EQUINE VETERINARY EDUCATION / AE / MAY 2018
243
V + 10 + + 20 + * + + + +
Fig 2: Longitudinal section through the dorsal part of a caecocaecal intussusception. The caecal wall (arrowheads) shows oedema. Due to the intraluminal caecal fluid (+) caecal mucosal folds (arrows) are visible. The image was taken halfway down the right cranial flank. Right on screen is cranioventral and total penetration depth is 21 cm.
Fig 4: Longitudinal section through a caecocolic intussusception. The caecal apex (pointing towards the right of the image) and caecal body show marked wall oedema (arrowheads) and are found inside the colon, surrounded by intraluminal fluid (+). In the centre of the intussusceptum, an echogenic caecal taenia (arrow) and hypoechoic peritoneal fluid (*) are visible. The image was taken in the right cranioventral abdomen and total penetration is 27 cm.
* +
during surgery. These horses were not included in the study. No horses were diagnosed with colocolic intussusception.
Fig 3: Transverse section through a caecocolic intussusception with congested wall of the intussusceptum (arrowheads) surrounded by hypoechoic intestinal fluid (+). In the centre of the intussusceptum, the echogenic taeniae of the caecum (arrows) and hypoechoic peritoneal fluid (*) are visible. The image was taken in the right cranioventral abdomen and total penetration is 27 cm.
visible in the cranioventral abdomen, to the left of the midline. If the intussusception was examined more caudally, no abnormalities or only an oedematous caecal wall were found. Fourteen horses (24%) were diagnosed with caecocaecal intussusception and 46 (76%) with caecocolic intussusception. All intussusceptions were diagnosed based upon clinical signs and ultrasonographic findings before surgery or necropsy. In 55 cases (92%) a correct differentiation between caecocaecal and caecocolic intussusception could be made by means of transabdominal ultrasound. One case (2%) with ultrasonographic diagnosis of a caecocolic intussusception, because of a concentric ring structure in the ventral third of the abdomen just below the 13th intercostal space, had a caecocaecal intussusception at surgery. In four other cases (7%), no ultrasonographic differentiation could be made. Furthermore, in the 5-year study period, two horses with an ultrasonographic suspicion of caecocaecal intussusception before surgery, were diagnosed with typhlitis
Clinical signs, surgical treatment and short-term outcome The most important clinical signs were colic with acute onset (<1 day; 58%, 35/60), mild colic for 2 to 7 days (23%, 14/60), intermittent colic for >7 days (8%, 5/60), diarrhoea (15%; 9/60), anorexia (10%, 6/60), fever (8%, 5/60) and weight loss (7%, 4/ 60). Blood values were variable depending on the severity and duration of colic (Table 1). Abdominal paracentesis was conducted in only three horses: the fluid was normal (protein <15 g/L, total nucleated cell count <5.0 x 109 cells/L, lactate <2 mmol/L) in two horses and abnormal in one horse (protein 32 g/L, total nucleated cell count 30 9 109 cells/L, lactate 7.1 mmol/L). Of 14 horses diagnosed with caecocaecal intussusception,
4 (29%) were subjected to euthanasia due to financial constraints of the owners and 10 (71%) underwent midline laparotomy (Table 2). In 4/10 (40%), a simple reduction of the intussuscepted caecal apex was possible, 5/10 (50%) needed partial typhlectomy and one horse was subjected to euthanasia during surgery due to an unreducible intussusception and financial constraints of the owner. Four days after surgery, one (10%) horse, which had undergone a simple reduction of the caecum, died due to severe typhlocolitis. Eight out of 10 (80%) of the horses subjected to surgery and 8/9 (88%) of the horses successfully operated for caecocaecal intussusception survived to discharge. Of 46 horses diagnosed with caecocolic intussusception,
18 (39%) were subjected to euthanasia due to severe peritonitis or financial constraints of the owners and 28 horses (61%) underwent exploratory midline laparotomy (Table 2). Seven out of 28 (25%) were subjected to euthanasia during surgery due to extensive tissue necrosis or severe
© 2017 EVJ Ltd
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
