EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2018
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a)
divided into two different lobes (Fig 1b). The histopathological study confirmed the diagnosis of lipoma.
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Case 2 A 23-year-old, 607 kg Andalusian mare was referred for evaluation of acute signs of abdominal pain with a duration of approximately 5 h. Prior to presentation, the horse was administered i.v.
flunixin meglumine and xylazine
hydrochloride by the referring veterinarian. Physical examination revealed a heart rate of 70 beats/
min, respiratory rate was 32 breaths/min, the temperature was 37.4°C and the capillary refill time was <2 s. Mucous membranes were slightly dry and cyanotic. Borborygmi were absent in all quadrants on abdominal auscultation. Multiple loops of distended small intestine were palpated during rectal examination. Nasogastric intubation yielded 5 L of foul smelling reflux.
The haematology values were within the physiological b)
limits. The serum biochemistry was normal with the exception of hyperglycaemia (10.11 mmol/l) and hyperlactataemia (8.3 mmol/L). The peritoneal fluid analysis revealed high lactate concentration (6.6 mmol/L).
Abdominal ultrasonography Transcutaneous abdominal ultrasound with a 2.5–5 MHz curvilinear transducer (Logiq 5 Expert2) revealed several thickened, amotile loops of distended small intestine localised in the caudoventral abdomen, with the thickest loop’s wall
Fig 1: a) Ultrasonographic image of the caudoventral abdomen of Case 1. There is a rounded echogenic mass with a central heterogeneous hypoechoic area (arrows) representing a lipoma. There is anechoic peritoneal fluid (asterisk). b) Gross cross- section of the lipoma after resection, with a smooth and uniform appearance.
therefore an end-to-end jejunojejunostomy (Garcıa-Seco et al. 2005) was performed, after the resection of approximately 90 cm of the jejunum. The abdomen was closed routinely and the horse recovered from anaesthesia uneventfully. Post-operative care included the administration of
prokinetics (erythromycin, 2.2 mg/kg bwt diluted in 1 L of saline and administered over 1 h, q.i.d., i.v.), lidocaine (loading dose 1.3 mg/kg bwt for 15 min followed by a maintenance dose of 0.05 mg/kg bwt/min), antibiotics (sodium benzylpenicillin 22,000 iu/kg bwt, q.i.d. and gentamicin 6.6 mg/kg bwt s.i.d., both i.v.), anti-inflammatory drugs (flunixin meglumine 1.1 mg/kg bwt b.i.d., i.v.), polymyxin B (5000 iu/kg bwt, as a 1 L infusion, b.i.d., i.v.) and gastric protectants (ranitidine 1.5 mg/kg bwt, t.i.d., i.v.). The mare was discharged 2 weeks later.
Diagnosis Macroscopically, the mass was round and had a bright surface. The surface was smooth and uniform and it was
measuring 1.45 cm. A large amount of anechoic peritoneal fluid was identified within the dependent aspect of the abdominal cavity surrounding the small intestine. In addition, a well-circumscribed, oval-shaped, hyperechoic mass was observed within the ventral aspect of the abdomen, surrounded by thickened small intestine loops and measuring approximately 7 9 4cm (Fig 2a). Small intestinal mesentery was visible as thin linear hyperechoic bands due to surrounding peritoneal effusion (Fig 2a). Based on the ultrasonographic findings, a diagnosis of
small intestine strangulation secondary to a possible pedunculated lipoma was established.
Treatment and outcome An exploratory laparotomy under general anaesthesia revealed several loops of distended small intestine. A red– black coloured segment of nonmotile and severely oedematous small intestine along with its haemorrhagic mesentery was strangulated by a pedunculated, yellowish and spherical mass that measured approximately 8 cm in diameter. The root of the pedicle was located on the mesentery away from the intestine. Additionally, there were three smaller nonpedunculated and similar in appearance masses attached to the small intestine mesentery. A total of 3 m of small intestine comprising the aboral portion of the jejunum and approximately 50% of ileum were severely damaged. The strangulation was resolved and the appearance of the intestine did not improve after decompression. Due to the guarded prognosis for recovery and financial constraints, the horse was subjected to euthanasia during surgery upon owner consent.
Diagnosis Macroscopically, the pedunculated mass was spherical, the surface was smooth and uniform and measured 8 9 9 cm.
© 2016 EVJ Ltd
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