Outcome following emergency laparotomy in 33 UK donkeys: A retrospective multicentre study

BACKGROUND

Emergency laparotomies in donkeys are infrequently performed and there is limited literature on the subject.

OBJECTIVES

To determine findings and associated outcomes of exploratory laparotomies in donkeys.

STUDY DESIGN

Descriptive retrospective study.

METHODS

Donkeys undergoing emergency exploratory laparotomy for investigation and treatment of colic at seven UK referral hospitals between 2005-2017 were included. Data were retrieved from available hospital records. Descriptive statistics and inferential statistical analysis of outcomes of interest was performed in three steps.

RESULTS

Thirty-three cases fulfilled the inclusion criteria. Clinical signs on presentation were available for 32 donkeys, of which 53.1% (17/32) presented for investigation of colic while in 46.9% (15/32) the presenting complaint was non-specific. Primary lesion location included small intestine (42.4%, 14/33), large colon (39.3%, 13/33), caecum (6.1%, 2/33), stomach (6.1%, 2/33) and 6.1% (2/33) had multiple abnormal findings without a clear primary lesion. Overall survival to discharge was 54.5% (18/33). Five donkeys (15.2%, 5/33) were euthanased at surgery and of those recovering from general anaesthesia a further 35.7% (10/28) were euthanased or died prior to discharge. Six donkeys (21.4%, 6/28) required a second laparotomy of which 4 (66.7%, 4/6) survived. Post-operative complications occurred in 82.1% (23/28) of cases and included hyperlipaemia (42.9%, 12/28), incisional complications (21.4%, 6/28), ileus (21.4%, 6/28) and persistent colic (17.9%, 5/28). When adjusted for other complications, donkeys with primary gastric lesions were less likely to have presented with severe colic compared with those with primary small intestinal lesions (OR: 0.07, 95% CI 0.01-0.95, p = 0.05). Only age was positively associated with death prior to discharge (OR: 1.18, 95% CI 1.03-1.36, p = 0.02).

MAIN LIMITATIONS

Small sample size and retrospective design.

CONCLUSION

Donkeys with abdominal lesions may present with a range of signs often not including colic. Surgical findings were diverse and survival to discharge appears to be lower than in horses.

Standing flank laparotomy for colic: 37 cases

BACKGROUND

Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy.

OBJECTIVE

To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy.

STUDY DESIGN

Retrospective case series.

METHODS

Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis was performed.

RESULTS

Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey (euthanised) were subjected to standing flank laparotomy via the left flank (n = 31), right flank (n = 2) or both flanks (n = 4). The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived). Enterotomy was performed in four animals (all survived). Partial typhlectomy was performed in one horse (euthanised). Resection-anastomosis of the SI or LC was performed in three animals (one survived). Three animals had intraoperative complications that negatively affected the outcome: Two ponies had intolerance to abdominopelvic exploration; one mare had spontaneous exteriorisation of a long segment of the SI leading to a large tear in the mesentery. In seven cases, severe/extensive lesions found during standing flank laparotomy warranted immediate euthanasia. The survival rate was 54%. All owners were satisfied with the decision to perform standing flank laparotomy.

MAIN LIMITATIONS

The retrospective design, lack of a control group, small number of cases and lack of standardised protocols between hospitals.

CONCLUSIONS

Although ventral midline laparotomy is the standard of care for horses with colic, standing flank laparotomy is a viable approach for some types of colic. Systemic administration of analgesics may not produce sufficient peritoneal analgesia, which can lead to intolerance to abdominopelvic exploration during standing flank laparotomy in horses with colic and may negatively affect the outcome.

Use of polyamide cable ties during experimental omentectomy in adult horses with histopathological assessment

OBJECTIVE

To report the use of nylon cable ties (NCT) for omentectomy in the horse.

STUDY DESIGN

Experimental study.

ANIMALS

Eight healthy adult horses.

METHODS

Horses underwent nylon cable tie (NCT) ligation of the greater omentum after ventral midline celiotomy. The time required to complete the omentectomy was recorded. Horses were recovered for 14 days before repeat celiotomy, adhesions assessment, and histological examination of the omentectomy site using a proposed histologic grading scheme. The total time for omentectomy procedure and histologic score was assessed for normality. Data are expressed as mean ± standard deviation.

RESULTS

NCT ligation provided sufficient hemostasis to complete the omentectomy (28 ± 15 s), without rescue ligation. No gross evidence of intra-abdominal adhesion or morbidity was associated with the omentectomy site 14 days after surgery. NCT were intact at the site of application, covered with smooth fibrous connective tissue. Adiponecrosis with minimal inflammation and fibrovascular occlusion of omental vessels was present at the surgical site. Mild inflammation was present at the NCT-tissue interface.

CONCLUSION

The use of NCT resulted in fast and effective omentectomy in healthy horses without short-term evidence of inflammatory reaction or intra-abdominal adhesion.

CLINICAL SIGNIFICANCE

The described technique provides an alternative for omentectomy in healthy adult horses.

Use of perioperative variables to determine the requirement for repeat celiotomy in horses with postoperative reflux after small intestinal surgery

OBJECTIVE

To determine whether perioperative variables can be used to differentiate a medical vs a surgical reason for postoperative reflux (POR) after small intestinal (SI) surgery in horses.

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

Horses >1 year of age that recovered from SI surgery and had POR.

METHODS

Medical records of horses that underwent SI surgery and developed POR from 2009-2015 were reviewed. Surgical reasons for POR were defined as an anastomosis complication, mechanical obstruction, or nonviable intestine identified at repeat celiotomy/necropsy. A medical reason for POR was presumed when the POR improved with medical treatment or when no surgical reasons were identified at repeat celiotomy/necropsy. Perioperative variables were analyzed and used to develop a logistic regression model.

RESULTS

Fifty-one horses had POR after SI surgery. After initial SI surgery, 14 horses had surgical reasons for POR diagnosed at repeat celiotomy or necropsy. Thirty-seven horses were considered to have medical reasons for POR because their POR resolved with medical management or functional ileus was diagnosed at repeat celiotomy/necropsy. A greater volume and a greater duration of POR were not associated with a surgical reason for POR. Rather, a postoperative (PO) fever and the timing of colic in the PO period were associated with a surgical reason for POR.

CONCLUSION

Horses that developed a fever and colic in the PO period after SI surgery were more likely to have a surgical reason for POR.

CLINICAL SIGNIFICANCE

These findings may provide guidance for clinicians when they are making decisions about repeat celiotomy in horses with POR after SI surgery.