Received: 10 Janauary 2023 | Accepted: 24 April 2023 DOI: 10.1111/eve.13818_1
C A S E R E POR T
Large intestinal ganglioneuromatosis in a juvenile Arabian filly: Management and long- term follow- up
Mona Hoerdemann 1 | Imane Ait Nasr 1 | Thomas Westermann 2 | Chris P. Champion 2
1 Dubai Equine Hospital , Dubai , UAE 2 College of Veterinary Medicine , Cornell University , Ithaca , New York , USA
Correspondence : Mona Hoerdemann, College of Veterinary Medicine, Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, Iowa State University, 1809 S Riverside Drive, Ames, Iowa, USA. Email:
mohoerdemann@hotmail.com
Present address Mona Hoerdemann, College of Veterinary Medicine , Iowa State University , Ames , Iowa , USA Imane Ait Nasr, American Fondouk , Fez , Morocco Thomas Westermann, Charles River Laboratories International, Inc. , Wilmington , Massachusetts , USA
SUMMARY
An 11- month- old Arabian filly was presented for chronic diarrhoea, ill- thrift and intermittent colic. Abdominal ultrasonography revealed multifocal regions of colonic wall thickening in the ventral abdomen that measured up to 11 mm. In addition, a locally extensive region of intestinal wall in the left upper quadrant— adjacent and slightly ventral to the nephrosplenic window— was markedly thickened up to 35 mm, with loss of normal wall layering. An exploratory laparotomy was necessitated by persistent and progressive colic symptoms. It revealed numerous variably sized, multifocal- to- coalescing, firm, tan nodules scattered throughout the right ventral colon (Figure 1), as well as a locally extensive region of mural thickening of the transverse colon. The latter resulted in severe luminal restriction (<2.5 cm) and subsequent obstruction of both the orad transverse colon and right dorsal colon with impacted feed material. Since the lesions were un- resectable, full- thickness biopsy samples were submitted for histo- pathological evaluation. Histopathology revealed transmural nodular masses composed of three distinct cell populations including cells of fibroblastic (or myofibroblastic) origin, cells of neuroglial origin and neuronal cell bodies. The histogenesis of these cells was confirmed with immunohistochemical assays for S100, GFAP, PGP9.5 and CD117. Based on the histological and immunohistochemical features
of the masses, the filly was diagnosed with transmural intestinal gan- glioneuromatosis of the right ventral and transverse colons. The filly was subsequently successfully conservatively managed over a 24- month follow- up period. Management consisted of long- term dietary modifications consisting of a low- bulk diet, as well as enteral laxatives and a tapering course of corticosteroids postoperatively. The filly developed well and successfully competed in Arabian Horse shows, while the abdominal ultrasonography findings remained unchanged. This is the first case of intestinal ganglioneuromatosis in veterinary literature that was (1) diagnosed in a juvenile horse, (2) successfully medically managed and (3) followed up for more than 12 months.
K E YWORDS horse , colon , intestinal ganglioneuromatosis , intestinal obstructive disorder , dietary management
Key points
• Intestinal ganglioneuromatosis is a rare disorder of the en- teric nervous system that can occur in young and mature horses and can cause clinical signs indicative of intestinal dysmotility or obstruction.
• Intestinal ganglioneuromatosis should be considered as a dif- ferential diagnosis for multifocal- to- coalescing or locally ex- tensive gastrointestinal wall thickenings; histopathology and immunohistochemistry are necessary for a definitive diagnosis.
FIGURE 1 Intraoperative view of numerous variably sized, multifocal- to- coalescing, firm, tan nodules along the antimesenteric side of the right ventral colon.
Equine Vet Educ. 2024;36:11.
• Cases of intestinal ganglioneuromatosis with extensive or inoperable lesions may respond favourably to medical management with dietary modifications.
aaep.org/wiley-redirect © 2023 EVJ Ltd. | 11
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76
