Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010.

REASONS FOR PERFORMING THE STUDY: There is disagreement among surgeons over whether jejunoileostomy (JI) or jejunocaecostomy (JC) is the better method of anastomosis following proximal ileal resection. OBJECTIVE: To compare short- and long-term complications and outcome in horses undergoing jejunojejunostomy (JJ), JI and JC and to test the hypotheses that a higher proportion of horses undergoing JI would have short-term complications and mortality compared with horses undergoing JC or JJ and that JC would be associated with a higher long-term mortality and occurrence of colic. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Medical records of horses undergoing celiotomy for a small intestinal obstruction and JJ, JI or JC from 2005 to 2010 were reviewed. Post operative complications were recorded. Short-term outcome was alive vs. dead at hospital discharge and was analysed using a Chi-squared test. Long-term follow-up was obtained and a Kaplan-Meier estimate of the survivor function was performed. RESULTS: There were 112 horses included. A higher proportion of JI horses had a repeat celiotomy during hospitalisation compared with horses undergoing JC. The number of horses alive at hospital discharge was not different between groups: JJ 79% (95% confidence interval [CI] 68-90%), JI 78% (95% CI 61-96%), JC 83% (95% CI 71-96%). Among horses discharged with long-term follow-up, more horses had colic after JC compared with JJ or JI. Long-term post discharge survival based on the Kaplan-Meier survivor function was lower for horses undergoing JC than JJ or JI (P = 0.04). CONCLUSION: While there was no difference in short-term outcome between groups, more horses with JI underwent a repeat celiotomy during hospitalisation. Horses with a JC were more likely to have long-term complications with colic. Horses that were subjected to euthanasia because of colic within 12 months of hospital discharge either had a JC or repeat celiotomy. The results suggest that, when possible, a JI may be the preferred method of anastomosis based on more favourable survival and lower occurrence of colic long term.

Evaluation of equine cecal motility by ausculation, ultrasonography and electrointestinography after jejunocecostomy.

OBJECTIVE: Horses often suffer reduced intestinal motility after jejunocecostomy. Therefore, accurate evaluation of intestinal motility is important for the prevention, diagnosis and treatment of this condition. The purpose of this study was to evaluate intestinal motility in horses after jejunocecostomy using three different methods, i.e. auscultation, ultrasonography and electrointestinography. ANIMALS: Six healthy thoroughbreds were used in this study. They were subjected to jejunocecostomy. PROCEDURE: Bowel sounds in the right paralumbar fossa were assigned a score of 0-3 for intestinal motility evaluation by auscultation, and the number of cecal contractions during a 3-min period were counted by ultrasonography. Electrointestinography (EIG) was used to measure percutaneous potential of the cecum. RESULTS: We identified three specific postoperative periods: the period of reduced intestinal motility (postoperative day 1 to day 2), in which intestinal motility declined, the unstable period (day 3 to day 7), in which intestinal motility partially recovered, and the full recovery period (day 8 to day 31), in which intestinal motility returned to preoperative state. Careful management was found to be especially important during the period of reduced intestinal motility and the unstable period. We found that, in healthy horses that underwent jejunocecostomy, it takes approximately one month for the cecum to return to normal motility patterns observed before surgery. CONCLUSION: We have shown in this study that evaluation of intestinal motility after jejunocecostomy in horses by EIG is more objective and provides more details than evaluation by auscultation or ultrasonography.

Corrección quirúrgica de infartode intestino delgado en un equinomediante yeyunocecostomíacon grapadora quirúrgica mecánica / Surgical management of small intestine infarction by stapled jejunocecostomy in a horse

Un equino macho, entero, criollo colombiano de siete años de edad, fue remitido a la clínica de grandes animales del centro de veterinaria y zootecnia CES debido a síndrome abdominal agudo. Al ser evaluado clínicamente presentó depresión, ruidos abdominales disminuidos, deshidratación (6%), frecuencia cardiaca y respiratoria en 40 lpm y 28 rpm, respectivamente, temperatura en 37.1 °C y distensión marcada de intestino delgado evidente mediante palpación rectal y ultrasonografía transabdominal. No hubo respuesta a los analgésicos por parte del equino; los parámetros en líquido peritoneal estuvieron alterados. Se sospechó lesión estrangulante en intestino delgado. La laparotomía exploratoria reveló infarto idiopático de siete metros de yeyuno y la porción proximal del íleon. Fue practicada una yeyunocecostomía latero lateral con grapadora quirúrgica mecánica (GIA 80). El animal permaneció hospitalizado 10 días y la recuperación postquirúrgica fue exitosa. Este caso es el primer reporte en el país de esta cirugía.

A 7- years-old criollo colombiano stallion was referred to the Large Animal Hospital Centro de Veterinaria y Zootecnia CES (Envigado, Colombia) because of an acute abdominal syndrome that had persisted for seven hours despite medical treatment. On physical examination the stallion was depressed, dehydrated (6%), borborygmi were diminished, rectal temperature was � 37.1 °C,hearth and respiration rates were 40 beats/min and 28 breaths/min, respectively. On rectal examination and abdominal ultrasonography small intestine was distended. Peritoneal fluid analysis was altered. Signs of pain were nonresponsive to analgesics. The diagnosis by exploratory � laparotomywas infarctionof small intestine (seven meters of the jejunum and proximal portion of the ileum) of unknown etiology. A jejunocecostomy was done using a GIA 80 surgical stapler (United Surgical). Postsurgical recuperation was successful. This case becomes the first report of a jejunocecostomy in a horse in Colombia.

Quantification of digesta flow into the caeca.

1. A caecal intubation technique was developed to determine the amount of digesta that enters the caeca of fed and feed-deprived chickens. 2. Dry matter intakes per day for control and caecostomised chickens were not significantly different. 3. For fed and feed-deprived roosters, water intake was significantly increased by caecostomy in control birds and was significantly increased by feeding. 4. Amount of caecal dry matter excretion was significantly increased by feeding, but no difference in caecal water excretion was observed. 5. The ratio of caecal excretion (caecal/total excretion) of dry matter and water tended to decrease in response to feeding. 6. It is concluded that dry matter entry into the caeca represents 18% or 25% of the total dry matter excretion in fed or feed-deprived birds, respectively. Corresponding values for water entry are 17 and 26%. Therefore, the caeca play an important role in water balance.

Efficacy of metoclopramide for treatment of ileus in horses following small intestinal surgery: 70 cases (1989-1992).

In this retrospective study, postoperative ileus was studied in horses having resection of the small intestine followed by a jejunojejunal (n = 35) or a jejunocaecal (n = 35) anastomosis. Twenty-six horses received no metoclopramide, 27 received metoclopramide as an intermittent intravenous infusion and 17 horses received metoclopramide as a continuous intravenous infusion (0.04 mg/kg/hour). Horses receiving a continuous infusion of metoclopramide had a reduced total volume (P < 0.001), shorter duration (P < 0.001), and a slower rate (P < 0.001) of postoperative gastric reflux, and a shorter postoperative hospital stay (P < 0.01) when compared to horses receiving no metoclopramide and horses receiving metoclopramide as an intermittent infusion. Horses having jejunocaecostomy performed had a larger volume (P < 0.05), longer duration (P < 0.05), and a greater rate (P < 0.05) of postoperative gastric reflux, and a longer postoperative hospital stay (P < 0.001) than horses undergoing jejunojejunostomy. Horses that had an abdominal drain placed during surgery had a longer length of intestine resected (P < 0.05) and a longer postoperative hospital stay (P < 0.05) than horses without an abdominal drain. Horses that died or were euthanased during the postoperative period had a greater total volume (P < 0.05), longer duration (P < 0.05), and greater rate of postoperative gastric reflux (P < 0.01), a longer length of small intestine resected (P < 0.01), and a shorter postoperative hospital stay (P < 0.05) than horses that survived until discharge from the hospital. In a multivariate regression analysis the continuous infusion of metoclopramide was the only variable that contributed significantly to predicting the total volume (P < 0.001; r2 = 0.24), duration (P < 0.001; r2 = 0.24) and rate (P < 0.001; r2 = 0.25) of postoperative gastric reflux. We concluded that metoclopramide given as a continuous intravenous infusion decreased the incidence and severity of ileus following small intestinal resection and anastomosis in horses.

Technique for creating a permanent cecal fistula in the rat.

A method was developed to surgically implant a silicone/stainless steel fistula-cannula in the cecum of freely moving rats. The specially designed fistula-cannula allows sampling of cecal contents at any time without disturbing the physiologic functions of the intestinal tract, as evaluated by observation of general well-being and postmortem macroscopic inspection. The fistula-cannula was implanted in 12 male rats under general anesthesia. The animals remained in good health during the postoperative period lasting up to 9 weeks. They gained weight normally compared with a control group (n = 8) that had not undergone surgery. Samples of 0.2 to 1.0 g of contents could be collected with a microspatula, without the need to anesthetize the animal. The model provides a useful system for sampling cecal contents without the need to sacrifice the animal. Because it allows cross-over studies to be carried out, this approach may result in significantly reducing the number of animals required for digestive studies.

Effect of intestinal resection on two juvenile horses with granulomatous enteritis.

Two horses were presented with lethargy, weight loss, anorexia, and swelling of the limbs and ventral body wall. One horse, a 12-month-old American Paso Fino colt, also had acute abdominal pain. The other horse, a seven-month-old Tennessee Walking Horse (TWH) filly passed diarrheic stools during the initial examination. Each horse had low serum protein, neutropenia, and a normal packed cell volume (3.2 g/dl, 1300 cells/ul, and 38%, respectively, for the colt, and 2.4 g/dl, 696 cells/ul, and 44%, respectively for the filly). After intravenously administering plasma, the colt's PCV dropped to 23%, and the filly's dropped to 30%. During exploratory surgery, 3.5 and 2.0 meters of thickened terminal small intestine were removed from the colt and filly respectively, and a jejunocecostomy performed. The results of histologic examination of resected intestine were consistent with a diagnosis of equine granulomatous enteritis (EGE). Both horses showed clinical improvement within two days after surgery. The colt developed a neutrophilia (20,500 cells/ul) within 24 hours of surgery. Serum protein concentrations remained stable and gradually elevated to normal or near normal values of 7.0 g/dl (colt) and 5.8 g/dl (filly) by two weeks. The colt was killed four months after surgery because of signs of abdominal pain. Postmortem examination revealed a small intestinal volvulus associated with an adhesion. The TWH filly remains clinically normal 13 months after surgery.