Partial volvulus, entrapment, and extraluminal obstruction of the jejunum in a cat

A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.

Efficacy of gelatin sponge in the prevention of post-surgical intra-abdominal adhesion in a rat model

Although different products have been developed to prevent post-surgical adhesion, their efficacy remains unsatisfactory. This study aimed to evaluate the efficacy of the gelatin sponge in the prevention of post-surgical intra-abdominal adhesions in a rat model. Rats were randomly divided into sham, adhesion, and gelatin groups. All rats, except the sham group, underwent cecal abrasion to establish an adhesion model. After celiotomy, a sterile gelatin sponge was applied intra-abdominal on the abraded cecum in the gelatin group. Rats were sacrificed on day 14 post-surgery and intra-abdominal adhesions were evaluated and scored. Adhesion tissues were evaluated by histological, histochemical, and immunohistochemical analysis. Intra-abdominal adhesions were recorded in all rats of the adhesion group. Intra-abdominal application of gelatin sponge significantly (P < 0.001) reduced intra-abdominal adhesions by 91% in the gelatin group relative to the adhesion group. The histological analysis revealed a marked decrease (P < 0.001) in the inflammatory score and neovascularization in the gelatin group. The histochemical analysis found that gelatin sponge administration reduced adhesion formation and thickness of adhesion tissue. Moreover, gelatin sponge significantly (P < 0.0001) increased MMP-9 expression and decreased macrophage marker expression in adhesive tissue. This study revealed that the application of gelatin sponge markedly reduced the post-surgical intra-abdominal adhesions and suggests new guidance for using gelatin sponge as an anti-adhesive substance in clinical practice.

An apparently healthy female crossbred Labrador retriever-poodle dog with severe intra-abdominal adhesions as an incidental finding to ovariohysterectomy

An apparently healthy 1-year-old, female crossbred Labrador retriever-poodle dog was brought to a veterinary clinic for elective ovariohysterectomy (OVH). Severe abdominal adhesions complicated the procedure. There was no report of a previous illness or surgical procedure that would be a predisposing cause for the adhesions. The OVH was completed despite the adhesions and the dog recovered well. It is unclear whether this was simply a case of severe intra-abdominal adhesions or an atypical sclerosing encapsulating peritonitis (SEP). The differential diagnoses include inflammatory processes, a genetic predisposition, or an idiopathic cause. Fourteen days later, at the time of surgical staple removal, the dog was healthy and had reportedly been doing very well. Although rare, intra-abdominal adhesions can occur in young and previously healthy dogs without causing clinical signs. Veterinarians should be aware of such a condition when approaching abdominal surgeries and be prepared to manage these cases appropriately.

Characterization of microbes associated with cervico-vaginal adhesion in the reproductive system of camels (Camelus dromedaries)

Vaginal and cervical adhesions are severe long-standing reproductive disorder in dromedaries and consequently result in a high culling rate. This study was designed to compare the microbial communities of the vaginae, cervices, and uteri of normal (n = 10) camels versus camels suffering from cervico-vaginal adhesion (n = 23). Vaginal, cervical, and uterine swab samples were collected from control and affected animals. Furthermore, serum samples were obtained for serological testing of Chlamydiosis and Coxiellosis. For bacteriological and fungal examination, swab samples were plated on Columbia and Saboraud's dextrose agar, respectively. Polymerase chain reaction (PCR) assay was applied to samples expressed seropositive for Chlamydiosis. Vaginal swab bacterial cultures showed that the affected animals were significantly infected with Staphylococcus aureus (P = 0.0322, CI: 0.25-0.95) than the control, while mycological cultures showed that both control and affected animals were infected with Cryptococcus and Candida albicans. Corynebacterium spp. (22.7%), Pseudomonas spp. (4.5%), Klebsiella spp. (9.1%), T. pyogenes (18.2%), and anaerobic bacteria (Fusobacterium necrophorum and Clostridium spp.; 34.78%) were also identified in affected animals. Cervical samples from affected animals were distinguished by the existence of S. aureus (27.8%), Klebsiella spp. (5.6%), Corynebacterium spp. (22.2%), Cryptococcus (16.7%), Proteus spp. (11.1% (, T. pyogenes (11.1%), Pseudomonas spp. (5.6%), and Fusobacterium necrophorum (17.4%). Uterine samples from affected animals were characterized by the presence of S. aureus (22.2%), Streptococcus (22.2%), Corynebacterium spp. (11.1%), E. coli (11.1%), and Pseudomonas spp. (11.1%). Anaerobic bacteria were not isolated from control nor affected animals. Enzyme immunoassays revealed that 50% and 34.8% of the control and affected animals were positive for Coxiella burnetii, respectively, Chlamydia was detected in 43.5% of samples from affected animals, only 60% of which were confirmed positive. These results show that microbial communities linked with cervico-vaginal adhesion in dromedary camels are likely to be polymicrobial. The findings of this study are helpful in designing antimicrobial therapies toward reducing the incidence for cervico-vaginal adhesion.

Experimental laparoscopic pyloromyotomy in pigs

The objective of this study was to evaluate and compare laparoscopic pyloromyotomy methods involving the laparoscopic scalpel and the harmonic scalpel in pigs. The experiment was conducted on 4 subgroups of 12 animals subjected to laparoscopic-assisted pyloromyotomy with a surgical scalpel and the harmonic scalpel, as well as laparoscopic pyloromyotomy with Berci's laparoscopic scalpel and the harmonic scalpel. No postsurgical complications were observed. Four weeks after the surgery, the animals were sacrificed and autopsy was performed. In one animal peritoneal adhesions between the intestines and the mini-laparotomy incision were found. Laparoscopic pyloromyotomy and laparoscopic-assisted pyloromyotomy performed in pigs enabled the selection of laparoscopic entry sites, instruments for pyloromyotomy and evaluation of the applied surgical procedures in animals. The results of this study indicate that the methods applied can be safely used in clinical practice in dogs and cats due to minimal post-operative complications and fast healing of laparoscopic incisions in comparison with classical surgical wounds, and that the harmonic scalpel is a safe surgical instru- ment.

Inflammatory responses and side effects generated by several adjuvant-containing vaccines in turbot

Several of the adjuvants used in fish vaccines cause adhesions in internal organs when they are injected intraperitoneally. We describe the damage caused by vaccines containing different adjuvants in the turbot Scophthalmus maximus and show that internal adhesions can be greatly reduced by injecting the fish in a specific way. Injection of fish with the needle directed towards the anterior part of the peritoneal cavity induced formation of a single cell-vaccine mass (CVM) that became attached to the parietal peritoneum. However, injection of the fish with the needle pointing in the opposite direction generated many small CVM that became attached to the visceral and parietal peritoneum and in some cases caused internal adhesions. We describe the structural and cellular changes in the adjuvant-induced CVMs. The CVMs mainly comprised neutrophils and macrophages, although most of the former underwent apoptosis, which was particularly evident from day 3 post-injection. The apoptotic cells were phagocytosed by macrophages, which were the dominant cell type from the first days onwards. All of the vaccines induced angiogenesis in the area of contact between the CVM and the mesothelium. Vaccines containing oil-based adjuvants or microspheres induced the formation of granulomas in the CVM; however, no granulomas were observed in the CVM induced by vaccines containing aluminium hydroxide or Matrix-Q(®) as adjuvants. All of the vaccines induced strong migration of cells to the peritoneal cavity. Although some of these cells remained unattached in the peritoneal cavity, most of them formed part of the CVM. We also observed migration of the cells from the peritoneal cavity to lymphoid organs, indicating bidirectional traffic of cells between the inflamed areas and these organs.

An unusual case of urinary retention and ulcerative cystitis in a horse, sequelae of pelvic abscessation, and adhesions

A 21-year-old Quarter horse gelding was presented with stranguria and incontinence of 10 days duration. Despite catheterization and antibiotic therapy, the horse was euthanized. Necropsy revealed posterior abdominal and pelvic abscessation with adhesions of the urinary bladder and severe ulcerative cystitis.

Human amniotic membrane and vitamin E/selenium for control of postoperative adhesion in dogs

This study was undertaken to compare between the human amniotic membrane (HAM) and intraperitoneal vitamin E (Vit E) and selenium in prevention of postoperative adhesions in dogs. A total of 18 apparently healthy adult Mongrel dogs were divided into three equal groups and the group (I) was treated with a sterile solution of 0.9% sodium chloride intraperitoneally as a control. Group II was treated with the HAM at jejunal enterotomy while group III was treated with Vit E and selenium administered intraperitonally. Dogs were euthanized 30 days postoperatively for histopathological examination. The results showed that both HAM and Vit E and selenium were effective in reduction of the postoperative adhesion in comparison with the group I. In terms of extent of adhesions, there was no significant difference between the HAM group and the Vit E and selenium group.

Treating navicular syndrome in equine patients

Navicular syndrome is a chronic, progressive condition affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. The treatment options for navicular syndrome are as varied as the proposed causes of the condition. The severity of clinical signs, intended use and workload of the horse, and owner compliance with therapy are important considerations in developing a treatment plan. Nonsurgical treatment of navicular syndrome consists of rest, hoof balance and corrective trimming/shoeing, and medical therapy, including administration of systemic antiinflammatories, hemorheologic medications, and intraarticular medications. While surgical therapy can include desmotomy of the collateral (suspensory) ligaments of the navicular bone, palmar digital neurectomy is more commonly performed when medical therapy is ineffective. Recently, adjunct therapies, such as acupuncture and extracorporeal shock wave therapy, have also been used to treat horses with navicular syndrome. Because of the wide range of pathologic changes and the lack of a definitive cure associated with navicular syndrome, treatment is directed toward the individual horse, focusing on the management of clinical signs to alleviate stress and retard degenerative changes of the navicular bursal and navicular regions.

Navicular syndrome in equine patients anatomy, causes, and diagnosis

Navicular syndrome is a chronic and often progressive disease affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. This syndrome has long been considered one of the most common causes of forelimb lameness in horses. Diagnosis of navicular syndrome is based on history, physical examination, lameness examination, and peripheral and/or intraarticular diagnostic anesthesia. Several imaging techniques (e.g., radiography, ultrasonography, nuclear scintigraphy, thermography, computed tomography [CT], magnetic resonance imaging [MRI]) are used to identify pathologic alterations associated with navicular syndrome. Radiographic changes of the navicular bone are not pathognomonic for navicular syndrome. Additionally, not all horses with clinical signs of navicular syndrome have radiographic changes associated with the navicular bone. Therefore, newer imaging modalities, including CT and especially MRI, can play an important role in identifying lesions that were not observed on radiographs. Navicular bursoscopy may be necessary if the clinical findings suggest that lameness originates from the navicular region of the foot and if other imaging modalities are nondiagnostic. With new diagnostic imaging techniques, clinicians are learning that anatomic structures other than the navicular bursa, navicular bone, and DDFT may play an important role in navicular syndrome.

Prevention of ischaemia-induced small intestinal adhesions in foals

REASONS FOR PERFORMING STUDY

Treatments addressing variously theorised pathophysiological mechanisms of small intestinal adhesions have been reported. This study applied those classes of treatments to the most clinically relevant aetiology of post operative adhesions.

HYPOTHESIS

Treatments addressing the pathophysiology of ischaemia-reperfusion induced adhesions would accordingly reduce the incidence of adhesions from this model.

METHODS

Four classes of treatments were administered for 72 h to 16 foals subjected to complete ischaemia followed by reperfusion to create peritoneal adhesions. These groups were: 1) FPG group--flunixin meglumine (1.1 mg/kg bwt i.v., divided q.i.d.), potassium penicillin G (22,000 iu/kg bwt i.v., q.i.d.) and gentamicin (2.2 mg/kg bwt i.v., t.i.d.); 2) HEP group--heparin (80 iu/kg bwt subcut., b.i.d.); 3) DMSO group--dimethylsulphoxide (DMSO) (20 mg/kg bwt [diluted in 500 ml normal saline] i.v., b.i.d.); and 4) SCMC group--sodium carboxymethylcellulose (500 ml 3% sterile solution intraperitoneally, administered only at the beginning of surgery).

RESULTS

Post operative intestinal obstruction did not occur in any foal. After 10 days, necropsy revealed bowel-to-bowel adhesions in none of the FPG or DMSO groups, in 2/4 of the SCMC group, in 3/4 of the HEP group and 5/6 foals subjected to the procedure without treatment (UIR group).

CONCLUSIONS

Inhibition of the inflammation associated with ischaemia and reperfusion in foals treated with FPG or DMSO decreased small intestinal adhesions in foals.

POTENTIAL RELEVANCE

Although anti-inflammatory therapy was shown to eliminate bowel-bowel adhesions in this controlled study, it must be remembered that clinical cases are without control. These therapies are advised to improve the result but are unlikely to eliminate the problem.

Association of spinal deformity and vaccine-induced abdominal lesions in harvest-sized Atlantic salmon, Salmo salar L

Spinal deformities in Atlantic salmon, Salmo salar L., have been described as a disease of multifactorial origin for which vaccines and time of vaccination have been suggested as risk factors. A vaccine efficacy trial where spinal deformity became evident was continued by the observational study reported here. In the preharvest part of the study 17 months post-sea transfer, there was a prevalence of 11.3% spinal deformity, with deformities present only in one vaccine group indicating a strong vaccine involvement. At slaughter, the prevalence of spinal deformities was 11.7%, and deformed fish had only 62% of normal slaughter weight. Visual analogue scales (VAS) were used for continuous recordings of vaccine-induced abdominal lesions and deformity. A logistic regression model associating presence of spinal deformity with markers of abdominal lesions was developed. The odds ratio for spinal deformity was 5.7 (95% CI: 3.4-9.4) for each unit increase in adhesion score (0-6) and 4.9 (2.9-3.4) for each unit increase in melanin on abdominal organs (0-3). Lesions in the dorsal caudal part of the abdomen gave an odds ratio for spinal deformity of 2.2.

Intra-abdominal adhesions in horses: A retrospective evaluation of repeat laparotomy in 99 horses with acute gastrointestinal disease

The objectives of this study were (1) to determine the prevalence of pathological abdominal adhesion formation following exploratory laparotomy; (2) to establish the site of adhesion formation and its relationship to the initial lesion; (3) to ascertain whether the development of intra-abdominal adhesions decreases long-term survival and (4) to identify risk factors for adhesion formation. Of 1014 horses treated surgically for acute gastrointestinal disease, 113 (10.1%) were subjected to repeat laparotomy, with surgical records available for 99 of these cases. Pathological adhesions were the most common diagnosis at repeat laparotomy (28%), followed by complications associated with the anastomosis (16%). Adhesions were not associated with the site of the primary lesion, resection, or endotoxaemia, consistent with the hypothesis that surgical trauma is the most important stimulus in adhesion formation. Together these findings strongly support the need for pan-abdominal, rather than site-specific adhesion prevention measures in all horses undergoing exploratory laparotomy.

Time of vaccination influences development of adhesions, growth and spinal deformities in Atlantic salmon Salmo salar

In August 1998, 3000 Atlantic salmon Salmo salar L. parr were divided into 7 groups with 2 replicates. Every 6 wk until March of the following year 1 group was vaccinated. One group was held as an unvaccinated control. The fish were transferred to seawater in May 1999, and slaughtered in February 2000. Temperature, fish size and photoperiod at vaccination, and the time between vaccination and sea transfer thus varied among the groups. In all vaccinated groups, growth was reduced for 1 to 2 mo following vaccination. Intra-abdominal lesions developed faster, and stabilised at a higher level in the groups vaccinated early at the highest temperature and the smallest fish size. Growth in seawater was influenced by the time of vaccination. At the end of the experiment, the group vaccinated last (MAR) was the heaviest of the vaccinated groups (4.0 kg), and the group vaccinated first, i.e. in August (AUG) was smallest (3.2 kg). Growth rate in seawater differed only in the summer when specific growth rate was above 1.45 in all groups. There was a correlation between adhesion, condition factor and number of weeks from vaccination to sea transfer. The AUG group had the highest condition factor, with a top level of 1.64 in autumn, and this group also displayed the highest incidence of deformed vertebra. The experiment shows that side effects of vaccination can be significantly reduced when planning the vaccination strategy, by taking environmental factors and fish biology into consideration.

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival

REASONS FOR PERFORMING STUDY

Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis.

OBJECTIVE

To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed.

METHODS

History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners.

RESULTS

The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection.

CONCLUSIONS

This study identified various factors that appear to predispose horses to long-term complications after colic surgery.

POTENTIAL RELEVANCE

Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.

The effects of combined liquid and membrane barriers in prevention of post-operative intra-abdominal adhesions after experimental jejunal anastomosis in dogs

The study was carried out on 40 apparently clinical healthy dogs classified into 5 groups of 8 dogs each. Adhesion was experimentally induced by transsection and reanastomosis of jejunum. In the control group the site of anastomosis and abdominal cavity was lavaged with 250 ml saline solution. In group two lavage was done with 250 ml of a liquid barrier composed of a combination of high molecular weight solution (1% sodium carboxymethylcellulose) as a carrier, non-steroidal anti-inflammatory drug (Piroxecam), broad spectrum antibiotic (Cephalosporin), anticoagulant (Heparin) and antioxidant (0.5% methylene blue). In group three the anastomosis site was covered with a sodium hyalouronate/carboxymethylcellulose bioresorbable membrane (Seprafilm). In group four a natural biocompatible collagen sheet (VET BIO SIS T) was applied on the anastomosis site. In group five the abdominal cavity was lavaged with 250 ml liquid barrier and the anastomosis site was covered by either Seprafilm membrane or VET BIO SIS T sheet. At the fourteen day after operation, adhesion was assessed by ultrasonography after instillation of 1000 ml of physiological saline solution into the abdominal cavity. The dogs were sacrificed and an autopsy examination was carried out with the attention to the number, density and site of the adhesion formation. The results revealed that all the control dogs and some dogs in the treatment groups had positive ultrasonographic findings. Transabdominal sonogram clearly showed echogenic bands floating in the abdominal cavity and echogenic masses in more serious subjects. Necropsy examination showed that all the control dogs had intra-abdominal adhesions (8 of 8 dogs) and treatment with liquid barrier (4 of 8 dogs), seprafilm membrane barrier (3 of 8 dogs), VET BIO SIS T sheet barrier (4 of 8 dogs) and combination of fluid and membrane barrier groups (4 of 8 dogs) significantly (p < 0.05) reduced the incidence of adhesion formation. The adhesion severity in the four treated groups was significantly (p < 0.05) decreased compared with the control group as shown by both ultrasonography and necropsy examination scores. In conclusion the suggested hypothesis is more or less positive and the combined liquid and membrane barriers might be an effective way to decrease intra-abdominal adhesion formation, and the ultrasonography is a useful tool to diagnose intra-abdominal adhesion, and their applications might be valuable to the clinical settings.

Evaluation of a Sheep Laparoscopic Uterine Trauma Model and Repeat Laparoscopy for Evaluation of Adhesion Formation and Prevention with Sodium Carboxymethylcellulose

OBJECTIVE

To evaluate topical application of 1% sodium carboxymethyl cellulose (SCMC) for prevention of postoperative adhesions in a laparoscopic model of uterine trauma in sheep.

STUDY DESIGN

Experimental study.

ANIMALS

Fourteen non-pregnant ewes.

METHODS

Ewes were randomly assigned to 1 of 2 groups: control (saline solution) or 1% SCMC treatment. By left flank laparoscopy, traumatic forceps were used to create serosal trauma (1.5 x 5 cm) and hemorrhage on the left uterine horn. Either 30 mL saline solution or 30 mL 1% SCMC was applied topically to the traumatized uterine horn. Adhesion formation was evaluated by repeat laparoscopy at days 14 and 21. Sheep were euthanatized on day 28 for necropsy evaluation of adhesions.

RESULTS

Five control sheep had adhesions of the uterine horn by day 14, but only 4 had adhesions at day 21, and 2 at day 28. Adhesions did not occur in SCMC-treated sheep. No adhesions occurred elsewhere in the abdomen.

CONCLUSIONS

Laparoscopically created uterine trauma is an effective method for induction of uterine adhesions, and laparoscopy is an excellent method for serial evaluation of adhesion formation. SCMC (1%) was effective at preventing adhesion formation in sheep and no inflammatory response was noted.

CLINICAL RELEVANCE

SCMC (1%) should be considered for prevention of adhesions in abdominal surgery in sheep.

Omentalization of a nonresectable uterine stump abscess in a dog

One month after ovariohysterectomy, a 2-year-old spayed female Golden Retriever was evaluated because of an extensive uterine stump abscess. Clinical signs included intermittent vomiting, signs of depression, lethargy, and pollakiuria. The dog underwent abdominal surgery; the greatly enlarged uterine stump was tightly adhered to the dorsal surface of the bladder, encompassing the distal portions of the ureters and the bladder's neurovascular supply. En bloc resection of the uterine stump was not considered an acceptable treatment option because of the risk of surgical damage to and subsequent devitalization of the bladder or ureters, urinary incontinence, or urinary tract obstruction. Therefore, the diseased uterine tissue that extended cranial to the bladder was resected, and the remaining abscess cavity was lavaged and packed with omentum. The dog recovered fully from the procedure. The omentum is an effective physiologic drain; its extensive vascular and lymphatic networks absorb fluid and actively promote elimination of infection. Omentalization appears to be an option for surgical management of nonresectable uterine stump abscesses in dogs.

Use of magnetic resonance imaging to identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses

Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament and the exostosis on the second metacarpal bone was identified and transected at surgery, and the exostosis and distal portion of the second metacarpal bone were removed. All horses were able to return to their previous athletic use following a 6-month rest and rehabilitation program for treatment of the suspensory desmitis. Findings in these horses suggest that adhesions between the suspensory ligament and an exostosis of the second metacarpal bone may be a cause of chronic or recurrent forelimb lameness in horses.

Comparison of two laparoscopic treatments for experimentally induced abdominal adhesions in pony foals

OBJECTIVE

To compare laparoscopic dissection with-laparoscopic dissection combined with abdominal instillation of ferric hyaluronate gel for the treatment of experimentally induced adhesions in pony foals.

ANIMALS

12 healthy pony foals.

PROCEDURE

A serosal abrasion method was used to create adhesions at 4 sites on the jejunum (day 0). At day 7 laparoscopy was performed and the adhesions observed in each foal were recorded. In group-1 foals (n = 6), the adhesions were separated laparoscopically (treatment 1). In group-2 foals (n = 6), 300 mL of 0.5% ferric hyaluronate gel was infused into the abdomen after the adhesions were separated laparoscopically (treatment 2). At day 24, terminal laparoscopy was performed and the adhesions observed were recorded. Total number of adhesions within each group was compared between day 7 and 24. Data were analyzed to determine whether an association existed between the number of adhesions on day 24 and treatment type.

RESULTS

At day 24, the number of adhesions was significantly decreased within each group, compared with the number of adhesions at day 7 (group-1 foals, 10 vs 22 adhesions; group-2 foals, 3 vs 20 adhesions). Treatment 1 was associated with a significantly higher number of adhesions at day 24, compared with treatment 2 (odds ratio, 4.54; 95% confidence interval, 1.03 to 23.02).

CONCLUSION AND CLINICAL RELEVANCE

Abdominal instillation of 0.5% ferric hyaluronate gel after laparoscopic dissection was a more effective technique than laparoscopic dissection alone to treat experimentally induced adhesions in pony foals. Laparoscopic adhesiolysis following abdominal surgery in foals is a safe and effective technique.

Effect of carboxymethylcellulose and hyaluronate solutions on jejunal healing in horses

OBJECTIVE

To compare a double-layer inverting anastomosis with a single-layer appositional anastomosis, coated with either 1% sodium carboxymethylcellulose (SCMC) or 0.4% sodium hyaluronate (HA) solutions, in the small intestine of horses with respect to anastomotic healing and adhesion formation.

ANIMALS

18 adult horses.

PROCEDURE

Midline celiotomy and end-to-end jejunal anastomoses were performed. In control group horses (n = 6), a double-layer inverting anastomosis coated with sterile lactated Ringer's solution was performed. In treatment group horses, a single-layer appositional anastomosis was performed that was coated with 1% carboxymethylcellulose solution (SAA + SCMC group horses, 6) or 0.4% hyaluronate solution (SAA + HA group horses, 6). An additional 500 mL of the respective treatment solution was applied to the jejunal serosal surface, and 2 jejunal serosal abrasion sites were created. Horses were euthanatized 10 days after surgery. Anastomoses and abdominal adhesions were evaluated grossly. Anastomotic healing was evaluated on the basis of bursting wall tension.

RESULTS

Bursting wall tension was significantly greater in SAA + SCMC group horses, compared with control group horses. All intestinal segments failed at a point distant to the anastomosis. Significantly fewer adhesions were found at the abrasion sites of SAA + HA group horses, compared with control group horses. No differences were found in adhesion formation at the anastomotic sites among groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Coating a single-layer appositional jejunal anastomosis with SCMC or HA solutions does not adversely affect anastomotic healing. Application of 0.4% HA solution to the serosal surface of the jejunum significantly decreases the incidence of experimentally induced intra-abdominal adhesion formation in horses.

Post surgical development of inflammatory adhesions and reticular function in cows suffering from traumatic reticuloperitonitis

Inflammatory adhesions between reticulum and ventral abdomen in patients suffering traumatic reticuloperitonitis (TRP) may induce a massive inhibition of reticular contractions and thereby an impairment of the separation process of particles in the reticulorumen. However, a substantial disturbance of digesta passage (Hoflund-syndrome) is found only in a few TRP-cows. We hypothesized that this is due to a retrieval of reticular motility due to rebuilding and degradation of adhesions within months after the removal of the foreign body as the primary inflammatory stimulus. Accordingly, it was the objective of this study (a) to assess the extent and structure of inflammatory adhesions in cows with TRP over a period of six months following surgery and (b) to persecute reticular function by characterizing the sequence of reticular contractions sonographically and by assessment of particle size distribution in the faeces of patients by means of wet-sieving. Twenty-six cows suffering from TRP were studied on the day of rumenotomy (day 1) and on day 6, day 12 and 6 months post operationem. Additionally, six healthy control cows were investigated once. All cows were on a hay and concentrate diet. On day 1, the reticular floor and the reticular wall were affected by adhesions in varying extent in all cows; the contraction distance and contraction velocity of the reticulum were markedly reduced and the portion of large particles in the faces increased compared to healthy cows. On day 12, the portion of large particles did not vary any more from that of control cows; a tendency towards an increased contraction distance compared to day 1 was found. Sonographically, only marginal differences were detected in respect to extent and consistency of adhesions. Six months after rumenotomy, in 9 of 16 re-investigated cows sonography revealed no adhesions at the reticulum at all, in other cases the extent of adhesions shrunk considerably. Contraction distance and contraction velocity and particle size distribution in the faeces were found to be nearly comparable to that of control cows. It is concluded that inflammatory adhesions disappear in the majority of the TRP-patients, as a consequence reticular function normalizes. A serious disturbance of digesta passage seems to develop exclusively in those patients with the most extensive adhesions and may be also in such cows, where the primary adhesions cause the development of extensive abscesses.

Prevention and treatment of gastrointestinal adhesions

As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, minimizing the propensity for adhesion formation between apposing adynamic segments of intestine. Mechanical separation of potentially adhesiogenic serosal and peritoneal surfaces is commonly achieved with use of abdominal lavage, protective coating solutions, and barrier membranes. Ongoing and future research is directed toward a better understanding of the local effects of intestinal trauma and the corresponding response of the fibrinolytic system. Recognition of horses at high risk for adhesion formation helps to guide the equine surgeon to an appropriate perioperative and intraoperative plan for adhesion prevention, including good surgical technique and a combination of adjunct therapies.

Symblepharon with aberrant protrusion of the nictitating membrane in the snowy owl (Nyctea scandiaca)

Two young snowy owl chicks were presented with aberrant protrusion of the nictitating membranes. This was caused by conjunctival adhesions causing symblepharon secondary to a previous septicemia episode. While symblepharon has been noted in birds before, this unusual presentation of the nictitating membrane has not been reported. Surgical intervention ameliorated the clinical signs, allowing vision in one bird by removal of the nictitating membranes, a technique which appeared to have no deleterious effects on the ocular surface.

Use of an active intra-abdominal drain in 67 horses

OBJECTIVE

To describe the insertion technique, efficacy, and complications associated with the use of an active (closed-suction) abdominal drain in horses.

STUDY DESIGN

Retrospective study. Animals-Sixty-seven horses with abdominal contamination treated by abdominal lavage and use of a closed-suction abdominal drain.

METHODS

Medical records of horses (1989-1996) that had a closed-suction abdominal drain were reviewed. Follow-up information was obtained by telephone interviews with owners.

RESULTS

Sixty-eight closed-suction abdominal drains were used in 67 horses that had abdominal contamination, peritonitis, or to prevent adhesion formation. The drain was placed under general anesthesia (62 horses) or in a standing position (6 horses). Abdominal lavage was performed every 4 to 12 hours and about 83% of the peritoneal lavage solution was retrieved. Minor complications associated with drain use occurred in 49% of the horses and included obstruction or slow passage of fluid through the drain in 18 horses (26%), leakage of fluid around the drain in 11 horses (16%), and subcutaneous fluid accumulation around the drain in 8 horses (12%). Incisional suppuration developed in 20 of 62 (32%) and incisional herniation in 5 of 46 (11%) horses.

CONCLUSIONS

A closed-suction drain system was easily placed and was associated with only minor complications in most horses.

CLINICAL RELEVANCE

Active abdominal drainage and lavage is a useful adjunct in the treatment of peritonitis or as a prophylactic procedure in horses at risk of developing septic peritonitis and abdominal adhesions. Clinicians should be aware of the high incidence of minor complications.

Evaluation of laparoscopic adhesiolysis for the treatment of experimentally induced adhesions in pony foals

OBJECTIVE

To assess the efficacy of laparoscopic adhesiolysis in the treatment of experimentally induced adhesions in foals.

ANIMALS

8 healthy pony foals.

PROCEDURE

Celiotomy was performed and adhesions created at the jejunoileal junction and at sites 0.5 and 1 m proximal to this junction, using a serosal abrasion method. Ten days after celiotomy, exploratory laparoscopy was performed. Laparoscopic adhesiolysis was performed in the treatment group only (4 foals, randomly selected). Thirty days after the exploratory laparoscopy, a final laparoscopic examination was performed, and the foals were euthanatized. The number and characteristics of abdominal adhesions were recorded during laparoscopy 10 and 30 days after celiotomy and during necropsy.

RESULTS

At 30 days after celiotomy, the number of adhesions in the control group was significantly higher than the number in the treatment group. In the control group, all adhesions observed during the exploratory laparoscopy were still evident at the final laparoscopy and necropsy. In the treatment group, adhesions did not form again after separation. During final laparoscopy and necropsy, a focal adhesion between the omentum and site of the initial laparoscope portal was observed in 5 of 8 foals.

CONCLUSIONS AND CLINICAL RELEVANCE

The serosal abrasion model is useful for studying abdominal adhesions in foals. Laparoscopic adhesiolysis was an effective technique to break down experimentally induced adhesions in the early maturation stage of formation in pony foals. Studies are required to investigate prevention of de novo adhesions at the laparoscope portal sites.

One percent sodium carboxymethylcellulose prevents experimentally induced abdominal adhesions in horses

OBJECTIVE

To evaluate the efficacy of 1% sodium carboxymethylcellulose (SCMC) for prevention of experimentally induced abdominal adhesions in horses.

STUDY DESIGN

Prospective, controlled, experimental study.

ANIMAL POPULATION

Twelve healthy adult horses.

METHODS

The effect of 1% SCMC on adhesion formation was evaluated in 12 healthy horses by using an established model of serosal trauma to induce intraabdominal adhesions. After ventral median celiotomy, 2 separate areas of the jejunum were abraded, and three 2-0 chromic gut sutures were placed in each abraded area. Jejunal resection and end-to-end anastomosis was performed at 2 sites distant to the abrasion sites. In treated horses (n = 6), 2 L of 1% SCMC was applied to the intestine before and after intestinal manipulation. In control horses (n = 6), 2 L of saline solution were applied to the intestine before and after surgical manipulation. All horses were euthanatized 10 days after surgery, and the abdominal cavity was evaluated for adhesion formation. The frequency of intraabdominal adhesions between groups was compared with a chi-square test. Statistical significance was set at P <.05.

RESULTS

All control horses had intraabdominal adhesions. Fibrous adhesions were associated with both jejunal abrasion sites in 5 control horses. Fibrous adhesions were also associated with 1 or both jejunal anastomotic sites in 5 control horses. Only 1 treated horse developed adhesions at the jejunal abrasion sites, and no adhesions were present at the anastomotic sites in the treated horses. There were significantly fewer adhesions in the SCMC treatment group compared with the control group (P <.05).

CONCLUSION

In this experimental model, application of 1% SCMC reduced the frequency of intraabdominal adhesions at areas of serosal abrasion and at jejunal anastomotic sites.

CLINICAL RELEVANCE

In horses at an increased risk for developing intraabdominal adhesions after intestinal surgery, the use of 1% SCMC during celiotomy may decrease the frequency of adhesion formation.

Chronic primary splenic torsion with peritoneal adhesions in a dog: case report and literature review

Primary splenic torsion in dogs is uncommon and can occur in acute or chronic form. The chronic form is difficult to diagnose because the clinical signs are vague and sometimes intermittent. A dog with a history of diaphragmatic hernia repair two years previously presented with chronic, vague clinical signs and an abdominal mass. The mass was revealed to be spleen on ultrasonography. On exploratory laparotomy, the dog was found to have a splenic torsion of approximately 180 degrees with mature, fibrous adhesions retaining the spleen in a torsed position. A splenectomy was performed, and the dog recovered uneventfully with complete resolution of prior clinical signs. Prognosis for dogs with splenic torsion is good, although complications are relatively common.

Evaluation of a bioresorbable hyaluronate-carboxymethylcellulose membrane for prevention of experimentally induced abdominal adhesions in horses

OBJECTIVE

To evaluate the efficacy of a bioresorbable hyaluronate-carboxymethylcellulose membrane (HA-membrane) for prevention of experimentally induced abdominal adhesions in horses.

STUDY DESIGN

Experimental study.

ANIMAL POPULATION

Twelve healthy adult horses.

METHODS

The effect of an HA-membrane on adhesion formation was evaluated in 12 healthy horses using an established model of serosal trauma to induce adhesions. A ventral median celiotomy and two jejunal resections and end-to-end anastomoses were performed. Two separate jejunal areas were abraded, and three 2-0 chromic gut sutures placed in the abraded areas. In treated horses (n = 6), HA-membranes were applied to the jejunum to completely cover the anastomoses and abraded areas of jejunum. Nontreated horses (n = 6) served as controls. All horses were killed 10 days after surgery. The abdominal cavity was evaluated for adhesion formation. The frequency of intra-abdominal adhesions between groups was compared with a chi2 test with statistical significance set at P < .05.

RESULTS

All control horses had intra-abdominal adhesions; fibrous adhesions were associated with both jejunal abrasion sites in 5 horses. One treated horse developed adhesions. There were significantly fewer adhesions in the HA-membrane-treated group (P < .0034).

CONCLUSIONS

In this experimental model, application of an HA-membrane to a localized area of serosal trauma reduced the frequency of intra-abdominal adhesion formation.

CLINICAL RELEVANCE

Application of an HA membrane may decrease the frequency of adhesions in horses at an increased risk of postoperative adhesion formation.

Tissue reactivity to poliglecaprone 25 in the feline linea alba

OBJECTIVE

To use poliglecaprone 25 for all ligations and closure in routine feline ovariohysterectomies and evaluate maintenance of tissue approximation and tissue reaction to the suture.

STUDY DESIGN

Prospective, descriptive study.

ANIMALS

Twenty four female cats.

METHODS

Ovariohysterectomies were performed in all cats. Abdominal incisions were inspected on days 1, 3, 7, 14, and 28 for dehiscence and swelling. All cats were euthanatized postoperatively, group 1 on day 7; group 2 on day 14; and group 3 on day 28. The peritoneal cavity was inspected for adhesions and all abdominal incisions were collected en bloc. Each linea alba was histologically evaluated and the inflammatory reaction was characterized.

RESULTS

Dehiscence did not occur in any of the 24 cats. The incisional swelling on day 1 was significantly smaller than on day 7, and the swelling on day 14 was significantly smaller than on days 1, 3, and 7 (P < .05). Intra-abdominal adhesions were found in all groups with the greatest number associated with the peritoneum at the incision site. Tissue reactions in group 1 were pyogranulomatous or fibromononuclear, group 2 were granulomatous or fibromononuclear, and group 3 were pyogranulomatous, granulomatous, fibromononuclear or fibrous. Eosinophilic infiltration was seen in 3 of the 8 cats in group 1.

CONCLUSIONS

Incisional swelling and inflammatory reactions seen with poliglecaprone 25 were consistent with those anticipated after implantation of suture in a surgically created wound.

CLINICAL RELEVANCE

Poliglecaprone 25 appears to be an acceptable suture for use in feline ovariohysterectomy. It causes a relatively short-lived inflammatory response.

Chyloperitoneum and abdominal adhesions in a miniature horse

Chyloperitoneum is a potential cause of colic in horses. Although rare in horses, chyloperitoneum can develop secondary to tearing of mesenteric adhesions and rupture of mesenteric lymphatic vessels. The prognosis for horses with chyloperitoneum depends on the underlying cause and the response to treatment.

The efficacy of mechanical abrasion and talc slurry as methods of pleurodesis in normal dogs

OBJECTIVE

To determine the efficacy of mechanical abrasion and talc slurry as methods for pleurodesis in normal dogs.

STUDY DESIGN

Experimental study.

ANIMALS OR SAMPLE POPULATION

Ten normal beagle dogs.

METHODS

Group I dogs had mechanical abrasion (MA) of the pulmonary and costal pleurae performed in one hemithorax with a dry gauze sponge with a median sternotomy approach. Group II dogs had 100 mL of a 1 g talc slurry (TS) administered into one hemithorax through a tube thoracostomy. Administration of the TS was visualized by using video thoracoscopy. All dogs were evaluated at 2, 10, 20, and 30 days postoperatively by means of thoracic radiography and ultrasonographic thoracic wall measurement. The dogs were euthanatized 30 days postoperatively and a gross necropsy was performed. Hemithoraces were assigned a pleurodesis score (0-4) and an obliteration grade (0-6). Tissues were collected for histopathologic examination of pulmonary pleura, costal pleura, and pleural adhesions. Pulmonary and costal pleurae were graded for the degree of fibrosis (0-4).

RESULTS

Obliteration grade and costal pleural fibrosis score were significantly higher for the treated sides in the MA dogs compared with the TS dogs. MA Dogs: Mechanical abrasion dogs had pleurodesis, obliteration, and pleural fibrosis scores that were greater on the treated side than the untreated side, however, the differences were not statistically significant. Only two MA dogs had firm adhesion of the pulmonary pleura to the costal pleura in portions of the cranial and middle lung lobes in the treated hemithorax. Thoracic wall surface area covered with adhesions was 15% and 21% in each of these two dogs. The median pulmonary pleural fibrosis score of all MA dogs for the treated hemithorax was 3 compared to 0 on the untreated side. TS Dogs: There was no statistical difference for pleurodesis scores and obliteration grades between the treated and untreated sides. No dogs showed evidence of pulmonary to costal pleural adhesions. Histopathology showed talc crossover into the untreated side in all five dogs. Median pulmonary fibrosis score of the treated hemithorax was 1 compared with 0 on the untreated side.

CONCLUSIONS

Neither method of pleurodesis produced sufficient pleural adhesions to obliterate the pleural space. It is possible that the degree of pulmonary pleural fibrosis present in MA dogs may be sufficient to limit air leakage from pulmonary blebs and bullae resulting in successful treatment of spontaneous pneumothorax.

Partial colonic obstruction following ovariohysterectomy: a report of three cases

Partial extramural obstruction of the descending colon was diagnosed in two dogs and a cat as a complication of elective ovariohysterectomy. In each case, the obstruction was caused by fibrous tissue that encircled or crossed the descending colon, severely restricting the organ's normal mobility and luminal diameter. Clinical signs secondary to obstipation were observed in two cases, five weeks and 27 months after elective ovariohysterectomy. In one dog without clinical signs, the adhesion was an incidental finding during a laparotomy performed nine years after the ovariohysterectomy. The fibrous adhesions were removed surgically in all three cases without additional complications.

Ultrasonographic evaluation of adhesions induced by incisional gastropexy in 16 dogs

A study was undertaken to evaluate the use of ultrasonography to assess the gastropexy site for permanent adhesion in clinical cases. Two groups, each comprising eight dogs, were studied, all 16 cases undergoing decompression, anatomical repositioning of the stomach and an incisional gastropexy after gastric dilatation-volvulus (GDV). Group 1 was set up as a prospective group in which ultrasonographic examinations were performed three times (mean three, 12 and 67 days) after surgery to evaluate the gastropexy region. The gastropexy site was assessed ultrasonographically at only one stage (mean 449 days after surgery) in the group 2 dogs. Criteria used to assess the usefulness of the ultrasonographic evaluation included the ability to identify the gastropexy site, to obtain measurements of the length and thickness of the site and to assess the ultrasonographic appearance of the different gastric wall layers. The average number of peristaltic contractions and degree of gastric filling were also evaluated. The fixation between the stomach and the abdominal wall was easily detected in all 16 cases. Ultrasonography proved to be a simple and non-invasive technique to assess the permanency of the gastropexy. The incisional gastropexy was relatively easy to perform and induced permanent adhesions in all 16 dogs, without recurrence of GDV.

Concurrent abomasal displacement and perforating ulceration in cattle: 21 cases (1985-1996)

OBJECTIVE

To evaluate the association of physical examination and clinicopathologic findings with surgical findings in cattle with concurrent abomasal displacement and perforating ulceration, to determine short- and long-term survival rates in these cattle, and to determine whether degree of peritonitis (focal vs diffuse) influences survival rates.

DESIGN

Retrospective study.

ANIMALS

21 cattle with concurrent abomasal displacement and perforating ulceration and 42 cattle with uncomplicated abomasal displacement.

PROCEDURE

Information on signalment, stage of lactation, physical examination findings, clinicopathologic data, surgical diagnosis, procedure(s) performed, and necropsy findings were retrieved from medical records of all cattle included in this study. Differences between physical examination findings of cattle with concurrent disease and those of cattle with uncomplicated displacements were evaluated, as were differences between survival rates in cattle with focal versus diffuse peritonitis.

RESULTS

Cattle with concurrent disease had a greater probability of having pneumoperitoneum and signs of abdominal pain identified on physical examination than did cattle with uncomplicated diseases. There was no relationship between clinicopathologic data and survival time. Short-term survival rate was 38%, and degree of peritonitis significantly influenced survival time in cattle with concurrent abomasal displacement and perforating ulceration. Long-term survival rate in these cattle was 14%.

CLINICAL IMPLICATIONS

Cattle with concurrent displaced abomasum and perforating ulceration have a poor chance for survival. In addition to detection of displaced abomasum, physical examination findings that can help lead to a presurgical diagnosis of this syndrome are pneumoperitoneum and signs of abdominal pain.

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.

Effect of omentectomy on adhesion formation in horses

OBJECTIVE

To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions.

STUDY DESIGN

Retrospective study.

ANIMALS OR SAMPLE POPULATION

44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery.

METHODS

Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model.

RESULTS

Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P = .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P = .001) than the frequency only in the large intestine.

CONCLUSIONS

Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine.

CLINICAL RELEVANCE

Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.

Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions

OBJECTIVE

To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.

STUDY DESIGN

Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.

ANIMALS OR SAMPLE POPULATION

12 horses.

METHODS

Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.

RESULTS

All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less (P < .0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.

CONCLUSIONS

Peritoneal lavage reduced the frequency of intraabdominal adhesions.

CLINICAL RELEVANCE

When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.

Survey of diplomates of the American College of Veterinary Surgeons regarding postoperative intra-abdominal adhesion formation in horses undergoing abdominal surgery

OBJECTIVE

To obtain information from specialists in equine surgery as to prevalence of, predisposing factors for, and methods to prevent postoperative adhesion formation in horses undergoing abdominal surgery.

DESIGN

Survey.

PROCEDURE

Surveys were mailed to 196 diplomates of the American College of Veterinary Surgeons involved in equine practice.

RESULTS

60 (31%) surveys were returned. Most respondents (55/60) routinely informed clients of the risk of postoperative adhesion formation in horses with small intestinal lesions. When asked after which procedures they routinely used measures to prevent adhesions, 56 of 60 (93%) indicated that they did after small intestinal resection and anastomosis and 56 of 60 (93%) indicated that they did after any abdominal surgery in foals. The 4 methods most frequently listed when respondents were asked which methods were effective at preventing adhesion formation were meticulous surgical technique, administration of antibiotics and nonsteroidal anti-inflammatory drugs, intraoperative peritoneal lavage, and methods that prevent abdominal contamination. Most respondents (50/60) thought that at least some horses with colic secondary to adhesion formation could be managed medically. Fifty-four (90%) respondents indicated that they were successful less than half of the time when treating horses with adhesions severe enough to require additional surgery.

CONCLUSION

In general, respondents thought that less than 15% of horses undergoing abdominal surgery would develop adhesions, but that horses with small intestinal disease and foals were most prone to develop adhesions. Meticulous surgical technique was thought to be the most important factor in preventing adhesions, and many prevention regimens reported to be effective in the literature were not commonly used in practice.

Chronic colic in the mature horse: a retrospective review of 106 cases

The clinical features of 106 horses presenting with chronic colic examined over a 5 year period were reviewed. Chronic colic was defined as colic signs observed daily for 3 days or longer, except when masked by analgesics. The diagnosed causes of chronic colic included colonic impaction (31%), peritonitis (16%), enteritis/colitis (7%), colonic displacement/torsion (6%) and lymphosarcoma (4%). A variety of other diseases were diagnosed in a small number of cases, including intestinal adhesions, ileal obstructions, grass sickness, liver disease, caecal impactions, thromboembolic disease, intussusceptions etc. No diagnosis was reached in 8% of cases. Diagnosis was relatively easily achieved in most cases of colonic impaction and peritonitis by results of transrectal palpation and evaluation of peritoneal fluid. Specific clinical features, transrectal palpation, abdominal paracentesis and laboratory evaluations of blood were helpful in the diagnosis of some of the other diseases, but exploratory laparotomy remained necessary in a few cases to achieve a diagnosis.

Laparoscopic adhesiolysis in a horse

OBJECTIVE

The purpose of this report was to describe the use of laparoscopy as a method of treatment for abdominal adhesions in the horse.

CLINICAL REPORT

Unilateral ovariectomy for removal of a granulosa cell tumor was performed through a diagonal paramedian approach in a 14-year-old Arabian mare. Progressive incisional swelling and hemorrhage culminated in acute incisional dehiscence with herniation of ileum on the sixth postoperative day. Septic peritonitis that responded to parenteral antibiotic therapy was identified 7 days after hernia repair. Seven days later, the mare had signs of abdominal pain, and adhesions of small intestine to the paramedian incision were identified on rectal palpation. Transrectally assisted laparoscopic adhesiolysis was performed. No further complications occurred.

CLINICAL RELEVANCE

Laparoscopic adhesiolysis may provide better observation of adhesions and reduced postoperative morbidity compared with laparotomy.

Recurrent colic in the mature horse: a retrospective review of 58 cases

The clinical features of 58 horses presenting with recurrent colic examined over a 5 year period were reviewed. The horses were categorised into 3 groups on the basis of the history of colic episodes. Recurrent transient colic Group 1 was characterised by 3 or more episodes of transient colic (of apparently similar type) occurring within one month. Recurrent transient colic Group 2 was characterised by 3 or more episodes of transient colic occurring within one year. Recurrent prolonged colic was characterised by 3 or more episodes of prolonged colic occurring within one year. Fifteen horses were classified as recurrent transient colic Group 1. This group had the highest mortality rate 53%. They included 3 horses with lymphosarcoma, 2 with intussusceptions, 2 with thromboembolic disease/verminous arteritis and 2 with partial ileal obstructions. The recurrent transient colic Group 2 comprised 27 cases with a mortality rate of 4%. Nine of these horses were affected by spasmodic colic. The recurrent prolonged group involved 16 horses with a mortality rate of 31%. These included 3 cases of recurrent colonic impaction and 2 cases each of lymphosarcoma, 2 thromboembolic disease, 2 partial ileal obstructions and 2 intestinal adhesions.

Evaluation of exploratory laparotomy in young horses: 102 cases (1987-1992)

OBJECTIVE

To determine, in a population of young horses, whether a variation exists among neonates, sucklings, weanlings, and yearlings regarding recovery from anesthesia, short- and long-term survival rates, and postoperative adhesion formation following exploratory laparotomy.

DESIGN

Retrospective study.

ANIMALS

102 horses < 25 months old that underwent exploratory laparotomy.

PROCEDURE

Pre-, intra-, and postoperative information was retrieved from medical records, conversations with referring veterinarians, owners, or trainers, and race records. Survival rates (recovery from anesthesia and short- and long-term survival) were compared with age, lesion type, lesion location, surgical procedure, and development of clinically important postoperative intestinal adhesions.

RESULTS

Of the 73 horses that recovered from anesthesia, 69 were available for follow-up. Of the 69 horses, 7 (10%) died of complications associated with formation of intestinal adhesions. Age did not affect incidence of adhesion formation, lesion type, lesion location, or surgical procedure performed. Long-term survival rate after surgery for correction of a small-intestinal lesion was 34%, whereas that after surgery for correction of a large-intestinal lesion was 65%.

CLINICAL IMPLICATIONS

Surgical treatment of colic in young horses resulted in survival rates that are similar to those reported for mature horses. The incidence of clinically important postoperative adhesions was greater than that found for young horses in earlier studies. This may be the result of the younger age of our study population. Alternatively, improvements in operative techniques and postoperative management may allow a larger percentage of horses to survive long term and develop complications such as adhesion formation.