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Topic:Intestinal Surgery
Intestinal surgery in horses involves surgical procedures performed on the horse's intestines to address conditions such as colic, obstructions, or strangulations. This type of surgery is a component of equine veterinary medicine focused on resolving gastrointestinal issues that cannot be managed through medical treatment alone. The surgical process may include resection, anastomosis, or bypass of affected intestinal segments. Post-operative care is critical, as horses are prone to complications such as adhesions and infections. This page compiles peer-reviewed research studies and scholarly articles that explore the techniques, outcomes, and post-operative management associated with intestinal surgery in horses.
Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses. In jejunocaecal anastomosis leaving a necrotic ileal stump has been implicated in complications and poor outcomes. Elective inversion of the necrotic stump using a nasogastric tube has been previously described, although this procedure can be cumbersome and can cause caecocolic orifice occlusion. Objective: To describe the use of a new device for elective inversion of necrotic ileal stumps. Methods: Case report. Methods: Details of the four horses that underwent intestinal resection and anastomosis with elective inversion of the ileal stump were retrieved from their medical records. For each c...
Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses. To compare single-layer anastomoses (modified continuous Lembert [mod-CL] and modified-interrupted Lembert [mod-IL]) and a 2-layer simple continuous anastomosis (2Â L; seromuscular and mucosal) for jejunojejunal anastomoses in equine cadavers and to compare ex vivo to in vivo time to complete the anastomosis and stoma size with a mod-IL pattern. Methods: Measurements in jejunum from cadaver and anesthetized horses. Methods: Ten live horses and 18 equine cadavers. Methods: Time to complete anastomosis, bursting pressures (BP), leakage sites, and anastomotic index (size ratio of anastomotic lume...
Transillumination Techniques for Vessel Identification During Small Colon Resection in Six Horses. Transillumination has been described in human surgery to improve vessel visualization but has not been described in horses. Since the equine mesocolon contains a great amount of fat which restricts visualization of the vessels, this technique could be useful during small colon resection. To describe transillumination of the mesocolon to provide an improved vessel identification during resection and anastomosis of the small colon in horses. Data of horses that underwent resection and anastomosis of small colon were recorded. Two transillumination techniques were used during resection and anasto...
Low Flow versus No Flow: Ischaemia Reperfusion Injury Following Different Experimental Models in the Equine Small Intestine. In experimental studies investigating strangulating intestinal lesions in horses, different ischaemia models have been used with diverging results. Therefore, the aim was to comparatively describe ischaemia reperfusion injury (IRI) in a low flow (LF) and no flow (NF) model. Under general anaesthesia, 120 min of jejunal ischaemia followed by 120 min of reperfusion was induced in 14 warmbloods. During ischaemia, blood flow was reduced by 80% (LF, n = 7) or by 100% (NF, n = 7). Intestinal blood flow and oxygen saturation were measured by Laser Doppler fluxmetry and spectrophotometry. Clinical, hi...
Umbilical Cord Herniation With Small Intestinal Evisceration in Two Thoroughbred Neonates. This report describes two cases of spontaneous small intestinal evisceration via normally inserted umbilical stumps, without abdominal wall trauma. Both cases occurred immediately following uneventful parturition. The authors believe that these represent cases of umbilical cord herniation. This is a well-recognised condition in humans, but has not been previously described in equines. One foal died before veterinary intervention. The second foal underwent a jejunal resection with end-to-end anastomosis and survived to successfully race. This report describes a previously unrecognised condition...
Effects of age, disease and anastomosis on short- and long-term survival after surgical correction of small intestinal strangulating diseases in 89 horses. Although survival rates have been reported after small intestinal surgery for strangulating diseases in horses, none have followed survival for periods relevant to the long lifespan of horses and none have described effect of age, disease and surgical treatments over such long survival periods. Objective: To examine effects of age, disease and type of surgery on long-term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse. Methods: Retrospective clinical study. Methods: Post-operative data were gather...
Interpreting abdominal fluid in colic horses: Understanding and applying peritoneal fluid evidence. Interpreting changes in peritoneal fluid helps clinicians manage colic and other diseases in horses. During abdominal problems in the horse, abdominal fluid characteristics such as color, turbidity, total nucleated and red blood cell counts, cytology, total protein, and l-lactate change in predictable ways, helping the clinician characterize the disease. Methods: Normal abdominal fluid in horses is odorless, clear to light yellow in color, and transparent. Peritoneal fluid becomes more turbid with increasing levels of protein, number of WBCs or RBCs, or with gross contamination following intes...
Age-Dependent Intestinal Repair: Implications for Foals with Severe Colic. Colic is a leading cause of death in horses, with the most fatal form being strangulating obstruction which directly damages the intestinal barrier. Following surgical intervention, it is imperative that the intestinal barrier rapidly repairs to prevent translocation of gut bacteria and their products and ensure survival of the patient. Age-related disparities in survival have been noted in many species, including horses, humans, and pigs, with younger patients suffering poorer clinical outcomes. Maintenance and repair of the intestinal barrier is regulated by a complex mucosal microenvironmen...
Combination of end-to-end jejuno-ileal anastomosis and side-to-side incomplete ileocecal bypass (hybrid jejuno-ileo-cecal anastomosis) following subtotal ileal resection in seven horses. 7 horses (3 geldings, 2 mares, and 2 stallions) were examined because of acute colic caused by small intestinal obstruction involving the aborad portion of the jejunum and orad portion of the ileum. All horses underwent a routine colic examination on arrival and had a diagnosis of strangulating obstruction of the small intestine. All horses underwent emergency exploratory laparotomy, in which the affected aborad portion of the jejunum and orad portion of the ileum were resected; in 5 horses, a hand-sewn end-to-end jejuno-ileal anastomosis was combined with a hand-sewn incomplete ileocecal bypa...
Comparison of liberal and goal-directed fluid therapy after small intestinal surgery for strangulating lesions in horses. There are few guidelines for the appropriate mode of fluid administration during and after colic surgery, and is challenging to reach the right balance while avoiding overhydration. This study aimed to compare goal-directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery. Methods: Eighteen horses subjected to small intestinal surgery were matched according to the surgical lesion, type of anastomosis, length of resection, and duration of clinical signs. Horses in the LFR group were administered intravenous (IV) fluids for at least 24 h. In ...
Standing flank laparotomy for colic: 37 cases. Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy. Objective: To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy. Methods: Retrospective case series. Methods: Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis w...
Use of Polyamide (Nylon) Cable Ties for Vascular Ligation of Healthy Equine Jejunal Mesentery. Jejunal vascular ligation is an essential step in performing jejunojejunostomy. Hand sewn ligation is typically used and can increase operative time with long sections of bowel to be removed. Nylon cable ties (NCT) have been used for vascular ligation in horses but are yet to be investigated for application on the mesenteric vasculature of the gastrointestinal tract. Our objective was to evaluate the efficacy and short-term safety of NCT jejunal mesenteric vessel ligation in healthy horses. Eight healthy adult horses underwent midline celiotomy. A segment of jejunal mesentery was identified (â...
Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery. To compare the sublingual microcirculation between healthy horses anesthetized for elective procedures and horses with colic anesthetized for abdominal surgery and to determine the effect of mean arterial blood pressure (MAP) on the microcirculation. Methods: 9 horses in the elective group and 8 horses in the colic group. Methods: Sublingual microcirculation was assessed with sidestream dark field video microscopy. Videos were captured at 3 time points during anesthesia. Recorded microvasculature parameters were De Backer score (DBS), total density of perfused vessels (PVD) and small vessels (...
Ischaemic postconditioning reduces apoptosis in experimental jejunal ischaemia in horses. Ischaemic postconditioning (IPoC) refers to brief periods of reocclusion of blood supply following an ischaemic event. This has been shown to ameliorate ischaemia reperfusion injury in different tissues, and it may represent a feasible therapeutic strategy for ischaemia reperfusion injury following strangulating small intestinal lesions in horses. The objective of this study was to assess the degree cell death, inflammation, oxidative stress, and heat shock response in an equine experimental jejunal ischaemia model with and without IPoC. Methods: In this randomized, controlled, experimental in...
Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments. Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses w...
Ex Vivo Comparison of a UV-Polymerizable Methacrylate Adhesive versus an Inverting Pattern as the Second Layer of a Two-Layer Hand-Sewn Jejunal Anastomosis in Horses: A Pilot Study. Resection and anastomosis of small intestine during colic can lead to adhesions and recurrent colic. Several methods are available to reduce the rate of adhesions in the postoperative period, such as the use of serosal barriers. Surgical glues form a smooth surface, are fast to apply, and could reduce surgery time when performing anastomosis. A recently developed UV-polymerizable methacrylate adhesive (UV-PMA) is designed to anchor into the biological tissues' top surface offering sealant and a smooth cover over the anastomosis site. This adhesive was used ex vivo on fifteen samples of equine ...
Use of quantitative real-time PCR to determine the local inflammatory response in the intestinal mucosa and muscularis of horses undergoing small intestinal resection. Studies in rodents and humans have demonstrated that intestinal manipulation or surgical trauma initiates an inflammatory response in the intestine which results in leucocyte recruitment to the muscularis externa causing smooth muscle dysfunction. Objective: To examine the intestinal inflammatory response in horses undergoing colic surgery by measuring relative differential gene expression in intestinal tissues harvested from surgical colic cases and control horses. Methods: Prospective case-control study. Methods: Mucosa and muscularis externa were harvested from healthy margins of resected s...
Incomplete Ileocecal Bypass for Ileal Pathology in Horses: 21 Cases (2012-2019). Incomplete ileocecal bypass can be performed in cases in which an ileal disfunction is suspected but resection of the diseased ileum is not necessary. Objective: To describe the clinical findings, the surgical technique, and the outcome of 21 cases of colic with ileal pathologies that underwent an incomplete ileocecal bypass. Methods: Historical, clinical, and surgical features of cases diagnosed with pathologies involving the ileum or the ileocecal valve that underwent ileocecal anastomosis without ileal resection were retrieved. Clinical (heart rate, duration of symptoms, presence of reflux,...
Equine colic associated with small intestinal epiploic foramen entrapment. Intestinal epiploic foramen entrapment (EFE) is an important differential diagnosis in horses with colic, but disappointing short- and long-term outcomes are reported in the scientific literature. Many horses are euthanased during surgery due to a predicted poor prognosis or due to uncontrollable intraoperative haemorrhage. The ileum is involved in the majority of cases. Several risk factors for the development of EFE are described; crib-biting/windsucking being the most important one. The recurrence rate of EFE is low despite the described risk factors, probably due to spontaneous closure of ...
Ex vivo comparison of sliding knot ligatures vs. haemostatic clips for equine small intestinal mesenteric vessel occlusion. In equine abdominal surgery, resection and anastomosis of strangulated intestine is a commonly performed procedure. To date, ligatures, vessel sealing devices and the ligate-divide stapler have been described for this use in horses. The objective of this study was to compare the application of haemostatic clips and ligatures to occlude equine mesenteric vessels. Portions of jejunum with ten associated mesenteric vessels were collected from 12 horses at a local abattoir and divided into two groups. Portions of intestine were divided into two sections comprising five vessels each and assigned to...
Mesh closure of epiploic foramen by ventral laparotomy in 17 horses with entrapment. Epiploic foramen entrapment (EFE) of small intestine is a severe cause of strangulating small intestinal obstruction (SSI) with long-term survival seeming lower than for other causes of SSI in horses. Different techniques via laparoscopy or laparotomy for epiploic foramen (EF) closure have been developed. This study describes a technique of peroperative mesh closure of the EF in clinical cases and their long-term follow up. In the study period of 5.5 years, 36 horses were admitted to the clinic with EFE. Of these, 17 horses had peroperative mesh closure, with resection anastomosis in 4 cases a...
Diagnostic value of plasma and peritoneal fluid procalcitonin concentrations in horses with strangulating intestinal lesions. To assess the diagnostic value of plasma and peritoneal fluid procalcitonin concentrations for identification of horses with strangulating intestinal lesions. Methods: 65 horses with signs of colic of intestinal origin and 10 healthy (control) horses. Methods: For each horse, plasma and peritoneal fluid samples were obtained for a CBC and determination of total protein, procalcitonin, and lactate concentrations. Signalment and clinicopathologic findings were compared among control horses and horses with strangulating and nonstrangulating intestinal lesions. Results: Mean ± SD plasma (274.9 ±...
Preconditioning with lidocaine and xylazine in experimental equine jejunal ischaemia. Pharmacological preconditioning of dexmedetomidine on small intestinal ischaemia/reperfusion injury has been reported in different animal models including horses. Objective: The objective was to assess if xylazine and lidocaine have a preconditioning effect in an experimental model of equine jejunal ischaemia. Methods: Terminal in vivo experiment. Methods: Ten horses under general anaesthesia were either preconditioned with xylazine (group X; n = 5) or lidocaine (group L; n = 5). A historical untreated control group (group C; n = 5) was used for comparison. An established experimental mo...
Small Intestine Ultrasound Findings on Horses Following Exploratory Laparotomy, Can We Predict Postoperative Reflux? Postoperative reflux (POR) is a well-recognized complication after colic surgery in horses, particularly when presenting small intestinal pathology. Even though much has been written about the pathophysiology and management of POR, additional clinical studies are needed to better understand and anticipate this complication. The aim of the study was to provide clinical evidence of ultrasound findings in the postoperative period (three days). The study is based on transcutaneous abdominal ultrasounds of the caudoventral abdomen during the postoperative period (three days), in 58 horses, presente...
Ex vivo comparison of barbed sutures for pelvic flexure enterotomy in horses. To evaluate two different barbed sutures for closure of pelvic flexure enterotomies and compare results achieved with two previously described closure techniques. Methods: Ex vivo. Methods: Twenty-four fresh cadaver adult equine large colons. Methods: Cadavers were randomly assigned to four closure groups (n = 6 each group): single-layer absorbable suture, double-layer absorbable suture, single-layer unidirectional barbed suture, or single-layer bidirectional barbed suture. Construction time, luminal reduction (percentage), bursting pressure, and method of failure were measured. Cost, leakage,...
Ex vivo comparison of barbed and unbarbed sutures for the closure of caecal and pelvic flexure enterotomies in horses. In this study the caecum and large colon were harvested from 24 slaughtered horses. On each sample, an 8‑cm long enterotomy was performed. Enterotomies were closed using either barbed or unbarbed glycomer‑631. We compared the time to close, appearance, length of suture material, bursting pressure, and costs associated with each type of material. Our findings demonstrated that time to close was significantly shorter (caecum, P = 0.034; pelvic flexure, P = 0.039) using barbed sutures (caecum 610.4 seconds; pelvic flexure 699.3 seconds) than unbarbed sutures (caecum 661.0 seconds, pelvic flex...
Use of perioperative variables to determine the requirement for repeat celiotomy in horses with postoperative reflux after small intestinal surgery. To determine whether perioperative variables can be used to differentiate a medical vs a surgical reason for postoperative reflux (POR) after small intestinal (SI) surgery in horses. Methods: Retrospective study. Methods: Horses >1 year of age that recovered from SI surgery and had POR. Methods: Medical records of horses that underwent SI surgery and developed POR from 2009-2015 were reviewed. Surgical reasons for POR were defined as an anastomosis complication, mechanical obstruction, or nonviable intestine identified at repeat celiotomy/necropsy. A medical reason for POR was presumed wh...
Clinical findings associated with development of postoperative reflux and short-term survival after small intestinal surgery in geriatric and mature nongeriatric horses. To determine risk factors, especially age, associated with postoperative reflux (POR; >2 L of reflux present upon intubation), high-volume POR (≥20 L in 24 hours), and short-term outcome after small intestinal (SI) surgery. Methods: Retrospective case-control study. Methods: Horses aged ≥16 years (geriatric; range, 16-30; n = 44) and <16 years (mature; range, 2-15; n = 39) with an SI surgical lesion that survived general anesthesia and did not have a second exploratory celiotomy during the same visit. Methods: Medical records (2009-2015) were reviewed; perioperative var...
