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

Caecal dysfunction following standing surgical procedures

The aim of this study is to report cases of caecal dysfunction following surgical procedures in the standing horse. The study design is retrospective. Six client‐owned horses developed caecal dysfunction following a variety of surgical procedures undertaken in the standing sedated horse. Medical records were reviewed for caecal dysfunctions that had occurred in horses within 2 weeks of standing surgical procedures. Signalment, details of the original standing surgery and medications administered were recorded. Short‐term outcome was obtained from clinical records. Long‐term outcome was obtained by telephone questionnaire with the owner. Six horses were identified to have developed caecal dysfunction following standing surgery for tooth extraction, laparoscopic ovariectomy, laparoscopic cryptorchidectomy, fracture repair, melanoma removal and castration. Three horses were euthanised with caecal perforation at the time of diagnosis. Three underwent surgical treatment (typhlotomy, decompression and caecal bypass by ileocolostomy). All three horses were alive post‐operatively (follow‐up at 2, 12 and 24 months). Caecal dysfunction may develop following surgical procedures performed under standing sedation. Careful post‐operative monitoring and early identification of caecal dysfunction, and consequent potential need for surgical intervention, are important to optimise outcomes and minimise the risk of fatal caecal perforation occurring.

Clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum: 7 cases (2000-2010)

OBJECTIVE

To determine the clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum (cecal cupula).

DESIGN

Retrospective observational case series.

ANIMALS

7 horses with colic attributed to cecal cupula impaction.

PROCEDURES

Medical records were reviewed and horses that underwent exploratory celiotomy from 2000 through 2010 were identified. Horses with cecal cupula impaction and without other abdominal problems to which colic could be attributed were selected for inclusion in the study. Information regarding history, clinical findings, diagnostic testing, surgical findings and treatments, and treatments and complications after surgery was recorded. Rate of survival of horses to discharge from the hospital was determined. Long-term follow-up information was obtained with telephone questionnaires.

RESULTS

Cecal cupula impaction without other cecal abnormalities was identified in 7 horses during exploratory celiotomy. Although clinical signs varied, horses typically had mild signs of colic and nondiagnostic rectal examination findings but were in systemically stable conditions at the time of the initial evaluation. Typhlotomies were performed and impactions were resolved by means of lavage and evacuation. All horses survived to discharge from the hospital and lived ≥ 2 years after surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of this study suggested cecal cupula impaction was a novel type of cecal impaction that was uncommon. Impactions did not involve the cecal body or apex and hypertrophy of the cecal wall was not grossly detected. Impactions were successfully treated with typhlotomy, lavage, and evacuation. Horses had a good prognosis after surgical treatment.

Complete caecal bypass without ileal transection for caecal impaction in horses: seven clinical cases (1997-2007)

OBJECTIVES

To report the clinical outcome in seven horses following use of a newly described surgical technique for treating caecal impaction.

METHODS

The medical records of seven horses with caecal impaction treated surgically using a stapling technique to create a complete caecal bypass without ileal transection were reviewed. Data were obtained from the records and through telephone interviews with case-associated personnel.

RESULTS

The mean age was 10 years (range 2-22 years) and duration of colic ranged from 24 h to 2 weeks. Five horses had type II motility dysfunction and the remaining two had type I. Mean surgical time was 185 min (range 146-245 min) and the horses were hospitalised for a mean of 12.4 days (range 9-22 days); 71% (5/7) were discharged from hospital and all five were alive 60 days from the surgery date. One horse was lost to follow-up. The four (66.7%) available remaining horses were alive ≥ 1 year (long-term survivors).

CONCLUSIONS

Complete caecal bypass without ileal transection for clinical cases of caecal impaction had comparable outcomes to complete bypass with ileal transection. The technique is easy to perform, has the potential to reduce surgical time, compared with traditional bypass techniques, and may reduce the risk of intraoperative abdominal contamination. It is recommended for use in clinical cases in which caecal bypass is desirable.

Outcome and long-term follow-up of 20 horses undergoing surgery for caecal impaction: a retrospective study (2000-2008)

REASONS FOR PERFORMING STUDY

If untreated, caecal impaction may progress to rupture of the caecum and reports of long-term outcome for horses undergoing surgery for caecal impaction are required.

OBJECTIVES

To describe short- and long-term complication rates for horses undergoing surgery for caecal impaction in an otherwise life-threatening gastrointestinal condition.

METHODS

Case records were reviewed for horses undergoing surgery for caecal impaction. Horses were included in the study if an abnormally large, fluid-distended or feed-impacted caecum was the primary diagnosis at surgery and excluded if the caecum had already ruptured upon opening the abdomen, necessitating euthanasia. Short-term follow-up data were obtained from clinical records; and included complications, repeat celiotomy and survival to discharge. Long-term survival was defined as survival for >1 year post operatively. Long-term follow-up data were obtained through telephone interviews with owners and referring veterinary surgeons. Survival, occurrence of post operative colic and subsequent use of the horse were recorded.

RESULTS

Twenty horses underwent surgery for caecal impaction: 16 horses underwent caecal bypass (typhlotomy and removal of caecal contents, ileal transection followed by ileocolostomy); 3 underwent typhlotomy alone; and one horse underwent typhlotomy followed by a second procedure where caecal bypass was performed. Five horses (25%) were admitted for colic evaluation with primary caecal impactions, in 10/20 (50%) of cases the impaction was secondary to previous orthopaedic surgery and in 5/20 (25%) caecal impaction was identified at repeat celiotomy following a previous colic surgery. Sixty-five percent (13/20) of horses survived to discharge; 11/13 (85%) of horses discharged survived long term; 100% (3/3) horses that received typhlotomy alone were discharged and survived long term.

CONCLUSIONS

The prognosis following caecal impaction surgery is fair, if the horse survives to discharge then prognosis for long-term survival is good.

POTENTIAL RELEVANCE

Surgery for caecal impaction carries a fair prognosis for a potentially life threatening disease, in particular where caecal dysfunction is suspected.

Initial Evaluation of a Technique for Complete Cecal Bypass in the Horse

OBJECTIVE

To describe a novel stapling technique for creation of a complete cecal bypass, without ileal transection in horses.

STUDY DESIGN

Experimental study.

ANIMALS

Four adult horses.

METHODS

Through a ventral median celiotomy, jejunocolostomy was made with an intraluminal anastomosis device (ILA-100) and oversewn with a Cushing pattern to reinforce the staple line. Immediately distal to the anastomosis, 4 rows of staples were applied using a thoracoabdominal stapling device (TA-90) to occlude the lumen of the distal jejunum and proximal ileum. Necropsy exams were performed at least 60 days after surgery.

RESULTS

No intraoperative complications occurred. Cecal bypass was functional in all horses at necropsy. The most oral staple line across the ileum partially failed in 1 horse; however cecal bypass was functional.

CONCLUSIONS

Complete cecal bypass without ileal transection is a viable alternative to traditional methods of complete cecal bypass. Two sets of staple lines across the ileum are recommended. Longer term follow-up is warranted before clinical use of this technique.

CLINICAL RELEVANCE

Cecal bypass without ileal transection is technically simple and effectively bypasses the cecum. It also should intuitively require less time and have a reduced risk of contamination compared with complete cecal bypass with ileal transection.