Small intestinal herniation through the epiploic foramen: 53 cases (1987-1993).

This study investigates the incidence of small intestine entrapment (herniation) through the epiploic foramen in horses, focusing on the effects of age, breed, and peritoneal protein levels as prognostic indicators, the role of ultrasound in diagnosis, and surgical intervention outcomes.

Overview of the Study’s Context and Aims

• The research was prompted by the need to understand the epiploic entrapment of the small intestine in horses. This condition usually leads to a surgical intervention called celiotomy, commonly done to alleviate horse colic.
• The overall aim of the study was to document the prevalence of this condition, identify any breed or age predispositions, determine useful prognostic indicators, and evaluate the effectiveness of surgical intervention.

Findings of the Study

• The researchers found that about 5% of horses undergoing a celiotomy for colic suffered from an epiploic entrapment of the small intestine. The study further identified a correlation with age and breed: it is particularly prevalent in older horses (average age of approximately 10 years) and, specifically, in Thoroughbred geldings.
• The study indicated that peritoneal protein level could serve as a good prognostic indicator. Horses that did not survive had significantly higher peritoneal protein levels than the horses that survived.
• Abdominal ultrasonography was pinpointed as a tool that enabled early diagnosis and subsequent surgical intervention, particularly in cases where there was no pain and rectal findings were inconclusive.
• Of the horses, 44 underwent successful surgery, but nine died either during (seven) or after (two) the surgical procedures. Recurrent laparotomies were carried out on 27% of the horses.

Post-surgery Outcomes and Complications

• The most common post-surgery complication was adynamic ileus, observed in 16% of the cases. The incidence of adhesion formation, at 6%, was however lower than previously reported.
• Other complications after surgery included gastric ulceration, liver disease, diarrhea, and weight loss.
• The short-term and long-term survival rates after surgery were 79% and 70% respectively. The increase in survival rates was attributed to early referral and diagnosis, as well as prompt surgical intervention.
• The use of repeat celiotomy and improved treatment of the endotoxic horse in the perioperative period also contributed to survival.