Hemorrhagic Septic Thrombophlebitis in Horses

Abstract

Background: Thrombophlebitis represents the main disease of the cardiovascular system of horses, its occurrence is strongly associated with the use of inappropriate materials and techniques. Its clinical presentation varies according to the degree of vessel obstruction and the appearance of complications, in the diagnosis it is essential to assess the extent of damage and the severity of the case. Establishing appropriate treatments, it should be noted that these are mostly clinical, reserving surgical interventions for severe cases, so the aim of the study is report a case of hemorrhagic septic thrombophlebitis treated by partial phlebectomy of the left jugular vein.

Case: A 9-year-old male castrated equine, with no defined racial pattern, weighing 345 kg, used in the practice of vaquejada was attended at the Veterinary Hospital (HV) of the Federal University of Campina Grande (UFCG), Campus Patos (PB). During the anamnesis, it was reported that the animal presented colic a month ago, it was treated, recovered and since then, it started presenting an area with increase in volume in the neck region that ruptured the day before the HV attendance, where blood and pus came from. On physical exam, slight edema was noted in the left masseteric region, a volume rise involving the middle and cranial third of the neck with firm consistency in the left jugular sulcus, sensitivity to palpation and little drainage of purulent bloody secretion was observed. Additionally, tachycardia, tachypnea and intestinal hypomotility were found. In turn, in the ultrasound exam, a hypoechoic structure was seen, causing partial obstruction of the vessel, proximal to the fistulated region and total obstruction distal to it. With this information, antibiotic therapy was prescribed, a warm compress followed by the use of anti-inflammatory gel every 8 hours. By choice of the owner, the animal returned to the farm, in the next day returned to the Veterinary Hospital, due to extensive bleeding observed on the estate, immediately tried to stanch the bleeding by compressive banding, without success, we opted for the surgical intervention aiming to perform ligation and partial resection of the jugular vein. Pre-anesthetic medication was performed and under general anesthesia a rectilinear incision was made over the left jugular vein of the neck caudal region to bifurcation of lingual and facial veins, blunt dissection aiming to loosen the vessel and hemostasis of the installed neovascularization, transfixing proximal ligation with 1-0 nylon thread, diaeresis, removal of the vessel, reduction of the subcutaneous space, application of drain, dermorrhaphy in simple continuous pattern and use of compressive curative. For the postoperative period, maintenance of the initial antibiotic therapy was prescribed, adding flunixin meglumine 1.1 mg/kg, i.m, SID, 4 applications, tetanus serum 5000 UI/IM, antiphlogistic massage in the masseter region and wound treatment by washing with hypersaturated solution, use of sugar, healing pomade and repellent. One month after surgery, the animal received medical release with satisfactory healing, recovery from anemic and infectious condition, without circulatory complications.

Discussion: The present report shows the feasibility of unilateral partial phlebectomy of the jugular vein as a therapeutic option in complicated cases of thrombophlebitis. In which thrombectomy techniques are contraindicated and ineffective clinical treatments, another alternative is vascular transplantation, which encounters many logistical difficulties in the routine. Despite the interruption of blood flow being pointed out as an aggravating factor, it should be noted that often thrombophlebitis itself leads to this condition, and the development of collateral circulation secondary to venous flow obstruction has been observed.