were examined by this means. The results showed the procedure offered the clinician useful information about the nature of the interior of these structures, particularly as regards the presence of adhesio...
Prevention of retrosternal adhesions after pericardiotomy. Because repeat sternotomies are becoming much more prevalent with repeat coronary bypass operations, prevention of direct adhesions of the heart and grafts to the back of the sternum by use of synthetic or xenograft material to close the pericardiotomy has become a matter for investigation. In this study bovine and equine glutaraldehyde-processed xenografts were implanted bilaterally in dogs for implant intervals of 6 weeks and 3, 6, 9, and 12 months. The bovine and equine xenografts both performed well in resisting the adhesion of the heart to their inner surfaces and less well in resisting a...
Incidence, diagnosis and treatment of postoperative complications in colic cases. A survey of 259 surgical colic cases revealed that over 50 per cent of fatalities occurred in the postoperative period. Postoperative ileus and circulatory/endotoxaemic shock accounted for 70 per cent of these deaths. Other less important complications were salmonellosis, long bone fracture, adhesions, haemorrhage, laminitis, wound infection and ischaemic muscle damage. Close monitoring of postoperative progress is necessary to enable early diagnosis and treatment. Recent developments in understanding of the pathophysiology of endotoxic shock and ileus may lead to more successful treatment reg...
Pathologic findings in the oviducts of mares. Oviducts from 325 mares were evaluated macroscopically, and oviducts from 124 mares were evaluated microscopically. Two hundred and eighty-five (87.69%) of the mares had at least 1 macroscopic lesion and 116 (93.54%) had at least 1 microscopic lesion. The most frequently seen macroscopic lesions were adhesions, paraovarian cysts, and thick fibrous bands. Microscopically, intraepithelial cysts, slight, focal lymphocytic infiltration in the infundibular-ampullary region, and proteinoid material in the oviductal lumen were the most common findings. In general, the proximal segments of the oviduct...
Comparison of suture materials and suture patterns for inverting intestinal anastomosis of the jejunum in the horse. In 7 horses, 4 anastomoses were done in the small intestine in each, using the combinations of synthetic absorbable monofilament and multifilament suture materials with continuous- and interrupted-suture patterns in the serosubmucosal layer of a 2-layer inverting-suture technique. Horses were evaluated 30 days after the operation for adhesion formation, lumen diameter, evidence of chronic obstruction, and suture tract inflammation at the anastomosis. Postoperative obstruction occurred in 5 of the 7 horses, and 6 horses survived. One horse was euthanatized on postoperative day 6 after 48 hours ...