EQUINE VETERINARY EDUCATION Equine vet. Educ. (2020) 32 (8) 411 doi: 10.1111/eve.13045_1


Case Report


Mesenteric strangulation by pedunculated lipomas without involvement of associated intestine in four horses


A. G. Bauck†*, A. S. Graham†, A. Smith†, H. J. Rapp‡ and D. E. Freeman† †Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, USA; and ‡Tier€


arztliche Praxis f€ ur Pferde, R€ ottenbach, Germany


*Corresponding author email: baucka@ufl.edu Keywords: horse; mesentery; colic; lipoma


Summary


This report describes the clinical signs, pathological findings and outcome in four horses with mesenteric strangulation by pedunculated lipomas. In each case, there was no intestinal strangulation. These horses were presented with no specific preoperative evidence of intestinal obstruction or a strangulating lesion other than degree of pain (no nasogastric reflux, no dilated loops of intestine on rectal examination/ultrasound). The small intestinal mesentery was involved in three horses and the small colon mesentery in the fourth horse but the associated intestine was not strangulated, haemorrhagic, nor obviously obstructed in any horse. In all horses, a patch of haemorrhagic mesentery of variable size was evident around the origin of a mesenteric


lipoma and a major mesenteric vessel (Fig 1). One horse was subjected to euthanasia for financial reasons and the remaining three had surgery from which they made a complete recovery after removal of the lipoma. Intestinal resection was not performed in any of the three horses undergoing surgery, although a mesenteric defect had to be closed in the small colon mesentery. Traction on the mesenteric vessels as they were drawn


into the mesenteric strangulation by the lipoma caused pain and mesenteric haemorrhage. The equine small intestine and small colon both have extensive collateral circulation so that arcuate blood vessels from major mesenteric branches outside the strangulated region could provide adequate blood flow to the intestine. Furthermore, the thick-walled arteries could remain patent and continue to perfuse the intestinal segment during this process so that intestinal viability was preserved. In the three cases that underwent surgery, the excellent post-operative outcome indicated that resection is not required in cases of mesenteric strangulation.


411


Key points


• This report describes management of an unusual but important form of colic caused by strangulation of the mesentery by a pedunculated lipoma, without intestinal strangulation.


Fig 1: Intraoperative picture after correction with white arrow pointing to the lipoma and the small black arrow to its pedicle. The lipoma was detached from the mesentery at this stage to allow correction but is replaced on its point of origin. Note that haemorrhage follows the mesenteric vessels.


• Surgical treatment involved removal of the lipoma and repair of any mesenteric defects, but not resection of the intestines.


• In the three horses that underwent surgery, all survived to discharge with no episodes of post-operative colic or reflux.


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