Laparoscopic nephrosplenic space ablation with barbed suture in eight horses.

CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon. CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region. TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon. CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.

Prosthetic Mesh for Obliteration of the Nephrosplenic Space in Horses: 26 Clinical Cases.

OBJECTIVE: To report surgical complications, occurrence of post-obliteration colic, long term outcome, and return to previous function for horses treated with prosthetic mesh obliteration of the nephrosplenic space. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n = 26) having nephrosplenic space obliteration using prosthetic mesh. METHODS: Horses undergoing mesh obliteration between January 2006 and May 2013 were included. A Proxplast™ mesh was secured to the nephrosplenic space with titanium helical coils in standing horses using laparoscopic technique. Perioperative data were obtained from the medical record and by telephone followup. Tests of proportion were used to compare the study population to the hospital colic population. Occurrence of colic within 1 year of obliteration was compared between horses where the diagnosis was confirmed at laparotomy and those diagnosed by abdominal palpation per rectum using a Fisher's exact test. RESULTS: All 26 horses undergoing mesh obliteration during the study period survived to discharge. Long term followup was available for 25 horses, with 23 returning to their previous level of function, and 21 alive at the time of followup. Cause of death was not associated with the surgical procedure in any case. Geldings and Warmbloods were overrepresented compared to the hospital colic population. Ten horses (38%) demonstrated colic after mesh obliteration. All 10 horses were examined by a veterinarian and none were diagnosed with recurrence of nephrosplenic entrapment. CONCLUSION: Mesh obliteration of the nephrosplenic space is an effective alternative to suture closure for preventing nephrosplenic entrapment of the large colon in horses. No complications related to mesh obliteration were reported in our study population.

Surgical correction of nephrosplenic entrapment of the large colon in 3 horses via standing left flank laparotomy.

OBJECTIVE: To describe a technique for surgical correction of nephrosplenic entrapment via standing left flank laparotomy. STUDY DESIGN: Case series. ANIMALS: Horses (n = 3). METHODS: Nephrosplenic entrapment was diagnosed by abdominal palpation per rectum in all 3 horses and confirmed by transabdominal ultrasonography in 2 horses. Duration of colic was variable and failed to resolve after medical management, phenylephrine administration, and jogging. With sedation and local analgesia, standing left flank laparotomy using a modified grid approach was performed to correct the entrapment. Follow-up information was obtained by telephone communication with trainers or owners. RESULTS: Nephrosplenic entrapment was successfully corrected in all horses; postoperative fever occurred in 1 horse. Horses were discharged after 48-72 hours and returned to previous use within 30 days. CONCLUSION: Standing flank laparotomy is an alternative for horses with nephrosplenic entrapment unresponsive to medical therapy when general anesthesia and exploratory celiotomy are not an option because of financial constraints or a high anesthetic risk. This approach leads to a favorable outcome, reduces hospital stay and associated costs and leads to a rapid return to function.

Chronic intestinal pseudo-obstruction in a horse: a case of myenteric ganglionitis.

An 11-year-old Quarter horse mare was presented for recurrent episodes of colic. A chronic intestinal pseudo-obstruction was diagnosed. Medical treatment and surgical resection of the colon were performed but the condition did not improve and the horse was euthanized. Histopathological examination revealed a myenteric ganglionitis of the small intestine and ascending colon.

Colonic obstruction in three captive reticulated giraffe (Giraffa camelopardalis reticulata).

Fatal colonic obstructions were diagnosed in three captive, adult, reticulated giraffe (Giraffa camelopardalis reticulata). Clinical presentations varied, but all cases displayed decreased activity, anorexia, and considerably decreased fecal production, consistent with intestinal obstruction. Case 1 was diagnosed at necropsy with a phytobezoar obstructing the spiral colon. Case 2 was diagnosed at necropsy with a fecal impaction of the colon. Case 3 was diagnosed during surgery with colonic ileus. Cases 2 and 3 underwent surgical intervention but were markedly compromised by the time of surgery and died during surgery or 24 hr postoperatively. Gastrointestinal obstruction, requiring aggressive supportive care and early surgical intervention, should be considered in giraffe in which anorexia and substantially decreased fecal production are observed. Abdominal exploratory surgery will likely be necessary for diagnosis and treatment. Based on a small number of cases, gastrointestinal obstruction has a poor prognosis in giraffe.

Accuracy of increased large-intestine wall thickness during ultrasonography for diagnosing large-colon torsion in 42 horses.

Large-colon torsion is a common cause of colic in horses and has a worse prognosis and higher cost than other causes of surgical colic of the large colon. During large-colon torsion, the colon wall becomes thick due to vascular occlusion. Therefore, we hypothesized that detecting increased colon wall thickness during ultrasonography would be an accurate preoperative test for large-colon torsion. The sample population consisted of 42 horses that were admitted for surgical treatment of colic localized to the large colon. The diagnosis was confirmed at surgery or necropsy examination. Twelve (29%) of these horses were diagnosed with large-colon torsion. Duplicate ultrasonographic measurements of colon wall thickness were made at six abdominal locations and an average measurement was calculated. For four of these six sites, a significant difference (P < 0.005) was detected between horses with and without large-colon torsion. All four tests were moderately sensitive and highly specific for diagnosing large-colon torsion using five decision criteria. Using a ventral abdominal window, a colon wall thickness > or = 9 mm accurately predicted large-colon torsion in eight of the 12 horses (sensitivity, 67%; confidence interval [CI], 36-98%) and correctly predicted that large-colon torsion was absent in 28/28 horses (specificity 100%; CI, 98-100%). Intraobserver repeatability was assessed by evaluating the difference between the first and second measurements obtained, which was < or = 2 mm. Therefore, detecting increased large-colon wall thickness during ultrasonography is a reproducible and accurate preoperative test for large-colon torsion in horses with surgical colic localized to the large colon.

Use of pelvic flexure biopsies to predict survival after large colon torsion in horses.

OBJECTIVE: To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict outcome in horses with large colon torsion. STUDY DESIGN: Clinical study. ANIMALS: Fifty-four horses with large colon torsion. METHODS: A full-thickness biopsy was collected from the pelvic flexure of the ascending colon after correction of naturally occurring colonic torsion. Morphologic changes were evaluated and graded for interstitial tissue to crypt ratio (I:C ratio), percentage loss of superficial and glandular epithelium, and the degree of hemorrhage and edema. These variables were then used to predict survival. RESULTS: Morphologic variables could be used to correctly predict survival or death in 51 horses (P < .0001). This corresponded to a sensitivity of 95.1% (82.2%-99.2%; 95% CI) and a specificity of 92.3% (62.0%-99.6%; 95% CI). Of 6 horses that had colonic resection, 5 survived; an accurate prediction of outcome based on morphologic criteria was made for each horse. CONCLUSIONS: Interpretation of changes in colonic morphology can be used to accurately predict postoperative survival in horses with large colon torsion. CLINICAL RELEVANCE: Use of frozen colonic tissue sections is a rapid, reliable, and relatively inexpensive method for assessing morphologic damage associated with large colon torsion during surgery. Intraoperative evaluation of pelvic flexure biopsies can aid in the prediction of survival and guide surgical judgment as to the need for colonic resection.

Segmental eosinophilic colitis: a review of 22 cases.

Twenty-two horses with colic, referred to the University of Liverpool Equine Hospital (1992-1998), were found at laparotomy to have a partial obstruction of the large colon caused by a segmental mural lesion located in the left dorsal colon. The decision to take the horses to surgery was based on rectal examination findings of secondary impaction and mural oedema of the large colon and turbid peritoneal fluid containing large numbers of neutrophils obtained by paracentesis. The affected segment of colon showed oedema and serosal changes varying from erythema to well-defined necrosis. These pathological changes were considered to be sufficiently severe in 16 horses to merit partial resection of the left colon. Histology revealed varying degrees of mucosal necrosis, marked submucosal oedema and infiltration with large numbers of eosinophilic leucocytes. No cause was identified for the lesions. Sixteen of the 18 horses discharged from the hospital were alive 3 months to 7 years after surgery and have returned to their previous type of work and level of performance. The remaining 2 horses were subjected to euthanasia because of a recurrence of colic but no autopsy was performed.

Nephrosplenic entrapment in the horse: a retrospective study of 174 cases.

The clinical findings and outcome of 161 horses diagnosed with 174 episodes of nephrosplenic entrapment (NSE) were reviewed retrospectively. The median age at presentation was 5 years (9 months to 24 years), and duration of colic was 2-92 h. Nasogastric reflux was present in 49 of 113 horses (43.4%) and was significant (> or = 21) in 32 (28.3%) horses. The recurrence rate was 13/161 (8.1%). Thirteen horses (13/174, 7.5%) had other lesions including small intestinal obstruction (4), 360 degrees large colon torsion (5), gastric rupture (2), thromboembolic colic (1) and small colon infarction (1). Of 115 cases, in 107 horses treated by surgery alone, 2 horses required a large colon resection, and 8 (8/107, 7.5%) horses died or were subjected to euthanasia. Twenty-six of 35 horses (74%) were successfully corrected by rolling under general anesthesia and, of the 9 horses taken to surgery after rolling, 4 had other lesions and 2 were corrected at surgery. Phenylephrine was used in 20 of 35 horses that were rolled and 2 horses required surgery after rolling with phenylephrine. Five horses were jogged after phenylephrine administration and all were successfully corrected. Eleven horses presented with the left colon located between the spleen and the body wall were treated successfully by fasting and/or i.v. fluids. One horse had a gastric rupture after rolling. The overall success rate was 92.5%. In conclusion, NSE is a condition associated with a good prognosis for medical or surgical correction. A small number of horses may have additional gastrointestinal lesions, which may affect outcome.

Equine myenteric ganglionitis: a case of chronic intestinal pseudo-obstruction.

A 4-year-old Standardbred mare was referred to the New York State College of Veterinary Medicine for colic evaluation. Physical examination revealed a small colon impaction which initially responded to conservative medical management. Her signs soon recurred, however, and an exploratory celiotomy was recommended. At surgery the small colon impaction was confirmed. The impaction was evacuated and a surgical biopsy was submitted for histopathologic evaluation. Microscopic examination of H&E and Trichrome sections revealed a massive mononuclear cell infiltration of the myenteric plexus. In addition, there was remarkable fibrosis within the neuropil of the myenteric ganglia and interganglionic fascicles. Postoperatively, the mares's colic signs recurred within two weeks and she was euthanatized. Samples of the proximal and distal small colon as well as the original biopsy site were obtained. Over the intervening two weeks, the inflammatory infiltrate within the myenteric ganglia had subsided, while the previous intraganglionic and fascicular fibrosis had increased substantially. The number of myenteric neurons appeared diminished when compared to age-matched controls. There was evidence of neuronal degeneration among the surviving neurons including central chromatolysis and cytoplasmic vacuolization. Furthermore, many degenerate axons were observed with the electron microscope. This scenario represents an equine example of chronic idiopathic intestinal pseudo-obstruction (CIIP) which has been extensively described in the human literature. In this case, the syndrome arose as a consequence of recurrent inflammatory injury to the mare's enteric nervous system, thereby altering normal gastrointestinal motility. The ensuing neurogenic functional obstruction manifested as frequent bouts of small colon impactions. Equine CIIP should be considered in the differential diagnosis of colic.