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of caecum prior to resection can be difficult to perform, with cut through of the oedematous tissue. The use of polyamide cable ties resulted in minimal tissue cut through, which could be attributed to its larger surface area (4.8 mm). The application was quick and technically easy to perform and appears to have provided a secure ligation in this case. Similarly, the sternal ZipFix System used in human sternotomy patients provides a large implant-to-bone contact for better force distribution and avoiding bone cut through when compared with steel wire (Grapow et al. 2012). It is not known whether the tie-wraps within the lumen of the caecum remained in situ and became encapsulated in tissue, or whether they became dislodged over time due to tissue necrosis and sloughing. On repeat laparoscopy following ovariectomy, complete encapsulation of the stump and tie- wrap was reported after 3–4 weeks (Cokelaere et al. 2005). The use of four tie-wraps may have been excessive in this case and fewer tie-wraps may be adequate. A decrease in prognosis has been reported if severe
infarctive changes are present in either the base of the caecum, right colon, or distal ileum (Edwards 1986). Following amputation and manual reduction, further necrotic tissue towards the base of the caecum may require resection, or inversion and oversewing until healthy serosal surface is encountered. An inability to exteriorise the caecum through a standard ventral midline coeliotomy can make this difficult, or even impossible to perform. The seromuscular layer was oversewn in this case with an inverting Cushing pattern, taking care to avoid the caecal vessels. The serosal surface appeared healthy and so this step may have been unnecessary. If the distal ileum is affected and tissue is nonviable, an ileal resection with a jejuno- or ileocolostomy may be required. Apart from mild oedema, the ileum in this horse appeared fully viable, with minimal resistance encountered through the ileocaecal valve when the small intestinal contents were decompressed into the caecum. The horse presented with relatively normal cardiovascular
parameters. Peritoneal fluid was not suggestive of a strangulating lesion. This may reflect the relatively quick referral, with the devitalised and necrotic tissue being contained within the intussuscepiens effectively sealing the affected caecum from the abdomen, with compression of the caecal vessels most likely minimising the circulation of endotoxin. The low post-operative peripheral white blood cell count is consistent with a systemic inflammatory response syndrome in response to both release of endotoxin and the surgical procedure itself. Polyamide tie-wraps provided a secure ligation of the intussusceptum, allowing for partial typhlectomy through an enterotomy and subsequent reduction of the inverted caecum back out of the colon and into the abdomen in this case. Their use could be considered in cases where tissue oedema makes suture ligation difficult. However previously described complications may still arise using this technique. In addition, since this report represents one horse, further cases are needed to establish whether complications such as caecal wall necrosis or failure of the tie-wraps resulting in leakage and intra-abdominal contamination need to be considered.
Author’s declaration of interests No conflicts of interest have been declared.
© 2017 EVJ Ltd
Ethical animal research
Preparation of the manuscript was approved by the Dubai Equine Hospital Research Committee.
Acknowledgements The author would like to thank N. Nogradi for her pre- and post-operative care of this case and to all the support staff of the Dubai Equine Hospital.
Manufacturers' addresses
1Quibi SA, Bogota, Columbia. 2Merck Animal Health, Germany. 3Vedco Inc, St. Joseph, Missouri, USA. 4Zoetis, Alcobendas, Madrid, Spain. 5Laboratorios PiSA, Guadalajara, Jalisco, Mexico. 6Troy Laboratories PTY Ltd, Glendenning, New South Wales, Australia. 7Teuto, An
apolis, Goi as, Brazil.
8Abbott Laboratories, North Chicago, Illinois, USA. 9Kruuse, Havretoften 4, Langeskov, Denmark. 10Covidien, Mansfield, Massachusetts, USA. 11MKATS International, General Trading LLC, Dubai, United Arab
Emirates. 12Hospira Inc, Lake Forest, Illinois, USA. 13X-Gen Pharmaceuticals Inc, New York, USA. 14Equidiet (UK) Ltd., Nettleton, Lincolnshire, UK
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