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.