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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (9) 458-459 doi: 10.1111/eve.12979


Highlights of recent clinically relevant papers


Colic incisonal infections This prospective cohort study by Casja Isgren and colleagues in the UK aimed to investigate the bacterial isolates present on equine midline incisions during and following exploratory laparotomy. A total of 31 horses undergoing exploratory laparotomy


due to signs of colic at The University of Liverpool Equine Hospital during a 12-month period were included in this study. Swabs from the ventral midline of all horses were collected for culture and sensitivity immediately after clipping, after aseptic preparation for surgery, after closure of the linea alba, after closure of the skin, immediately after recovery from general anaesthesia and every 48 h post-surgery at the time of abdominal bandage changes. A wide range of bacterial species were cultured both


intraoperatively and immediately following recovery. Following aseptic preparation of the surgical site a positive culture was obtained from only one horse. Of the 22 horses that underwent an enterotomy or anastomosis, 16 (73%) had a negative culture immediately following incisional closure. Seven horses (22.6%) developed surgical site infection (SSI) but a positive culture from an intraoperative swab or immediately following recovery did not predict the development of SSI. The prevalence of a positive bacterial culture result increased over time even in the absence of SSI, likely due to bacterial recolonisation of the skin. Incisional contamination alone is unlikely to cause SSI in horses undergoing exploratory laparotomy.


Equine sepsis scoring


In this study, D.M. Wong and colleagues in the USA evaluated updated sepsis scoring systems and systemic inflammatory response syndrome (SIRS) criteria and their association with sepsis in equine neonates. The original equine sepsis score provided a method of


identifying foals with sepsis. In this study, which included 273 sick foals and 25 healthy control foals, the authors evaluated the sensitivity and specificity of two updated sepsis scores and the SIRS criteria in regard to detecting sepsis in foals. The original sepsis score and two updated sepsis scores


were calculated from historical, physical examination, and clinicopathological findings. SIRS criteria were also evaluated. There were 126 septic foals and 147 sick-nonseptic. The original and updated sepsis scores were significantly higher in septic foals than in sick-nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. The original SIRS criteria were met by 127/273 (46.5%) foals and the equine neonatal SIRS criteria were met by 88/273 (32%) foals. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the three sepsis scores in the study. The authors concluded that the updated sepsis scores


did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.


© 2018 EVJ Ltd Large intestinal thickening


This retrospective study by Elizabeth Biscoe and colleagues in the USA aimed to describe the clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography. Medical records of horses that had undergone transabdominal ultrasonography over an 8-year period were reviewed which identified 25 horses with the wall of the large intestine ≥9 mm thick in any of six abdominal zones. The median age was 13 years (range 3–28 years) and the reasons for the initial examination were colic, diarrhoea, inappetence, weight loss, lethargy, fever, or haematuria. Severe large intestinal thickening (range 9–46.6 mm; mean


s.d., 18.8 6.8 mm) was the primary ultrasonographic finding in all horses. Thickened large intestine was more likely to


be detected in ventral vs. upper (i.e. combined paralumbar and intercostal) abdominal zones and in right vs. left zones. Of the 25 horses, 11 survived and had resolution of clinical signs, including one horse treated surgically for colon torsion; one horse survived but continued to have intermittent colic; 10 horses were subjected to euthanasia or died, including three horses with neoplasia and three with colitis; and three horses were lost to follow-up, including one horse with a caecal mass and one with hepatosplenic lymphoma. The severity of thickening and the number of zones affected were not significantly different between survivors and nonsurvivors. The authors concluded that in horses undergoing


transabdominal ultrasonography for a variety of conditions, large intestinal wall thickness ≥9 mm may be detected. Ultrasonographic examination of all abdominal zones was helpful to determine the extent of thickening and identify additional findings that helped prioritise differential diagnoses.


Hindlimb computed tomographic contrast tenography


The aim of this prospective, anatomical, pilot study by Rachel Agass and colleagues in the UK was to describe the anatomy of the equine hindlimb digital flexor tendon sheath using a combination of computed tomography (CT) and computed tomographic contrast tenography in clinically normal limbs. Ten pairs of cadaver hindlimbs with no external


abnormalities were examined from the level of the tarsometatarsal joint distally. Limbs initially underwent noncontrast CT examination using 120 kVp, 300 mAs, and 1.5 mm slice thickness. Using a basilar sesamoidean approach, 60 mL of ioversol iodinated contrast media and saline (final concentration 100 mg/mL) were injected. The computed tomographic contrast tenography examination was then repeated, before the specimens were dissected to compare gross and imaging findings. The combined CT and computed tomographic contrast tenography examinations provided excellent anatomical detail of intra-thecal


structures. The borders of the superficial and deep digital flexor tendons, and the manica flexoria were consistently identifiable in all limbs. Detailed anatomy including that of the mesotenons, two of which are previously undescribed, and the plantar annular ligament were also consistently

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