Case report: Incomplete bypass ileocolostomy without partial typhlectomy in five horses with acute, non-reducible cecocolic intussusceptions and review of literature

Cecocolic intussusceptions are a rare condition of acute colic in horses requiring immediate surgical intervention due to persistent uncontrollable pain and ongoing ischemic cecal necrosis. Particularly in cases where reduction of the intussusception is surgically not feasible surgical interventions such as partial typhlectomy through colotomy (partial cecal amputation) combined with or without cecal bypass techniques are described. Alternatively, surgical interventions can also be performed without partial typhlectomy via incomplete bypass ileocolostomy. Information regarding applicable techniques and outcomes base on sparse literature of single case reports or small case series. Therefore, this case series aims to add more cases treated with incomplete bypass ileocolostomy without typhlectomy to existing literature and to compare the outcome by reviewing medical records from January 2009 to March 2024 in context to literature. Five horses were surgically treated and were followed-up between 1 and 9 years. Minor short-term complications were recorded during hospitalization such as transient mild colic and febrile episodes. Long-term outcome revealed that horses received or exceed their previous level of use. By adding the hereby presented cases to published data horses treated with ileocolostomy without partial typhlectomy had a long-term survival rate of 100%. However, numbers of published cases are still low with 49 horses being included in the literature review whereof 42 recovered from surgery. The overall long-term survival rate was 53%. The added value of this study is based on the comprehensive documentation of a cohort of five horses successfully treated with an incomplete bypass procedure, demonstrating favorable long-term outcomes. Furthermore, the study advances the surgical technique by implementing the closure of mesenteric gap. The evidence for the application of the surgical technique has been strengthened.

Epidemiological and pathological aspects of noninfectious diseases of the gastrointestinal tract in 114 horses in Southern Brazil

ABSTRACT: Equine colic is one of the most common cause of death in horses, but few studies have investigated specifically the conditions at the necropsy. This study aimed to describe the epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract in horses. A retrospective study was conducted in search of cases of these diseases affecting horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114). Mixed breeds horses (56/114) and males (69/114) were mostly affected. The horses had a median and mean age of 10 and 10.9-years old, respectively. Primary gastric dilation was characterized by distension of the stomach by moderate to large amounts of content, which in 21 cases caused tearing of the stomach wall at the greater curvature (peritonitis), and the main predisposing factor was alimentary overload (17/27). Intestinal volvulus occurred within the small intestine (14 cases) and within the large intestines (13 cases). Grossly, there was intestinal ischemia with reddened to deep-black serosa and diffusely red mucosae. Enterolithiasis caused partial or complete obstruction of the right dorsal colon (9/20), transverse colon (4/20), small colon and right dorsal colon (3/20), rectum and right dorsal colon (2/20), and small colon (2/20). Viscera perforation and peritonitis occurred in 11 cases. Rectal (colonic) perforation involved the rectum (10/15), rectum/small colon (4/15), and the small colon (1/15). It was characterized by a focally extensive transmural tearing, associated with reddened borders, and retroperitoneal to diffuse peritonitis. Palpation related iatrogenic injuries (11/15) were the main cause. Impactions affected the large colon (7/10), the cecum (2/10), and the stomach (1/10). Incarcerations consisted of inguinoscrotal hernias (2/6), small intestine entrapment by a mesenteric failure (2/6), diaphragmatic hernia, and umbilical eventration. Grossly, the organs were constricted by a hernial ring, with intestinal ischemia and reddened to dark-red serosa. Predisposing factors included previous surgeries (2/6) and patent inguinal ring (1/6). Intussusception involved the small intestine (3/4) and ileocecum (1/4). Foals with lack of colostrum intake and concomitant pneumonia was a characteristic presentation (3/4). Grossly, the intussusceptum slipped into intussuscipiens, with diffuse deep black-red discoloration. Other causes included large colon displacement (2/5), extrinsic and intrinsic obstruction of the small intestine (2/5), and an intestinal adenocarcinoma. Noninfectious gastrointestinal diseases are major causes of death in horses. Epidemiological and gross features of the conditions should be accounted to obtain a final diagnosis of the cause of the colic.

Differences in gastrointestinal lesions in different horse types

Clinical impression suggests that some gastrointestinal lesions are more common in certain horse types. The study tested the hypothesis that relative prevalence of acute gastrointestinal lesions differs between equid types. In a retrospective caseâ€"control study, records (2010â€"2015) were reviewed for equids with acute gastrointestinal disease. Signalment, details of gastrointestinal lesions and diagnoses were recorded. Animals were categorised as miniature type, pony, Arabian, light breed or draft type. Exclusion criteria were no recorded breed/size/diagnosis, age less than one year and donkeys. Using binary logistic regression the influence of type, sex and age on lesion location, nature and diagnoses were investigated. 575 animals (33 miniature types, 136 ponies, 335 light breed types, 17 Arabians and 54 draft types) were included. Using light breed types as reference, ponies (including miniatures) had decreased odds of colon displacements (OR 0.11; 95 per cent CI 0.05 to 0.24; P<0.001) and ponies alone had increased odds of strangulation of the small intestine by lipomas (OR 2.3; 95 per cent CI 1.3 to 4.1; P=0.004). Miniature types had decreased odds of strangulating small intestinal lesions (OR 0.1; 95 per cent CI 0.01 to 0.83; P=0.033) and draft types had increased odds of caecal conditions (OR 9.0; 95 per cent CI 2.3 to 34.8; P<0.001). In conclusion, equid type influences development of gastrointestinal lesions.

Ultrasound of the equine acute abdomen

Abdominal ultrasound is an invaluable aid in the evaluation of the colic patient but can be heavily influenced by patient preparation, individual horse-to-horse variation, availability of ultrasound transducers, technique, experience level of the examiner, and complexity of the abdominal disorder. This article describes ultrasonographic anatomy of the normal equine abdomen and technique for examination of the equine colic patient. Common abnormalities of the stomach, small intestine, large intestine, and peritoneal cavity are described along with other abnormalities that may be discovered with abdominal ultrasonography of the colic patient, such as masses, urolithiasis, cholelithiasis, and thoracic or cardiac lesions.

Use of cecal bypass via side-to-side ileocolic anastomosis without ileal transection for treatment of ileocecal intussusception in a Vietnamese pot-bellied pig (Sus scrofa)

CASE DESCRIPTION

A 5-year-old castrated male Vietnamese pot-bellied pig (Sus scrofa) was evaluated because of anorexia, vomiting, diarrhea, and weight loss.

CLINICAL FINDINGS

Hypermotile gastrointestinal sounds were noted on abdominal auscultation. An inflammatory leukogram, dehydration, prerenal azotemia, hyponatremia, hypochloremia, hyperproteinemia, hyperglobulinemia, hypomagnesemia, and high γ-glutamyl transpeptidase activity were identified. Transabdominal ultrasonography revealed distended loops of small intestine.

TREATMENT

IV fluid therapy and analgesic treatment were unsuccessful in the resolution of clinical signs. Exploratory laparotomy revealed an ileocecal intussusception involving the distal portion of the ileum. Distal ileal and cecal bypass were achieved via side-to-side anastomosis of the proximal portion of the ileum and spiral colon with a gastrointestinal anastomosis stapler. Ileal transection or occlusion was not performed. Postoperative complications were minimal, and the pig was clinically normal 15 months after surgery and required no special care or diet.

CLINICAL RELEVANCE

Distal ileal and cecal bypass without ileal transection have not been described previously in Vietnamese pot-bellied pigs. Anastomosis of the proximal portion of the ileum to the spiral colon without major complications represents a novel, technically simple approach to bypass of the distal portion of the ileum and cecum.