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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2020) 32 (8) 424-430 doi: 10.1111/eve.13036


Original Article


Surgical management of foreign body obstruction of the small and large colons in 29 equids (2004–2016)


G. L. Oreff†* , A. J. Tatz‡, R. Dahan‡, T. Raz‡ and G. Kelmer‡ †Department for Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria; and ‡Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel *Corresponding author emails: gil.oreff@vetmeduni.ac.at


Keywords: horse; foreign body; colic


Summary The objectives of the study were to describe the clinical presentation, surgical findings, complications and outcome of a case series of small and large colon obstruction by foreign bodies (FBs) in horses. The study is a retrospective case series which included 29 equids (28 horses and one donkey). Medical records of cases diagnosed with FB obstruction of the large or small colon between the years 2004 and 2016 that underwent surgery were reviewed. Data regarding signalment, clinical signs, surgical findings and post-operative variables were recorded. Short- (survival to hospital discharge) and long- (1 year after surgery) term survival rates were obtained. Cases had a mean age of 4.2 years, with both females and Arabian horses being overrepresented. Abdominal distention was the most common observation on presentation and the FB could be palpated in 20% of the cases during rectal examination. The most common reason to go into surgery was severe pain with abdominal distention. Significantly more FBs were found in the small colon during surgery (P<0.0001) and most were removed by small colon enterotomy. Complications rate post-operatively was relatively high (41%) with fever and diarrhoea being most common. Twenty-three cases (79%) were released from the hospital and all cases that were available for long-term follow-up were alive and returned to previous activity. No correlation between the chosen method of surgical removal of the FB and survival or complications post-operatively was noted. These data reflect favourable prognosis for surgical removal of colonic FBs. Few techniques are available to improve the safety of removal and the preferred method depends on the FB location, appearance and mobility. As FB obstruction resembles ‘noncomplicated’ colonic impaction, it is essential to try and recognise FB cases since deterioration can be rapid and surgery is the only sufficient treatment.


Introduction


Small colon impaction is the most common disorder of the small colon in horses, accounting for 34–78% of all cases of small colon disease (Dart et al. 1992; Rhoads et al. 1999; de Bont et al. 2013). Most small colon impactions consist of feed material, however foreign body (FB) ingestion can also cause small colon impaction and may include nylon fibres, hay nets, twine, plastic material, cotton fibres and even metal (Boles and Kohn 1977; Gay et al. 1979; van Wuijckhuise-Sjouke 1984; de Oliveira Dearo et al. 2009). The


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ingestion occurs most commonly in young horses probably because they are less discriminatory in their eating habits (Dart et al. 1992; Schumacher and Mair 2002), however it may also occur in adult horses kept under unsanitary conditions (de Oliveira Dearo et al. 2009). Once ingested by the horse, the foreign object serves as a nidus for deposition of mineral elements over it, which increases its size. As a result, an irregular intestinal concretion is formed, often containing projections which can generate intestinal wall pressure necrosis (Edwards 1997; Schumacher and Mair 2002). Affected horses typically remain unresponsive to medical treatment. Surgical intervention is therefore recom- mended prior to initiation of irreversible intestinal damage (Schumacher and Mair 2002; Pierce 2009). During surgery, the FB can be manipulated using fluid distention to move it to a safe area where enterotomy can be performed (Pierce 2009). If the obstructed segment cannot be exteriorised, an alternative approach, such as a paramedian celiotomy, can be performed to facilitate safe removal of the obstruction (de Oliveira Dearo et al. 2009). In some cases, a FB trapped in the small colon can be removed by a high enema and external massage of the intestine to break up the surrounding obstruction and evacuate it through the rectum (Pierce 2009). Resection and anastomosis of the small colon may be indicated in severe cases where the obstruction has resulted in intestinal necrosis, provided the segment of intestine can be exteriorised (Schumacher and Mair 2002; Pierce 2009). There are few descriptions of the clinical presentation,


short- and long-term prognosis due to the low frequency with which these cases have been recognised in horses. Short- term prognosis for FB obstruction mentioned in the literature varies considerably and ranges from 0% to 100% (Boles and Kohn 1977; Gay et al. 1979; van Wuijckhuise-Sjouke 1984; de Oliveira Dearo et al. 2009). Previous publications have described relatively low case numbers, thereby making data interpretation more challenging. The largest case series was reported by Boles and Kohn (1977) presenting 10 cases with a success rate of 50%. The aim of the study was to describe the clinical


presentation, surgical findings, complications and outcome of a case series of small and large colon obstruction by FBs in equids. We hypothesised that surgical management of colonic


FBs would be associated with good short- and long-term survival rates.


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