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).
.