Cecal rupture by Anoplocephala perfoliata infection in a thoroughbred horse in Seoul Race Park, South Korea

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.

Treatment of irreducible caecocolic intussusception in horses by jejuno(ileo)colostomy

Six of eight horses with caecocolic intussusception were treated successfully by jejuno- or ileocolostomy. The other two horses were euthanased during surgery. Four of the six horses survived long term, but two died within two-and-a-half months, of problems related to the surgery. Compared with other techniques for treating caecocolic intussusception, jejuno- or ileocolostomy reduces surgical time and decreases the risk of abdominal contamination.

Strangulating obstruction caused by intestinal herniation through the proximal aspect of the cecocolic fold in 9 horses

OBJECTIVE

To report the clinical and surgical findings and outcome for horses with strangulating obstruction caused by herniation through the proximal aspect of the cecocolic fold.

STUDY DESIGN

Retrospective study.

ANIMALS

Nine horses.

METHODS

Medical records were reviewed for clinical signs, surgical findings and technique, and outcome. Cadaver ponies and necropsy specimens were also used to study the regional anatomy of the cecocolic fold.

RESULTS

The ileum and distal jejunum were strangulated in 8 horses, whereas in 1 horse the small intestine and the left ascending colons were incarcerated in a rent in the cecocolic fold. Two horses were euthanatized at surgery, 6 horses had a small intestinal resection (mean length, 3 m; range, 1.5-6.4 m) and an end-to-side jejunocecostomy, and the entrapment was reduced without resection in the horse that had small intestine and ascending colon incarceration; cecocolic fold defects were not closed. One horse was euthanatized 36 hours after surgery because of endotoxemia. Six horses were discharged; 4 were available for long-term follow-up, of which 2 were euthanatized, and 2 were euthanatized 12 and 18 months after surgery because of colic signs. Variations in thickness of the cecocolic fold were observed in specimens obtained from necropsy of other horses and ponies.

CONCLUSIONS

Reasons for this defect are unknown, although observed anatomic differences in cecocolic fold thickness may contribute to the development of defects.

CLINICAL RELEVANCE

Reduction of the entrapped bowel is easiest when traction is placed on the bowel at a 90 degrees to the base of the cecum. Intestinal incarceration through rents within the proximal part of the cecocolic fold should be considered as a differential diagnosis for strangulating obstruction in horses.

Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses

OBJECTIVES

To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses.

STUDY DESIGN

Retrospective study.

ANIMALS

Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy.

METHODS

Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern.

RESULTS

The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function.

CLINICAL RELEVANCE

Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.

Diagnosis and treatment of chronic recurrent caecal impaction

Ninety-six horses with chronic recurrent caecal impaction associated with hypertrophy of muscle layers in the caecal base or in the whole caecum were examined from 1990 to 1996. Enlargement of the caecocolic orifice was completed surgically in 58 horses. Of those horses having surgery, 50 were discharged from the hospital while 8 were subjected to euthanasia at the hospital due to complications. Twenty-seven of the 50 horses discharged were normal at follow-up while 23 died or were subjected to euthanasia due to acute or recurrent colic, recurrent impaction in the ascending or descending colon, complete caecal muscle layer hypertrophy, stomach rupture or lymphosarcoma. Approximately 50% of the cases were successfully treated by surgical enlargement of the caecocolic orifice. The results suggest, on the other hand, that enlargement of the caecocolic orifice was not successful in treating horses with hypertrophy of the caecal muscle layer in the whole caecum.

Caecal impactions managed surgically by typhlotomy in 10 cases (1988-1998)

Surgical management of caecal impactions has included several different procedures suggested over the years. Complete bypass of the caecum through an ileocolic or jejunocolic anastomosis has become common practice for first time caecal impaction management, especially when dysfunction is suspected. In our practice, however, caecal impactions have been managed surgically by typhlotomy alone and of the 10 cases (July 1988-June 1998), 9 underwent surgery for first time caecal impactions, received a typhlotomy, and had survived an average of 43 months at time of case review. At the time of surgery, all were considered to have a dysfunctional caecum. All horses received routine postoperative care with the addition of anthelmintics as recovery of Anoplocephala perfoliata occurred in several cases. Typhlotomy should be considered an acceptable technique for surgical management of first time caecal impactions. Postoperative pyrantel pamoate and larvicidal anthelmintics should also be considered.

Caecocaecal and caecocolic intussusceptions associated with larval cyathostomosis in four young horses

This report describes the clinical and pathological features of 4 horses affected by caecocaecal or caecocolic intussusceptions associated with larval cyathostomiasis. In each case, there was clinical and/or pathological evidence of concurrent larval cyathostomosis. They all demonstrated variable signs including diarrhoea, pyrexia, weight loss and subcutaneous oedema and cyathostome larvae were identified in the faeces of 3 of the horses. These cases highlight the need to consider caecal intussusceptions as a possible complication in horses affected by larval cyathostomosis, especially where signs of abdominal pain are severe or persistent.

Muscle thickness and neuron density in the caecum of horses with chronic recurrent caecal impaction

In this study, the hypothesis that caecal smooth muscle layers would be thinner and the linear neuron density of myenteric plexus greater was tested in normal horses compared to those with chronic recurrent caecal impaction. Four normal horses and 18 horses with chronic recurrent caecal impaction were subjected to euthanasia and 7 tissue samples were collected from each horse at different regions of the caecum (apex, dorsal body, cranial base, dorsal base, caudal base, caudal body, ventral body). Twelve horses with chronic recurrent caecal impaction were treated surgically. Only one tissue sample of the cranial part of the caecal base close to the caecocolic orifice was taken during surgery. The thickness of the circular muscle layer of all caecal regions measured in killed horses with chronic recurrent caecal impaction was significantly increased compared to the equivalent caecal region of normal horses. On the other hand, the longitudinal muscle layer was significantly thicker only in the cranial and caudal caecal base and in the dorsal region of the caecal body. The linear neuron densities of all caecal base areas and 2 caecal body regions, the caudal body region and of the apex, of killed horses with chronic recurrent caecal impaction were significantly lower compared with those in clinically normal horses. The circular muscle layer of all caecal regions was thickened (hypertrophied) probably as a consequence of chronic uncoordinated hypercontractility due to neuron deficit in the myenteric plexus of the caecal base.

Concentration of volatile fatty acids in digesta samples obtained from healthy cows and cows with cecal dilatation or dislocation

OBJECTIVE

To compare concentrations of acetic, propionic, butyric, and i- and n-valerianic acids in digesta samples obtained from the rumen, cecum, proximal loop of the ascending colon (PLAC), and rectum of healthy cows and cows with cecal dilatation or dislocation (CDD).

ANIMALS

20 cows with CDD and 20 healthy cows.

PROCEDURE

Samples were collected from all sites during surgical correction of CDD and also from the rectum 1, 2, and 3 days after surgery (group CDD). Samples from healthy (control) cows, matched on the basis of diet and milk yield, were obtained at a slaughterhouse. Concentrations of volatile fatty acids (VFA) were analyzed by use of gas chromatography. Absolute concentration of each VFA was additionally corrected for pH to allow calculation of the concentration of undissociated VFA.

RESULTS

Absolute concentration and concentration of the undissociated form of all analyzed VFA were significantly increased in samples collected from the cecum and PLAC of cows in group CDD, compared with concentrations for control cows. Within 3 days after surgery, significant decreases of the absolute concentration of butyric, i- and n-valerianic acids, and undissociated i- and n-valerianic acids were evident in samples obtained from the rectum of group-CDD cows. Concentrations of VFA in samples obtained from the rectum during surgery correlated with corresponding VFA concentrations in samples obtained from the PLAC.

CONCLUSIONS

Concentrations of VFA are increased in the cecum and PLAC of cows with CDD. However, the role of increased concentrations of VFA in the etiopathogenesis of CDD is unknown.

[Epidemiology and risk factors of cecal dilatation/dislocation and abomasal displacement in dairy cows]

The aims of the study were to determine the prevalence of cecal dilatation/dislocation (CDD) and abomasal displacement (DA) in Switzerland, to identify risk factors for both diseases, and to compare directly their epidemiologic situation. The epidemiologic study included 158 cases of CDD and 149 cases of DA from the cases referred to both University Clinics of Berne and Zurich. The results showed that DA was associated with nutrition-related risk factors: use of minerals and sodium chloride, inadequate concentrate feeding and beginning of the feeding. Furthermore, breed was significantly associated with DA, but not with CDD. Finally, milk yield and pasture were also significantly included in the models. For CDD, nutrition-related risk factors were also found: pasture in summer, use of corn pellets and corn silage in winter. In the final model, protein concentrate was also included. Although both diseases were found at comparable frequencies, the results of this study indicate marked differences between the epidemiology of occurrence of CDD and DA. Therefore, the hypothesis of a common etiopathogenesis appears unlikely.

[New aspects on the etiopathogenesis and treatment of cecal dilatation/-dislocation in cows--a review]

This paper describes the latest results of research in the areas of etiopathogenesis and treatment of cecal dilatation/-dislocation (CDD) in cows. Similar etiopathogenic mechanisms of CDD and displacement of the abomasum, as has been hypothesized in the literature, were not confirmed. Spontaneous CDD is most likely the consequence of a dysfunction of the spiral colon. Bethanechol is an appropriate motility-modulating drug for medical and postsurgical treatment of spontaneous CDD.

Cecal impaction due to dysautonomia in a llama (Lama glama)

A llama (Lama glama) died after 1 wk of obstipation, lethargy, and rolling. Necropsy showed that the stomach and small intestine were distended with gas and fluid. The cecum was impacted with dry contents and the colon was empty. No gross lesions were found in the wall of the gastrointestinal tract or other organs. Histologic changes consisted of chromatolysis of neurons of autonomic ganglia, enteric plexi, and the accessory cuneate nucleus, consistent with lesions associated with dysautonomia in other domestic animals.

Necrotizing mycotic vasculitis with cerebral infarction caused by Aspergillus niger in a horse with acute typholocolitis

An 18-year-old Morgan mare was presented to the Veterinary Medical Teaching Hospital, University of Illinois, with a 10-day history of watery diarrhea, depression, and dysphagia. On admission, the animal was severely dehydrated, depressed, and unable to swallow and had no clinical signs of diarrhea. The respiratory and heart rate and body temperature were within normal limits. Following fluid therapy, the mare developed severe watery diarrhea and continued to be depressed, incoordinated, and dysphagic. The animal died on the fourth day after admission and was sent to the Laboratories of Veterinary Diagnostic Medicine for necropsy. Gross postmortem findings were consistent with an acute cerebral infarction in the right cerebral hemisphere, an acute necrotizing typhlocolitis, multifocal petechial and ecchymotic hemorrhages, enlarged and congested pars intermedia of the pituitary gland, and marked bilateral adrenocortical hyperplasia with multifocal areas of necrosis and hemorrhage. Histologic evaluation of the affected brain demonstrated an area of coagulative necrosis of the gray matter, with hemorrhage, vasculitis, and thrombosis. There were many fungal hyphae 3.5-6.0 microm, pale basophilic, septate, and occasionally branching at 45 degrees present in the arterial walls and throughout the necrotic tissue. Immunohistochemical analysis revealed Aspergillus niger as the etiologic agent responsible for the mycotic vasculitis and infarction in the brain. Bacteria culture and immunohistochemical staining of the colon and cecum failed to demonstrate specific pathogens.

Ileocecocolic intussusception in a one-month-old llama

A 1-month-old female llama was examined because of signs of acute abdominal pain. Physical and ultrasonographic examination revealed a cylindrical mass in the left caudal quadrant of the abdomen. Results of serum biochemical analyses and CBC were within reference ranges. Exploratory laparotomy revealed an ileocecocolic intussusception. Ileocecal resection and end-to-end ileocolic anastomosis were performed. After surgery, fecal examination revealed many coccidial oocysts, although a direct association between coccidiosis and intussusception could not be determined. The cria recovered without serious complications.

Cecal inversion and subsequent colocolic intussusception in a red wolf (Canis rufus gregoryi)

A 2-yr-old female red wolf (Canis rufus gregoryi) presented with weight loss and diarrhea. Abnormal clinical pathology included low serum calcium, sodium, chloride, globulin, and albumin levels. Differential diagnosis included infectious enteritis, intestinal parasitism, inflammatory bowel disease, hepatic or renal disease, and malnutrition. The wolf was treated empirically, but did not improve. A second examination revealed persistent poor musculature and stool quality. Abdominal palpation revealed a firm mass; contrast radiography confirmed an intussusception. Exploratory laparotomy revealed a colocolic intussusception involving the cecum. Following reduction of the colocolic intussusception, cecal inversion (cecocolic intussusception) was identified. Because the cecal inversion could not be reduced, typhlectomy was performed through a colotomy incision. Bacterial culture of peritoneal fluid yielded two strains of Escherichia coli. Postoperatively, the wolf was placed on antibiotics and a soft diet. The diet was gradually returned to its normal formulation and the wolf progressively gained weight. Physical examination 7.5 mo following initial presentation revealed normal body weight and condition. To our knowledge, this is the first recorded incidence of cecal inversion with concurrent colocolic intussusception.

Cecocolic and cecocecal intussusception in horses: 30 cases (1976-1996)

OBJECTIVE

To determine the prognosis in horses with cecocolic or cecocecal intussusception.

DESIGN

Retrospective study.

ANIMALS

30 horses with cecocolic intussusception or cecocecal intussusception.

PROCEDURE

Information on history, physical examination findings, and laboratory values was summarized from the medical records. Laboratory data included results of hematologic examination, serum biochemical analysis, and peritoneal fluid color, total nucleated cell count, and total protein concentration. A one-year follow-up via the telephone was used to determine long-term survival.

RESULTS

Horses ranged from 7 months to 30 years old, but 63% were < or = 3 years. Standardbred horses were significantly overrepresented. Twenty-six horses had acute-to-subacute disease, and 4 had a chronic wasting disease. Cecal intussusceptions were suspected on the basis of finding a mass on abdominal palpation per rectum (14 of 24 horses) and positive ultrasonographic findings (2 of 3 horses). Thirteen horses with colic for > 1 day had scant, soft feces. Six horses died or were euthanatized without undergoing surgery, and 24 were treated surgically. Six of the latter horses were euthanatized during surgery because of peritonitis, rupture of the cecum, and irreducible intussusception. All 4 horses with a chronic disease were euthanatized because of irreversible changes in the cecum. Of the 18 horses allowed to recover from surgery, 15 survived long-term. Surgical treatments were reduction, with or without partial typhlectomy (6 horses), partial typhlectomy through a colotomy and reduction (6), reduction through a colotomy and partial typhlectomy (3), partial typhlectomy for a cecocecal intussusception (1) and an ileocolostomy (2).

CLINICAL IMPLICATIONS

Cecal intussusception has a good prognosis with surgical correction without delay. Reduction through colotomy has a high success rate. Bypass by ileocolostomy should be used as a last resort.

[Cecal intussusception in calves]

Among the patients admitted to the II. Medical Animal Clinic of the University of Munich from 1986 through 1994, there were 51 calves at an age of up to three months with intussusceptions in the caecal region. The following forms were observed: caecocaecal (n = 12), caecocolic (n = 22), ileocaecocolic (n = 6), ileocaecal (n = 8), and jejunoileocolic (n = 3). In 40 cases, the intussusception occurred in the course of diarrheal disease. The most important signs were scant faeces, that often contained blood and/or mucus, and the finding of a hard viscus upon abdominal palpation. Colic was observed in 27% of patients. In 18 cases, surgical intervention was not attempted because of the advanced stage of the disease or severe accompanying disease. From the remaining 33 calves, eight were cured. The others were either destroyed or died because of extensive peritonitis or other diseases. This report is to draw attention to the fact that (caecal) intussusception should be considered in diarrheal calves when faecal output decreases suddenly, and the general state deteriorates.

Enterohepatic lesions in SCID mice infected with Helicobacter bilis

Helicobacter bilis is a recently identified species that colonizes the intestine and liver of mice. In immunocompetent mice, infections have been associated with mild hepatitis, and in immunocompromised mice, inflammatory bowel disease has been induced by intraperitoneal inoculation of the organism. We report inoculation of 6-week-old C.B-17 scid/scid mice by gastric gavage with approximately 10(7) H. bilis colony-forming units. Groups of mice were euthanized and necropsied 12, 24, and 36 weeks after inoculation. Mild to moderate proliferative typhlitis was evident in all mice at 12 and 36 weeks after inoculation and in most mice 24 weeks after inoculation. Mild to severe chronic active hepatitis was detected in 10 of 10 male mice and 3 of 10 female mice. These results indicate that H. bilis can cause moderate to severe enterohepatic disease in immunocompromised mice.

Actinomycotic splenitis and intestinal volvulus in an alpaca (Lama pacos)

Morphologic, microbiologic, and polymerase chain reaction amplification techniques were used to evaluate an alpaca (Lama pacos) with splenitis and intestinal volvulus. The intestinal volvulus produced a severe necrosuppurative typhlocolitis associated with vascular thrombosis and was most likely the cause of death of this animal. In addition, this animal had multiple coalescing abscesses affecting most of the splenic tissue. The isolation of Actinomyces spp. from the spleen and the morphology of the colonies when stained with Gram and Steiner stains support a diagnosis of splenic actinomycosis.

Gastrointestinal ulceration and pulmonary aspergillosis in a llama treated for parelaphostrongylosis

A 9-year-old llama examined because of hind limb paresis was found to have parelaphostrongylosis. Despite treatment with ivermectin, fenbendazole, cimetidine, and ceftiofur, the llama developed gastrointestinal ulceration and pulmonary aspergillosis and was euthanatized. Parelaphostrongylus tenuis is a parasite of white-tailed deer, but ruminants can serve as aberrant or dead-end hosts after accidentally ingesting snails or slugs carrying third-stage larvae of the parasite. Gastrointestinal ulceration and pulmonary aspergillosis can develop secondarily in llamas with chronic disease. Treatment of gastrointestinal ulceration in llamas is difficult, because efficacy of commonly used antiulcer drugs in llamas has not been established.

Use of laparoscopic equipment to divide abdominal adhesions in a filly

Exploratory laparoscopy of the right dorsal portion of the abdominal cavity was performed on a Standardbred filly because of signs of mild abdominal pain of 7 days' duration. On the basis of clinical examination, diagnosis was suppurative peritonitis, abdominal adhesions in the area of the right ovary, and right displacement and impaction of the pelvic flexure of the ascending colon. During laparoscopy, an abdominal adhesion between the right uterine horn, the cecum, and the pelvic flexure was identified. The abdominal adhesions were either stretched with laparoscopic forceps used as a probe or dissected bluntly with the tips of a pair of 10-mm laparoscopic Kelly forceps. Antibiotics were administered for 21 days after surgery. The horse fully recovered and raced 11 months after the surgery.

Typhlitis caused by intestinal Serpulina-like bacteria in domestic guinea pigs (Cavia porcellus)

Between January 1992 and December 1996, Serpulina-like bacteria were demonstrated in intestinal tract lesions from 37 of 88 guinea pigs submitted to the University of Ghent in Ghent, Belgium, for necropsy because of disease and death from different unknown causes. All infected animals had a history of sudden death with minimal introductory clinical signs. Occasionally, they produced yellow, slimy feces or showed nervous signs, but the condition always had a fatal outcome within 24 h. When larger colonies of guinea pigs were involved, the disease spread very rapidly unless treatment with ronidazole was initiated. Lesions consisted of a catarrhal or hemorrhagic inflammation of the colon and cecum (typhlitis). Electron microscopy demonstrated the presence of large numbers of Serpulina-like organisms adhering to the cecal mucosae of these animals. Attempts to isolate the agents failed. The organisms did not stain by an immunofluorescence technique for the detection of Serpulina hyodysenteriae. The present data provide evidence that intestinal Serpulina-like organisms can be important as a cause of disease in guinea pigs.