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

The research discusses a case wherein a 16-year-old stallion underwent surgery for small intestinal obstruction due to strangulating incarceration through the epiploic foramen. Thrombus was found in the portal vein and the liver was severely damaged post-surgery. The horse ultimately passed away due to hypoglycemia and liver damage, indicating these could be potential complications of this kind of surgery that could partly explain the high mortality rate related to the condition.

Background

• The paper is based on the case of a 16-year-old stallion which was brought to the Louisiana State University Veterinary Teaching Hospital due to acute abdominal pain.
• Upon physical examination and diagnostic procedures, the experts found a strangulating obstruction in the small intestine of the horse.

Surgical Procedure

• The stallion underwent an exploratory celiotomy, a surgical procedure where the abdominal cavity is opened and explored.
• The doctors found a strangulating incarceration of the jejunum in the epiploic foramen, the passageway in the abdominal cavity between the left lobe of the liver and the stomach.
• The obstructed small intestine was adjusted, following which the nonviable part of the bowel was removed and an anastomosis, i.e., a surgical connection between two structures, was performed.

Post-Surgery Condition

• A post-operative evaluation revealed that the horse was showing clinical signs and laboratory findings associated with hypoglycemia which eventually led to its death despite emergency treatment.
• A post-mortem examination found a large thrombus, a blood clot, present in the portal vein at the level of the epiploic foramen.
• The liver was found to have multiple large infarcted areas, indicating extensive liver damage.

Conclusion

• The observations made during this case study indicate that hypoglycemia and widespread hepatic ischemic necrosis, which is extensive liver damage due to lack of adequate blood supply, could be potential complications post-surgery.
• Such findings have not been reported in earlier cases of epiploic foramen incarceration of the small intestine, and these complications could possibly explain the high mortality rate associated with this health issue in horses.