• 1. Sutter WW, Hardy J. Laparoscopic repair of a small intestinal mesenteric rent in a broodmare. Vet Surg 2004; 33: 9295.

  • 2. Huskamp D. Diagnosis and treatment of acute abdominal conditions in the horse: various types and frequency as seen at the animal hospital in Hochmoor, in Proceedings. Equine Colic Res Symp 1982; 1: 261272.

    • Search Google Scholar
    • Export Citation
  • 3. Tennant B. Intestinal obstruction in the horse: some aspects of differential diagnosis in equine colic, in Proceedings. 21st Annu Meet Am Assoc Equine Pract 1975; 426438.

    • Search Google Scholar
    • Export Citation
  • 4. Phillips TJ, Walmsley JP. Retrospective analysis of the results of 151 exploratory laparotomies in horses with gastrointestinal disease. Equine Vet J 1993; 25:427.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Edwards GB. Obstruction of the ileum—a common indication for surgery, in Proceedings. 14th Bain-Fallon Mem Lect 1992; 143150.

  • 6. Freeman DE. Small intestine. In: Auer J, Stick JA, eds. Equine surgery. 4th ed. St Louis: Elsevier, 2012; 434.

  • 7. Gayle JM, Blikslager AT, Bowman KF. Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990–1997). J Am Vet Med Assoc 2000; 216: 14461449.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Galuppo LD, Snyder JR, Pascoe JR. Laparoscopic anatomy of the equine abdomen. Am J Vet Res 1995; 56: 518531.

  • 9. Targarona EM, Gracia E, Rodriguez M, et al. Hand-assisted laparoscopic surgery. Arch Surg 2003; 138: 133141.

  • 10. Keoughan CG, Rodgerson DH, Brown MP. Hand-assisted laparoscopic left nephrectomy in standing horses. Vet Surg 2003; 32: 206212.

  • 11. Romero A, Rodgerson DH, Fontaine GL. Hand-assisted laparoscopic removal of a nephroblastoma in a horse. Can Vet J 2010; 51: 637639.

  • 12. Rodgerson DH, Brown MP, Watt BC, et al. Hand-assisted laparoscopic technique for removal of ovarian tumors in standing mares (Erratum published in J Am Vet Med Assoc 2002; 221:272). J Am Vet Med Assoc 2002; 220: 15031507.

    • Search Google Scholar
    • Export Citation
  • 13. Goodin JT, Rodgerson DH, Gomez JH. Standing hand-assisted laparoscopic ovariectomy in 65 mares. Vet Surg 2011; 40: 9092.

  • 14. Janicek JC, Rodgerson DH, Boone BL. Use of a hand-assisted laparoscopic technique for removal of a uterine leiomyoma in a standing mare. J Am Vet Med Assoc 2004; 225: 911914.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Muňoz J, Bussy C. Standing hand-assisted laparoscopic treatment of left dorsal displacement of the large colon and closure of the nephrosplenic space. Vet Surg 2013; 42: 595599.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Larsson A. Intracorporeal suturing and knot tying in surgical simulation. Stud Health Technol Inform 2001; 81: 266271.

Advertisement

Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse

Thomas H. WitteSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Thomas H. Witte in
Current site
Google Scholar
PubMed
Close
 BVetMed, PhD
,
Markus WilkeSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Markus Wilke in
Current site
Google Scholar
PubMed
Close
 Dr med vet
,
Christina StahlSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Christina Stahl in
Current site
Google Scholar
PubMed
Close
 Dr med vet
,
Vendula JandováSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Vendula Jandová in
Current site
Google Scholar
PubMed
Close
 Dr med vet
,
Rhea HaralambusSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Rhea Haralambus in
Current site
Google Scholar
PubMed
Close
 Dr med vet et scient
, and
Reto StraubSwiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland.
Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.

Search for other papers by Reto Straub in
Current site
Google Scholar
PubMed
Close
 Dr med vet

Abstract

Case Description—A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain.

Clinical Findings—Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain.

Treatment and Outcome—Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully.

Clinical Relevance—HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

Abstract

Case Description—A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain.

Clinical Findings—Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain.

Treatment and Outcome—Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully.

Clinical Relevance—HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

Contributor Notes

Dr. Witte's present address is Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, AL9 7TA, England.

Dr. Wilke's present address is AO Research Institute, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.

Dr. Jandovás’ present address is Equine Clinic Heřmanův Městec, Nový Dvůr 993, Heřmanův Městec, Czech Republic.

Dr. Haralambus' present address is Clinic for Equine Surgery, University of Veterinary Medicine Vienna, 1210 Vienna, Austria.

Address correspondence to Dr. Witte (twitte@rvc.ac.uk).