Case details
A 9-year-old Thoroughbred mare, three months pregnant, was referred to Hagyard Equine Medical Institute with a history of mild to moderate colic signs. Prior to arrival, 12 ml of flunixin meglumine was administered. Upon arrival, the mare was quiet, alert, and responsive. Mucous membranes were pink and moist with two seconds capillary refill time. Vitals demonstrated a heart rate of 44 beats per minute, respiratory rate of 16 breaths per minute, and temperature of 100.3°F. A nasogastric tube was placed yielding no net reflux. An intravenous catheter was placed aseptically in the left jugular vein.
Abdominal ultrasonography revealed a gas distended stomach, one distended loop of small intestine (6cm) with normal wall thickness (<2mm) on ventral midline, and in the same area another loop of small intestine associated with a circular mixed echogenicity (Fig 1 and 2). Abdominocentesis showed a mildly serosanguinous fluid, a lactate of 4.8 mmol/L (normal reference range: <2 mmol/L) and a total protein of 2.2 gm/dl (normal reference range:<2.5 gm/dl). Cytology was normal, with a few white blood cells seen, primarily polymorphonuclear (PMN) neutrophils, non-degenerated, and occasionally macrophages. Moderate red blood cells were also seen. There was no plant, fecal material or bacteria seen. Blood lactate was 1 mmol/L (normal reference range: <0.7 mmol/L). Due to ultrasound exam findings, exploratory celiotomy was recommended.
The mare was sedated with xylazine (1.1 mg/kg, IV) and butorphanol (0.02 mg/kg, IV) and then induced using ketamine (2.2 mg/kg, IV) and diazepam (0.05 mg/kg, IV). General anesthesia was maintained using isoflurane and 100% supplemental oxygen. The ventral abdomen was aseptically prepared.
An approximately 20 cm ventral midline skin incision was made cranially from the umbilicus with a number 10 scalpel blade and continued through the subcutaneous tissue and the line-alba. Abdominal exploration revealed approximately 1.5 feet of dark red, distended loop of small intestine in the distal one-third of the jejunum (Fig 3). Significant orad jejunal distension was present.
Due to the nonviable appearance, an end-to-end jejunojenunostomy was performed. First, the mesenteric vessels were double ligated using 2-0 polydioxanone proximal and distal to the affected segment. A ¼” penrose drain was placed surrounding the small intestinal lumen via a stab incision through the mesentery proximal and distal to the proposed resection location. The mesentery was transected using a Metzenbaum scissor at the level of the ligations previously performed. After that, the affected portion of the small intestine was transected using a number 10 scalpel blade at approximately 60 degrees from the mesenteric attachment, making the mesenteric portion longer than the antimesenteric, to create a large stoma and preserve blood flow to the antimesenteric side. Finally, the anastomosis of both ends of the small intestine was performed using a single-layer interrupted Cushing pattern at the mesenteric and antimesenteric borders using 2-0 polydioxanone.
A sample of the affected jejunum was submitted to the University of Kentucky Veterinary Diagnostic Lab for histopathology (Fig 4).
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