Use of cisapride in the resolution of pelvic flexure impaction in a horse.

This research showcases how a drug called cisapride monohydrate was used to treat a 21-year-old horse suffering from severe weight loss, difficulty in eating, and an inability to pass stool due to a feed blockage in its gut. The medical intervention offers an alternative solution to surgical procedures for limited-resource cases.

Overview of the Case

• The horse, an Appaloosa stallion, demonstrated signs of colic, severe weight loss, and difficulty chewing for five months. The state of the horse worsened three days before admission as it stopped eating food entirely.
• Physical examination revealed the horse was severely emaciated, exhibited significant muscle loss and had an abnormal formation of dental arcades due to the severe wearing of the lower molar arcades and missing molars.
• Sound-based examination (auscultation) revealed decreased gut activity across all four abdominal quadrants. A large (30cm-40cm) impaction was detected in the pelvic flexure upon palpation.
• Kidney function test showed increased pre-urine concentration and protein level, indicating dehydration.
• The horse was found to be suffering from a non-strangulating obstruction due to feed impaction in the pelvic flexure. Medical management of the condition was leveraged.

Treatment and Observation

• The initial treatment involved the administration of a homemade laxative (mineral oil with warm water) via a nasogastric tube. To replenish body fluids, intravenous fluid therapy was also initiated.
• Despite 24 hours of treatment, no improvements were observed: the horse remained unable to pass any stool, and its gut activity remained low, indicating that the impaction was undisturbed.
• More aggressive intervention was administered using a stronger laxative (dioctyl sodium sulphosuccinate in glycerine). Over the next few days, the administration of both the laxatives was alternated with intravenous fluids, but the condition of the horse remained unimproved.
• Daily rectum examination revealed no reduction in the impaction, and economic constraints precluded surgical exploration, leading to the consideration of alternative medical solutions.
• As per the observations, the intestinal activity of the horse was consistently diminished, which is common with such cases but usually increases in response to treatment with oral cathartic medication, which this case did not exhibit.

Administration of Cisapride Monohydrate

• Considering the maintenance of constant low intestinal activity, the decision was made to administer a prokinetic drug cisapride monohydrate, which is known to increase the propelling movement within the intestine and has been used in horses for the prevention and treatment of postoperative ileus (a disruption of the normal propulsive ability of the gastrointestinal tract).
• After nine doses over three days, an increase in gut activity was noted in all abdominal quadrants. However, the horse also exhibited symptoms of discomfort.
• An analgesic was administered to counter this discomfort, and finally, after about one and half day from the initiation of the drug therapy, the horse started passing stool.
• Cisapride monohydrate has been effectively utilized in humans and dogs, stimulating an increase in amplitude of contractions of the stomach, and both small and large intestines.

The horse exhibited a markedly improved condition after the new treatment. Prokinetic drugs like cisapride monohydrate may offer a less invasive and economically viable treatment option for similar future cases.