EQUINE VETERINARY EDUCATION Equine vet. Educ. (2018) 30 (5) 255-258 doi: 10.1111/eve.12770


Case Report


A novel use for polyamide tie-wraps in the surgical resolution of caecocolic intussusception in a horse


M. P. de Bont* Dubai Equine Hospital, Zabeel 2, Dubai, UAE. *Corresponding author email: t_debont@yahoo.co.uk


Keywords: horse; colic; caecocolic intussusception; typhlectomy; polyamide tie-wraps


Summary Caecocolic intussusception is an uncommon cause of colic in the horse. Surgical correction presents its own set of challenges. The affected tissue is often markedly oedematous and a partial typhlectomy through an enterotomy incision in the right ventral colon can be the only method of successfully reducing the intussusceptum. Suture ligation of the nonviable portion of caecum can result in cut through of tissue, which can lead to an insecure ligation. In addition, a right ventral colon enterotomy can result in life-threatening peritoneal contamination. This report describes the novel use of polyamide tie-wraps to ligate the inverted caecum, allowing for partial typhlectomy and reduction of the intussusceptum, as well as a method to minimise potential abdominal contamination. To the author’s knowledge, this is the first report of the use of polyamide tie-wraps in the gastrointestinal tract of the horse.


Introduction


Caecocolic intussusception is an uncommon cause of colic in the horse, having been reported in only 4/310 (1.29%) and 4/300 (1.3%) of horses undergoing exploratory laparotomy for colic in the UK (Edwards 1986; Mair and Smith 2005). In the USA, the condition appears to be equally rare, reported in only 11/842 (1.3%) of horse undergoing surgical treatment for colic (Gaughan and Hackett 1990). The condition appears to have a greater incidence in New Zealand, with 19/135 (14%) of surgical colics presenting with caecocolic intussusception, diagnosed either at exploratory laparotomy or necropsy (Bell and Textor 2010). Surgical correction presents its own set of challenges and as such a number of surgical techniques have been described to correct the condition. These include manual reduction of the intussusceptum, partial typhlectomy via an enterotomy in the right ventral colon and complete caecal bypass via a jejuno- or ileocolostomy (Robertson and Johnson 1980; Edwards 1986; Gaughan and Hackett 1990; Martin et al. 1999; Hubert et al. 2000; Boussauw et al. 2001; Bell and Textor 2010). Large scale reports of outcome of surgical techniques are lacking, due to the infrequent occurrence of the condition; only 0/3 horses survived more than a few hours post-operatively following partial typhlectomy via an enterotomy in the right ventral colon (Edwards 1986). In a second study, only 3/6 (50%) horses undergoing typhlectomy via enterotomy reportedly survived to discharge (Bell and Textor 2010) and 3/11 horses survived to discharge in another study (Gaughan and Hackett 1990). Of the three horses that underwent an enterotomy and partial typhlectomy, 0/3 survived, 2/3 having died of


peritonitis (Gaughan and Hackett 1990). In contrast, further studies have shown a markedly different outcome. In one case series, 6/18 horses underwent partial typhlectomy through an enterotomy when the caecocolic intussusception could not be manually reduced, with 100% survival (Martin et al. 1999). Similarly, in a further report, 8/8 (100%) horses undergoing enterotomy and typhlectomy for surgical correction of caecocolic intussusception survived to discharge (Hubert et al. 2000). Difficulties encountered include contamination due to the


anatomical location of the enterotomy site in the right ventral colon and ligation of the caecum prior to typhlectomy and reduction of the remaining viable portion. In the author’s experience, the tissue is often markedly friable and oedematous and suture used to ligate the nonviable portions of caecum can result in cut through of tissue, which can lead to an insecure ligation. It has been reported that jejuno- or ileocolostomy reduces surgical time and decreases the risk of abdominal contamination, compared with other techniques for treating caecocolic intussusception (Boussauw et al. 2001). However, only 4/8 (50%) horses survived longer than 2.5 months, with two horses subjected to euthanasia during surgery and two dying as a direct consequence of problems related to the initial surgery (Boussauw et al. 2001). This report describes the novel use of polyamide tie-wraps


to ligate the intussusceptum through an enterotomy in the right ventral colon, allowing for partial typhlectomy and subsequent reduction of the inverted caecum. Suturing of an impervious drape together with a laparotomy sponge to the right ventral colon prior to performing the enterotomy incision greatly minimised gross contamination. To the author’s knowledge, this is the first report of the use of polyamide tie- wraps in the gastrointestinal tract of the horse.


Case details


Case history A 12-year-old Arabian cross gelding presented with a history of colic of approximately 2 h duration. There had been no history of recurrent colic or weight loss. The horse had received a 10 L bolus of lactated Ringer’s solution (LRS: Lactado De Ringer Q-Vet)1, flunixin (Banamine)2 (1.1 mg/kg bwt i.v.) xylazine (TranquiVed injection)3 (0.3 mg/kg bwt i.v.) and butorphanol tartrate (Torbugesic Vet)4 (0.01 mg/kg bwt i.v.) immediately prior to referral.


Clinical findings On presentation, the gelding was quiet and showed intermittent signs of abdominal pain. He was in lean


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