Ileal Bypass Followed by Tiflostomy to Treat Acute Abdomen in a Horse
Background: Equine gastrointestinal colic cases represent one of the diseases with higher morbidity and mortality. Short and long term survivals are commonly correlated with the colic causes, being considered 50% the survival rate of horses referred to surgery because of small intestine strangulative causes. The jejuno-caecostomy technique is recommended in cases of ileum necrosis or ischemia that indicates ileum removal. The survival rate after this procedure is low, being even lower than others common terminal-terminal enteroanastomoses. This study reports a case of jejuno-caecostomy followed by tiflopexy and tiflostomy performed in a colic horse.
Case: A 12-year-old mare, mangalarga breed, with a history of acute abdomen during 18 h was referred to the FZEA-USP equine hospital. According to the owner, the animal suffered previous episodes of colic that had been solved without treatment. On this occasion, the owner, without veterinary advice, had administered 10 mL of flunixin meglumine, but the animal did not show improvement. During the examination, the patient presented tachycardia, tachypnea, toxemic mucosa, a large amount of enterogastric reflux, and it was possible to observe distended small intestine during rectal palpation. The horse was referred to surgery; it was possible to identify necrosis of the ileum and 30 cm of the aboral segment of the jejunum, caused by strangulation due to a pedunculated lipoma localized in the medial band of the caecum. Latero-lateral jejuno-caecostomy was performed between the medial and dorsal bands of the caecum, using polyglactin 910, nº 2.0, potassium penicillin 30.000 IU / kg, every 6 h, gentamicin 6.6 mg / kg, every 24 h, flunixin meglumine 1.1 mg / kg, every 12 h and maintenance fluid therapy were performed post operatively. The animal had ileus and severe enterogastric reflux for five days postoperatively, showing severe signs of endotoxemia, and parenteral hydration seemed to be not enough. So it was decided to hydrate the animal through the caecum. It was performed a tiflostomy and the implantation of a Foley catheter, nº 24, followed by tiflopexy. During this procedure, it was possible to diagnostic, via intra-abdominal palpation, a significant type I cecal impaction. Immediately after the procedure, the animal presented no more enterogastric reflux and started to defecate pasty manure. Two days after the procedure, the animal died. During necropsy, the anastomoses region showed a great healing process, without folds or stenosis and the functional test of the region was performed, showing no leakage, ensuring the success of the anastomosis technique; the tiflopexy was adequate, and the other intestinal segments presented normal.
Discussion: In this report it was possible to observe several postoperative complications such as enterogastric reflux, type I caecum impaction, ileus, and endotoxemia, which was determinant for the death of the animal. Probably the cecal impaction was responsible for the enterogastric reflux and ileus, contributing with the endotoxemia and hydro electrolytic imbalance. These facts evidenced the necessity of faster and more efficient actions in future cases with similar complications, such as the accomplishment of a tiflostomy more precociously avoiding the impaction of caecum and minimizing the electrolytic imbalances of the patients. It was concluded that the delay in the patient referral, followed by the advanced hydro electrolytic imbalance and endotoxemia were the main factors responsible for the treatment failure.
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