EQUINE VETERINARY EDUCATION / AE / JANUARY 2020
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15 9 5 9 5 cm pedunculated dark red polypoid ulcerated mass occluding the intestinal lumen (Fig 2b). There were multiple smaller polypoid masses ranging from 1 to 5 cm in length with 1–2 cm diameter adjacent to the larger polypoid mass. The polyps were distributed with one immediately oral, four were 5 cm oral, and two immediately aboral to the large polypoid mass. The large polypoid mass was dark red and congested. The mucosa was ulcerated on the distal end and partially adhered to the intestinal mucosa. The small polyps were tan to pinkish red on the surface. On cut section, the polyps had thickened yellow gelatinous material (oedema) within the mucosa. In addition, the mucosa had multifocal dark red areas with mineralisation. Approximately 10 cm oral to the large polypoid mass, there were multifocal 1–5 cm, linear, mucosal ulcers along the mesenteric side of the intestinal lumen. Throughout the entire length of the jejunum the mucosal surface had both scattered and diffuse areas of haemorrhage. There were no significant gross lesions noticed in any other tissues.
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Fig 1: Intraluminal 5 cm diameter mass with a heterogeneous appearance. Hyperechoic small intestinal wall (white arrow) is clearly distinct from the heterogeneous intraluminal mass (red arrow).
intussusception and neoplasia. The ultrasound images did not appear as the previously reported description of a small intestine intussusception (Fontaine-Rodgerson and Rodgerson 2001). This made foreign body and neoplasia the top two differential diagnoses.
Recommendations and treatments Exploratory celiotomy was recommended on the basis of the horse’s lack of response to analgesia, physical examination and ultrasound findings. However, the owner declined this recommendation. The horse was managed conservatively. Total nasogastric reflux was 17 L over the next 12 h. The horse started to show signs of colic 8 h after the initial presentation and was administered 7 mg detomidine intravenously (Dormosedan) (0.02 mg/kg bwt) (J€
ochle 1989). The horse
continued to show signs of colic and the owner elected humane euthanasia due to financial constraints. The horse was submitted for necropsy.
Gross finding post-mortem Necropsy revealed an enlarged segment of proximal jejunum measuring 15 cm with occasional serosal petechiae (Fig 2a). Approximately 1 m aborally from the pylorus, at the junction of the distal duodenum and proximal jejunum, there was a
Histopathology The intestinal mucosa of the distal duodenum and proximal jejunum were multifocally elevated into polypoid masses and the masses were lined by normal mucosal epithelium. The submucosa was markedly expanded by oedema (Fig 2c). The mucosa lining the polyps was hyperplastic characterised by multifocal areas of proliferation configured in a branching pattern. The mucosa lining the largest polypoid mass was ulcerated and the submucosa contained infiltrates of lymphocytes, plasma cells, and macrophages. The submucosal glands showed moderate goblet cell hyperplasia (Fig 2d) with moderate oedema in the deep submucosa admixed with small numbers of mixed inflammatory cells and occasional mineralisation. There were no significant microscopic lesions noticed in the ileum, caecum, or large colon.
Discussion
This case report describes the clinical and post-mortem diagnosis of intestinal adenomatous polyps resulting in colic due to chronic obstruction in a 3-year-old Quarter Horse gelding. Small intestinal tumours occur uncommonly and are typically a diagnosis of exclusion; however, in this case abdominal ultrasonography improved the clinical diagnosis (Reef 2012). Horses with intestinal neoplasia usually present for colic and/or a history that includes progressive weight loss, decreased appetite, intermittent colic, diarrhoea, or fever (Taylor et al. 2006). Following full clinical examination in this case differentials included neoplasia, foreign body and small intestinal
intussusception, because of the history, clinical examination findings and transudative peritoneal fluid (Fontaine- Rodgerson and Rodgerson 2001). The ultrasound provided key information on forming a clinical diagnosis of intraluminal neoplasia and an exact location for the cause of colic. The ultrasound images of the intraluminal polyp had a distinct hyperechoic luminal margin with a round heterogeneous intraluminal mass located centrally. This is in contrast with previous reports of intussusception where the classical ultrasound description is of a distinct hypoechoic ring which is the intussuscipiens surrounding a distinct hyperechoic centre which is the intussusceptum that was not observed in this case (Fontaine-Rodgerson and Rodgerson 2001). To the
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