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EQUINE VETERINARY EDUCATION / AE / MAY 2018


condition, weighing 349 kg. Muscle fasciculations were noted along the triceps and flanks bilaterally. Heart rate was 44 beats/min with a respiratory rate of 24 breaths/min and rectal temperature of 37.9°C. His mucous membranes were tacky with a capillary refill time of 2 s. The gelding appeared cardiovascularly stable with PCV of 0.29 L/L, total protein of 56 g/L and systemic lactate of 0.7 mmol/L. Peripheral white blood cell count was 6.49109/L. Intestinal borborygmi were increased in the left ventral quadrant. There was no evidence of abdominal distention and no reflux was obtained on nasogastric intubation. There were no significant abnormalities detected on rectal examination. Ultrasonography of the abdomen revealed an increase in hypoechogenic free abdominal fluid. In addition, a single loop of distended amotile small intestine was noted, with a diameter of 5.5 cm and wall thickness of 0.4 cm. Abdominocentesis yielded a serosanguinous peritoneal fluid sample, with white blood cell count of 0.89109/L, total protein


of 14 g/L and lactate of 1.7 mmol/L. Due to the clinical findings and persistent signs of colic, an exploratory laparotomy was undertaken.


Surgical findings The horse received preoperative sodium penicillin G (Bencilpenicilina)5, (22,000 u/kg i.v.), gentamicin6 (6.6 mg/kg bwt i.v.), xylazine3 (0.6 mg/kg bwt i.v.) and butorphanol tartrate4 (0.025 mg/kg bwt i.v.) prior to induction of anaesthesia with ketamine hydrochloride6 (2.2 mg/kg bwt i.v.) and diazepam7 (0.05 mg/kg bwt i.v.). Following orotracheal intubation (24 mm internal diameter), anaesthesia was maintained with isoflurane (IsoFlo)8, delivered in oxygen (O2 flow 6 L/min) at an end tidal concentration of 1.8–2.0%, via a large animal circle breathing system. The horse was placed in dorsal recumbency and a standard midline coeliotomy incision performed. Initial exploration of the abdomen revealed a caecocolic intussusception. The majority of the caecum, as well as the ileocaecal junction and a significant portion of ileum, were involved in the intussusception. Manual reduction of the intussusceptum was attempted, but was not successful due to the amount of caecal oedema. The abdominal incision was packed with sterile towels soaked in saline. An impervious drape (Buster Op-Cover 90 9 120 cm)9 and saline soaked laparotomy sponge (Curity X-ray detectable laparotomy sponges)10 were sutured to the surface of the right ventral colon in an elliptical shape, with 3 metric Vicryl in a simple continuous partial thickness suture pattern, 3–4 cm lateral of the ventral taenial band at the level of the sternal flexure (Fig 1). A second row of saline soaked laparotomy sponges (Curity X-ray detectable laparotomy sponges)10 was then placed along the length of the suture line, between the impervious drape and sutured laparotomy sponges. The central elliptical portions of impervious drape and laparotomy sponge were removed with scissors to expose the underlying colonic serosa. A full thickness 10 cm incision was made through the right ventral colon within the elliptical window (Fig 2a). A hand was placed into the lumen of the colon to try and manually reduce the intussusceptum. Manual reduction was unsuccessful due to the degree of caecal oedema, necessitating partial resection. The apex of the caecum was grasped manually and traction applied to exteriorise the apex and a portion of the body through the incision. The


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exact location of the ileocaecal valve and ileum within the intussusceptum could not be completely predetermined, but their anatomical location was considered to be far enough towards the caecal base to not be included within the partial typhlectomy. A 300 mm long, 4.8 mm polyamide tie- wrap (MKAT Cable Tie 4.8 9 300 mm)11 was placed around the body of the caecum and tightened (Fig 2b). This was repeated three times so that four polyamide tie-wraps were placed around the caecal body. The tie-wraps were then retightened in a sequential manner. The caecum was resected 5 cm distal of the tie-wraps and the apex and a portion of the body of the caecum discarded (Fig 2c). The long ends of the polyamide tie-wraps were cut and discarded. The intussusceptum was then manually reduced through the incision in the right ventral colon. The right ventral colon enterotomy incision was closed in two layers with 3 metric polyglactin 910 (Vicryl) in a simple continuous suture pattern followed by a Cushing suture pattern. The region was flushed with sterile saline prior to removal of the suture attaching the impervious drape (Buster Op-Cover 90 9 120 cm)9 and laparotomy sponges (Curity X-ray detectable laparotomy sponges)10 to the colon. The impervious drape (Buster Op-Cover 90 9 120 cm)9 and laparotomy sponges (Curity X-ray detectable laparotomy sponges)10 were discarded, further lavage performed and the surgeon rescrubbed. The remaining portion of caecum was then exteriorised through the ventral midline incision and the typhlectomy site oversewn with 4 metric polyglactin 910 in a Cushing suture pattern. The ileum was examined and apart from mild oedema was found to be viable. The jejunum was exteriorised and fluid contents evacuated into the caecum. The small colon was exteriorised, no abnormalities were detected and was replaced in the abdomen. The abdomen was lavaged with 20 L of sterile saline. Excess lavage fluid was removed with closed suction, prior to a routine three layer closure. The linea alba was closed with 6 metric polyglactin 910 in a simple continuous suture pattern. The subcutaneous tissue was closed with 3 metric polyglactin 910 in a simple continuous suture pattern.


Fig 1: The appearance of the enterotomy site following suturing of an impervious drape and saline soaked laparotomy sponge in an elliptical shape around the proposed incision site.


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