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EQUINE VETERINARY EDUCATION / AE / MAY 2018
Right ventral colon
Lateral caecal band with lateral caecal artery and vein
Caecum
Caecum
Fig 1: Transverse ultrasonographic image obtained using a 3.5 mm curvilinear probe percutaneously on the right ventral abdomen. Notice the target lesion formed by the congested caecal apex intussuscepted within the right ventral colon.
Right ventral colon
Fig 3: Manual reduction of the caecocolic intussusception was performed by placing traction on the medial and lateral bands of the caecal apex. Notice the congested appearance of the caecum, especially the lateral caecal band. Typhlectomy was performed in this case following reduction of the intussusception.
Caecum within the right ventral colon
Right ventral colon
Fig 2: Notice the mass formed by the intussuscepted caecum within the right ventral colon.
through a colotomy performed in the lateral band of the right ventral colon, using the procedure described by de Bont (2018). Abdominal contamination is concerning when a colotomy incision is made through the lateral colonic band to access the intussuscepted caecum within the right ventral colon. The procedure described by de Bont (2018) effectively limited contamination and contributed to the success of the case. Alternatively, a large sterile plastic bag may be sutured to the lateral band of the right ventral colon to contain contamination during the colotomy and typhlectomy procedures (Hubert et al. 2000). In the case report by de Bont (2018), a 300 mm long 4.8 mm polyamide tie-wrap was placed around the body of the caecum and tightened to prevent leakage and provide haemostasis. Previous reports suggest using a TA90 stapling device, 3 vicryl suture, or umbilical tape to ligate the caecum prior to typhlectomy (Hubert et al. 2000). The polyamide tie-wrap was an ingenious idea, much simpler and less expensive compared to alternatives, and easier to apply within the most oral segment of the right ventral colon. Limiting contamination by
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adequate draping during the colotomy and typhlectomy and preventing leakage by sealing the caecum and over- sewing the typhlectomy are essential components of a successful procedure. Previous reports suggested that opening the colon to reduce the caecocolic intussusception or perform a typhlectomy was uniformly fatal (Gaughan and Hackett 1990). Other reports suggest that long-term survival is quite good following typhlectomy through a colotomy to correct caecocolic intussusception (Robertson and Johnson 1980; Martin et al. 1999; Hubert et al. 2000). The case report by de Bont (2018) describes a novel technique to minimise contamination that is inherent during typhlectomy through a colotomy to correct a caecocolic intussusception and may be used effectively in future cases.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research Not applicable.
Source of funding None.
Authorship S. Holcombe and T. Shearer prepared this manuscript.
References
Barclay, W.P., Phillips, T.N. and Goerner, J.J. (1982) Intussusception associated with Anoplocephala perfoliata infection in five horses. J. Am. Vet. Med. Assoc. 180, 752-753.
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