EQUINE VETERINARY EDUCATION / AE / MAY 2018


257


The skin was closed with stainless steel staples. Surgery time from first incision to recovery was 2 h, 15 min. Recovery from anaesthesia was assisted with a head and tail rope.


Post-operative care The gelding was maintained on sodium penicillin G5 (22,000 u/kg i.v.) every 6 h and gentamicin6 (6.6 mg/kg i.v.) once daily for 7 days. Flunixin2 was reduced from 1.1 mg/kg i.v. twice daily to 0.55 mg/kg i.v. twice daily after 7 days and discontinued after 10 days. The horse received 4 L of 6% hetastarch12 immediately post-operatively and was maintained on LRS1 for 5 days (6mL /kg bwt/h reducing to 3 mL/kg bwt/h after 2 days). In addition the gelding received a continuous rate infusion of lidocaine3 (0.05 mg/kg bwt/h i.v.) for 3 days and polymixin B13 (5,000 U/kg i.v.) twice daily for 5 days. Food was gradually reintroduced, with the horse limited to


short fibre feed (Equidchop)14 for the first 10 days post- operatively. The gelding had a peripheral white blood cell count of 149109/L following surgery, which returned to normal values 7 days post-operatively. No post-operative colic was noted, with the horse passing normal faeces within 48 h of surgery. There was minimal oedema of the ventral abdominal incision site. The horse was hospitalised for 18 days prior to discharge. Long-term follow-up at the time of writing was for 10 months. The trainer had not reported any colic episodes during this period.


Discussion


This report describes the novel use of polyamide tie-wraps when performing a partial typhlectomy via an enterotomy in the right ventral colon in a horse. The use of sterile polyamide tie-wraps has previously been used for ovariectomies in mares (Cokelaere et al. 2005), for repair of multiple rib fractures in foals (Downs and Rodgerson 2011), in partial nephrectomy in pigs (Gofrit et al. 2010) and sternal closure in man following thoracic surgery using the sternal ZipFix System (Grapow et al. 2012). The tie-wraps used in this horse were not sterilised prior to use as they were placed within the caecal lumen at which time during the surgery neither the surgeon nor that portion of draping were sterile. Caecocolic intussusceptions present the surgeon with


greater technical problems than other types of intussusception (Edwards 1986). Successful partial resection of the intussusceptum via an enterotomy incision in the right ventral colon was first described by Robertson and Johnson (1980). A positive outcome was attributed to early intervention and minimal contamination during surgery (Robertson and Johnson 1980). Abdominal contamination is a concern when performing an enterotomy in the right ventral colon, but with due care this can be minimised. In this case, faecal contamination of the abdomen was prevented by suturing an impervious drape and saline soaked laparotomy sponges to the colon wall in an elliptical shape around the proposed enterotomy site. The intussusceptum is frequently oedematous, necrotic


and friable, with the thickness of the oedematous tissue often precluding the use of intestinal clamps (Edwards 1986). Ligation of the caecal vessels and closure of the stump can be achieved by placing a series of overlapping transfixion sutures across the width of the caecum, which is critical prior to resection (Edwards 1986). Using suture to ligate this portion


Fig 2: a) The exposed lumen of the right ventral colon. b) Placement of the first polyamide tie-wrap around the inverted body of the caecum and c) Resection of the apex and portion of the caecal body following placement of four polyamide tie- wraps.


© 2017 EVJ Ltd


a)


b)


c)


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