Clinical findings and outcome
On admission to the hospital the gelding was bright and alert with a slightly elevated heart rate of 44 beats per minute, but no colic signs. The abdominal bandage was in place with evidence of peritoneal fluid draining through it. A preoperative blood sample revealed a packed cell volume (PCV) of 28% (normal reference range [rr] 30-50%), total protein of 52g/L (rr 51-83g/L), peripheral lactate of 0 mmol/L (rr <10 mmol/L) and mild leucopenia (WBC count 4.7x109/l; rr 5-10 x109/l).
Following aseptic placement of a 14 gauge intravenous catheter2 in the left jugular vein and sedation with romifidine3 ( 0.15mg/kg IV), anaesthesia was induced with ketamine4 (2.8mg/kg IV) and diazepam5 (0.04mg/kg). A swing door was used to encourage safe induction and to minimize trauma to the intestines. The horse was placed in dorsal recumbency and anaesthesia was maintained with isofluorane6 in 100% oxygen. Removal of the bandage revealed a 15cm diameter necrotic full thickness segment of the body wall including the necrotic sarcoid on the ventral caudal midline abdomen (Figures 1 and 2). Direct communication with the peritoneal cavity was present on the left side of the lesion from which approximately 1m of jejunum had eviscerated. This jejunum was moderately contaminated with debris and pus, and there was serosal inflammation and haemorrhage within the mesentery. The body wall adjacent to the defect appeared devitalised with a 10cm diameter segment of compromised tissues, contaminated with maggots (Figure 3).
Due to the degree of contamination, and necrosis of the skin and muscular tissue, treatment by debridement and closure using a mesh device was recommended, and the owner was advised of a guarded prognosis due to potential risks of peritonitis, infection of the implant and wound dehiscence. Due to limited finances and the guarded prognosis, the owner elected to euthanase the horse.