Life-threatening hemorrhage from enterotomies and anastomoses in 7 horses.
Abstract: To report our experience with horses that presumptively had severe intraluminal hemorrhage from enterotomy or anastomosis. Methods: Clinical study. Methods: Six adult horses and 1 adult donkey. Methods: A retrospective study was conducted at the University of Illinois (April 1994 to December 2001) to determine the clinical course and outcome of horses with melena and/or anemia and evidence of life-threatening hemorrhage from intestinal incisions. Medical records of all horses that had colic surgery were reviewed to determine the proportion of horses with this complication. In addition, horses that fit the same criteria identified in 3 other veterinary clinics were included. Results: Three horses (1.3%) of those that had enterotomy or anastomosis at the University of Illinois and 4 horses from other clinics had complications presumptively related to severe hemorrhage from these intestinal procedures. Melena became evident within 72 hours of surgery and lasted 12 to 96 hours. Six horses had an acute and severe drop in packed cell volume (PCV), increased heart rates, and other signs of acute hemorrhage, and 1 horse had signs of colic postoperatively. Horses were administered intravenous formalin (3 horses) and whole blood transfusions (4 horses). Repeat celiotomy was performed on 2 horses. In 1 of these horses, a bleeding artery was ligated in the edge of the original enterotomy, and, in the other, a 25-cm-diameter intraluminal blood clot was found occluding the pelvic flexure. A horse that had jejunocolostomy for cecal impaction was not treated for hemorrhagic shock but was euthanatized and necropsied. Necropsy revealed blood-filled bowel from the jejunocolostomy to the anus. One of the remaining 6 horses died of enterocolitis and 5 survived to discharge. Conclusions: Hemorrhage from incisional edges, particularly in the large intestine, should be considered a rare but possibly fatal complication of enterotomy or anastomosis in horses. Conclusions: To prevent fatal hemorrhage from incisional edges during enterotomy or anastomosis, large vessels should be ligated at the original surgery, and hemostatic effects of different closure techniques should be considered. No intraoperative or postoperative findings were useful to predict this complication, and response to supportive medical therapy was favorable.
Publication Date: 2003-12-03 PubMed ID: 14648534DOI: 10.1111/j.1532-950x.2003.00553.xGoogle Scholar: Lookup
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- Journal Article
Summary
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The research article discusses a study focusing on severe internal hemorrhage occurring in horses after either enterotomy (surgical incision into the intestines) or anastomosis (surgical connection of two parts). The study found that although rare, this type of hemorrhage is potentially life-threatening and offers suggestions on preventative measures.
Methods of the Study
- The researchers conducted a retrospective study observing horses with severe intraluminal (within the intestine) hemorrhage occurring following an enterotomy or anastomosis. The study took place from April 1994 to December 2001 at the University of Illinois.
- Medical records for all horses that underwent colic surgery (surgery to relieve abdominal pain, often through enterotomy or anastomosis) were reviewed as part of this study.
- Additionally, horses that met the same criteria from three other veterinary clinics were included in the study.
Findings of the Study
- Out of the horses that had an enterotomy or anastomosis at the University of Illinois and four other clinics, seven had severe hemorrhage.
- These hemorrhages presented as melena (dark, tarry feces due to the presence of digested blood) and/or anemia within 72 hours of surgery, lasting for 12 to 96 hours.
- Indications of acute hemorrhage including an acute and pronounced drop in packed cell volume (PCV, a measure of the proportion of blood made up of cells) along with increased heart rates. One horse also showed signs of colic after surgery.
- These horses were treated with intravenous formalin or whole blood transfusions. Two had to undergo a repeat celiotomy (surgical incision into the abdominal cavity).
- Five of the six horses survived to discharge, while the sixth died from enterocolitis (inflammation of the intestines). Another horse was euthanized and a post-mortem exam showed a blood-filled bowel.
Conclusions of the Study
- According to the findings, hemorrhage from incisional edges following enterotomy or anastomosis in horses is a rare but potentially fatal complication.
- To thwart severe hemorrhage, the researchers suggest that large vessels be ligated (tied off to prevent bleeding) during original surgery. Also, the hemostatic effects (the ability to stop bleeding) of varying closure techniques should be considered.
- The study found no findings during or after surgery that could predict this complication, but noted that while not always successful, supportive medical therapy was generally effective.
Cite This Article
APA
Doyle AJ, Freeman DE, Rapp H, Murrell JA, Wilkins PA.
(2003).
Life-threatening hemorrhage from enterotomies and anastomoses in 7 horses.
Vet Surg, 32(6), 553-558.
https://doi.org/10.1111/j.1532-950x.2003.00553.x Publication
Researcher Affiliations
- University of Illinois, College of Veterinary Medicine, 1008 W. Hazelwood Drive, Urbana, IL, USA.
MeSH Terms
- Anastomosis, Surgical / adverse effects
- Anastomosis, Surgical / mortality
- Anastomosis, Surgical / veterinary
- Anemia / etiology
- Anemia / mortality
- Anemia / veterinary
- Animals
- Equidae / surgery
- Female
- Gastrointestinal Hemorrhage / etiology
- Gastrointestinal Hemorrhage / mortality
- Gastrointestinal Hemorrhage / veterinary
- Horse Diseases / etiology
- Horse Diseases / mortality
- Horses / surgery
- Intestines / surgery
- Male
- Melena / etiology
- Melena / mortality
- Melena / veterinary
- Postoperative Hemorrhage / etiology
- Postoperative Hemorrhage / mortality
- Postoperative Hemorrhage / veterinary
- Retrospective Studies
- Treatment Outcome
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