Surgical diseases of the equine cecum.

The research study outlines the most common diseases of the horse’s cecum; cecal impaction and cecal perforation. It also discusses effective methods of their diagnosis and treatment, using both medical and surgical methods.

Understanding Equine Cecal Diseases

• In horses, the two most common cecal diseases are cecal impaction and cecal perforation. These conditions can stem from the slowing or interruption of a single progressive motility pattern that typically propels ingesta (food or other material being digested) from the cecum – an organ similar to the human appendix – to the right ventral colon.
• Cecal impaction refers to the build-up of ingesta in the horse’s cecum, which can lead to severe intestinal blockage. Conversely, cecal perforation is a fatal disease where the cecum ruptures, causing severe internal damage.

Diagnosis and Treatment

• Diagnosing cecal impaction typically involves a rectal examination in horses. This technique allows the assessor to grade the severity of the condition based on their findings.
• If the impaction is considered to be mild to moderate, medical treatment is recommended. This typically involves therapy involving fluid administration and laxatives to help soften and move the impaction.
• Surgical treatment is required for severe cases. This involves a ventral midline celiotomy, which is a surgical incision into the abdomen, revealing a large ingesta-filled cecum and a relatively empty large colon.

Surgical Methods

• The preferred surgical method currently used involves typhlotomy (surgical incision into the cecum) with manual evacuation of the ingesta, combined with a complete bypass of the cecum via a jejunocolostomy (a surgical connection between the jejunum – part of the small intestine – and the colon).
• A cecocolic anastomosis, which is a surgical connection between the cecum and the colon, remains a viable secondary option.

Cecal Perforation and its Management

• Cecal perforation is most often seen when the subtle signs of cecal impaction have been missed or hidden by the administration of nonsteroidal antiinflammatory agents.
• The condition can occur in mares around the time of foaling and, unlike with impaction, it’s not associated with cecal outflow dysfunction.
• The surgical management of cecal perforation requires resection (removal) of the diseased portion of the cecum, either using extra- or intraluminal techniques.
• Techniques like a side-to-side or end-to-side jejunocecal anastomosis are also useful. These procedures allow bypass of simple or strangulating lesions of the ileum, another segment of the small intestine.