Clostridioides (Clostridium) difficile-associated disease, epiploic foramen entrapment, and gastric rupture in a Thoroughbred racehorse: case report and literature review.
Abstract: Epiploic foramen entrapment (EFE) is a common cause of small intestinal colic in horses and may lead to intestinal strangulation. Strangulating intestinal obstruction impairs the gastrointestinal outflow and can lead to secondary gastric rupture and endotoxemia. Clostridioides difficile can cause enterotyphlocolitis with colic in horses of all ages, and the process is commonly referred to as C. difficile-associated disease (CDAD). Here we report the results of the postmortem examination of a 7-y-old Thoroughbred racehorse with concurrent CDAD, EFE, and gastric rupture that was euthanized following a history of colic over several days. A segment of distal jejunum and proximal ileum had passed through the epiploic foramen, and the intestinal wall was thickened and dark-red. The remaining small intestinal loops were distended and filled with blood-tinged contents. Peritonitis had resulted from escape of gastric contents into the abdominal cavity through a tear in the major curvature of the stomach. Histologically, the incarcerated segment had acute transmural hemorrhage with congestion and mucosal necrosis; neutrophilic infiltrates with fibrin thrombi were in the mucosa of the non-incarcerated small intestinal segments. C. difficile toxins were detected in the small intestinal contents, and C. difficile was isolated from the small intestine, colon, and cecum.
Publication Date: 2022-08-10 PubMed ID: 35949155PubMed Central: PMC9446299DOI: 10.1177/10406387221118039Google Scholar: Lookup
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Summary
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The research article discusses a case of a Thoroughbred racehorse that developed a rare combination of three medical conditions: Clostridioides difficile-associated disease (CDAD), Epiploic Foramen Entrapment (EFE), and gastric rupture, which ultimately led to the horse being euthanized due to severe colic symptoms.
Understanding the Medical Conditions
- Epiploic foramen entrapment (EFE) is a type of colic in horses caused by a part of the small intestine getting entrapped in a small opening (the epiploic foramen) between two sections of the abdominal cavity. This can lead to a strangulated intestine, obstructing the flow of food material, and potentially causing a secondary gastric rupture.
- Clostridioides difficile, commonly referred to as C. difficile, is a type of bacteria that if present, can cause inflammation of the colon, severe diarrhea, and potentially death in multiple species, including horses.
- Gastric rupture refers to a tear or break in the wall of the stomach which allows the stomach’s contents to spill into the abdominal cavity causing peritonitis, an inflammation of the peritoneum, which can be fatal.
Postmortem Findings
- Postmortem examination showed that a segment of the intestine was passing through the epiploic foramen in the horse. This intestine portion was thick and had dark, red coloration indicative of inflammation and possible bleeding.
- The remaining loops of the small intestine were filled with blood-tinged contents, suggesting internal bleeding and inflammation.
- There was also a dangerous escape of gastric contents into the abdominal cavity due to a tear along the stomach’s natural curvature. This led to peritonitis, a severe inflammatory response due to the release of gastric contents into the abdomen.
Other Histological Observations
- The entrapped segment of the intestine suffered acute transmural hemorrhage, a serious condition where bleeding develops across the entire wall of the organ, as well as congestion and cell death in the mucosal lining. A collection of white blood cells along with fibrin thrombi, small blood clots, were found in the mucosa of the non-incarcerated small intestinal segments.
- C. difficile toxins were detected in the intestinal contents and the bacteria itself was isolated from multiple parts of the digestive tract, including the small intestine, colon, and cecum.
Cite This Article
APA
Asin J, Nyaoke AC, Samol MA, Arthur RM, Uzal FA.
(2022).
Clostridioides (Clostridium) difficile-associated disease, epiploic foramen entrapment, and gastric rupture in a Thoroughbred racehorse: case report and literature review.
J Vet Diagn Invest, 34(5), 913-917.
https://doi.org/10.1177/10406387221118039 Publication
Researcher Affiliations
- California Animal Health and Food Safety Laboratory, San Bernardino branch, University of California-Davis, Davis, CA, USA.
- California Animal Health and Food Safety Laboratory, San Bernardino branch, University of California-Davis, Davis, CA, USA.
- California Animal Health and Food Safety Laboratory, San Bernardino branch, University of California-Davis, Davis, CA, USA.
- School of Veterinary Medicine, University of California-Davis, Davis, CA, USA.
- California Animal Health and Food Safety Laboratory, San Bernardino branch, University of California-Davis, Davis, CA, USA.
MeSH Terms
- Animals
- Clostridioides
- Clostridioides difficile
- Clostridium
- Colic / complications
- Colic / veterinary
- Horse Diseases / diagnosis
- Horses
- Stomach Rupture / complications
- Stomach Rupture / veterinary
Conflict of Interest Statement
Declarations of conflicting interests: The authors declared no potential conflicts of interest with respect to the research,authorship, and/or publication of this article.
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