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EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2020) 32 (8) 398 doi: 10.1111/eve.13059_1
Case Report
Segmental ischaemic necrosis of the jejunum in a post-partum mare due to two mesenteric avulsions
L. Vilaregut* ,C.O’Shea, M. Lores , G. Couto and M. Misheff Sharjah Equine Hospital, Sharjah, United Arab Emirates *Corresponding author email:
lvilaregut@hotmail.com
Keywords: horse; post-partum; mesenteric avulsion; mesenteric rent; segmental ischaemic necrosis; peritonitis
Summary A 9-year-old Arabian maiden mare gave birth after 365 days of gestation. Parturition was assisted due to ventro-sacral presentation of the foal. After delivery the mare was referred to the hospital due to eversion of the bladder, which was corrected without complication. Flunixin meglumine and trimethoprim sulfadimidine were administered to reduce inflammation and prevent infection. For the first 24 h post- partum the mare was alert and vital signs were within normal limits. On the second day the heart rate and the haematocrit increased and the mare started to reflux. Transabdominal ultrasound revealed nonmotile small intestinal loops and an increased amount and echogenicity of the peritoneal fluid. Differential diagnoses at this time included haemoperitoneum due to arterial rupture, uroperitoneum due to bladder tear or peritonitis due to intestinal or uterine injury. Peritonitis was suspected but only confirmed on day 3 by
abdominocentesis which yielded haemorrhagic peritoneal fluid (red blood cell count 5.76 9 1012/L) with an increased WBC count (1.9 9 108/L, 85% neutrophils). Unremarkable bladder cystoscopy ruled out leakage from the traumatised bladder. Due to the lack of behavioural signs of colic, a uterine tear was considered likely. Hysteroscopy could not confirm the tear and medical treatment was attempted. The mare was placed on maintenance i.v. fluids supplemented with calcium gluconate, dimethyl sulfoxide and lidocaine CRI. The antibiotic therapy was changed from trimethoprim sulfadimidine to potassium penicillin and gentamicin. On the morning of the fourth day post-partum, in view of worsening clinical parameters, but in spite of continued absence of behavioural signs of colic, an exploratory laparotomy was performed. A 2-m segment of necrotic jejunum with avulsion of the corresponding mesentery that completely transected the mesenteric vessels was resected. The line of demarcation between normal and devitalised bowel was consistent with ischaemic necrosis and no evidence of a previous strangulation could be identified. A second mesenteric avulsion transecting the mesenteric vasculature, and resulting in a 20-cm segment of necrotic jejunum, was located in the proximal jejunum adjacent to the duodenum (Fig 1). Due to the distance of several metres from the larger avulsion, a second resection and hand sewn end-to-end jejunojejunostomy were performed. Unfortunately, the mare collapsed and died in recovery after several coordinated attempts to stand. In hindsight, this mare would have had a higher chance of survival if abdominocentesis and exploratory laparotomy had been undertaken earlier in the
Fig 1: Segmental ischaemic necrosis of a distal portion of the jejunum, which was separated from its mesentery by a tear to the latter.
course of the treatment. Peritonitis in a post-partum mare is often associated with a uterine tear. However, as this case illustrates, this is not always the underlying cause. Hence, we present this report as a reminder of the important diagnostic value of exploratory laparotomy, and to highlight an unusual differential diagnosis of mesenteric avulsion of the jejunum in a post-partum mare.
Key points • Mesenteric avulsion should be considered in cases of post-partum peritonitis even when there are no behavioural signs of colic.
• Exploratory laparotomy as a diagnostic procedure is recommended sooner rather than later in cases of peritonitis of an unknown origin.
© 2019 EVJ Ltd
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