OBJECTIVE To compare clinical findings and short-term outcome for horses with intestinal entrapment in the gastrosplenic ligament (GLE) with those of horses with intestinal entrapment in the epiploic foramen (EFE).
DESIGN Retrospective case-control study.
ANIMALS 43 horses with GLE (cases) and 73 horses with EFE (controls).
PROCEDURES Medical records of horses examined because of colic at a veterinary teaching hospital between 1992 and 2012 were reviewed. Signalment was extracted from medical records for all horses with colic (colic population), and additional information regarding colic history, clinical findings, treatments, and outcome was extracted from the records of horses in which GLE or EFE was diagnosed during surgery or necropsy. Signalment was compared between the colic population and the case and control populations. Clinical findings and short-term outcome were compared between the cases and controls.
RESULTS The proportions of middle-aged horses and geldings in both the case and control groups were greater than those in the colic population. Mean heart rate and blood and peritoneal fluid lactate concentrations in horses with EFE were significantly greater than those for horses with GLE. The proportion of horses that underwent surgery and were discharged from the hospital (short-term survival rate) did not differ between the GLE (22/25 [88%]) and EFE (29/34 [85%]) groups.
CONCLUSIONS AND CLINICAL RELEVANCE Compared with the colic population, results suggested middle-aged geldings might be predisposed to GLE and EFE. The short-term survival rate was similar between the GLE and EFE groups even though horses with EFE had more severe systemic derangements than did horses with GLE.
To assess the diagnostic value of plasma and peritoneal fluid procalcitonin concentrations for identification of horses with strangulating intestinal lesions.
65 horses with signs of colic of intestinal origin and 10 healthy (control) horses.
For each horse, plasma and peritoneal fluid samples were obtained for a CBC and determination of total protein, procalcitonin, and lactate concentrations. Signalment and clinicopathologic findings were compared among control horses and horses with strangulating and nonstrangulating intestinal lesions.
Mean ± SD plasma (274.9 ± 150.8 pg/mL) and peritoneal fluid (277 ± 50.6 pg/mL) procalcitonin concentrations for horses with colic were significantly greater than the mean ± SD plasma (175.5 ± 46.0 pg/mL) and peritoneal fluid (218.8 ± 48.7 pg/mL) procalcitonin concentrations for control horses. Mean procalcitonin concentration in peritoneal fluid, but not plasma, differed significantly between horses with strangulating lesions and those with nonstrangulating lesions. A peritoneal fluid procalcitonin concentration ≥ 281.7 pg/mL had a sensitivity of 81%, specificity of 69%, positive predictive value of 56.7%, and negative predictive value of 87.9% for detection of strangulating lesions.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that peritoneal fluid procalcitonin concentration, when evaluated in conjunction with other clinicopathologic results, might be a sensitive indicator of intestinal ischemia and facilitate early identification of horses that require surgery to address a strangulating lesion.
OBJECTIVE To assess incidence of incisional infection in horses following management with 1 of 3 protective dressings after exploratory celiotomy for treatment of acute signs of abdominal pain (ie, colic) and determine the risk of complications associated with each wound management approach.
DESIGN Prospective, randomized, controlled study.
ANIMALS 85 horses.
PROCEDURES Horses were assigned to 3 groups. After standardized abdominal closure, a sterile cotton towel (group 1) or polyhexamethylene biguanide–impregnated dressing (group 2) was secured over the incision site with 4 or 5 cruciate sutures of nonabsorbable monofilament, or sterile gauze was placed over the site and secured with an iodine-impregnated adhesive drape (group 3). Demographic and clinicopathologic data, intraoperative and postoperative variables, and development of complications were recorded and compared among groups by statistical methods. Follow-up information was collected 30 and 90 days after surgery. Incidence and odds of incisional complications were calculated.
RESULTS 75 horses completed the study. Group 3 typically had dressing displacement necessitating removal during anesthetic recovery; dressings were in place for a mean of 44 and 31 hours for groups 1 and 2, respectively. Purulent or persistent serosanguinous incisional discharge (ie, infection) was detected in 11 of 75 (15%) horses (2/24, 0/26, and 9/25 from groups 1, 2, and 3, respectively). Odds of incisional complications were significantly greater for group 3 than for groups 1 or 2.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that risk of infection after celiotomy for treatment of colic is lower for incisions covered with sterile towels or polyhexamethylene biguanide–impregnated dressings secured with sutures than for incisions covered with gauze secured with iodine-impregnated adhesive drapes.
Objective—To evaluate clinical findings, underlying causes, and short-term outcome associated with hemoperitoneum in horses.
Design—Retrospective case series.
Animals—67 horses with hemoperitoneum.
Procedures—Medical records of horses with hemo-peritoneum (excluding postoperative abdominal hemorrhage) from 1989 through 2004 were analyzed. Information obtained included history, signalment, physical examination findings, diagnostic test results, and short-term outcome.
Results—Breed distribution was 28 Thoroughbreds, 13 Arabians, 10 Quarter Horses, 5 Warmbloods, 3 Appaloosas, and 1 each of 8 other breeds. There were 40 mares, 23 geldings, and 4 stallions. Median age was 12 years (range, 1 month to 40 years). Signs of abdominal discomfort were the primary complaint in 79% of horses. Clinical findings included shock (60%) and pale mucous membranes (60%). Median heart rate was 76 beats/min (range, 30 to 216 beats/min), median respiratory rate was 30 breaths/min (range, 8 to 92 breaths/min), median Hct was 31% (range, 10.5% to 73.0%), and total protein concentration was 5.8 g/dL (range, 3.3 to 8.7 g/dL). Cause of hemoperitoneum was attributed to trauma (25.4%), neoplasia (17.9%), uterine artery rupture (13.4%), mesenteric injury (11.9%), disseminated intravascular coagulopathy (6.0%), other causes (3.0%), and idiopathic causes (22.4%). Fifty-one percent of horses survived to hospital discharge, 37% were euthanized, and 12% died. Poor short-term outcome was significantly associated with high respiratory rate and certain underlying causes.
Conclusions and Clinical Relevance—Hemoperitoneum is an infrequent but important cause of abdominal discomfort in horses. Predominant underlying causes were trauma, neoplasia, and idiopathic causes. Identification of underlying cause is important because of its association with outcome.
OBJECTIVE To determine the maximum concentration (Cmax) of amikacin and time to Cmax (Tmax) in the distal interphalangeal (DIP) joint in horses after IV regional limb perfusion (IVRLP) by use of the cephalic vein.
ANIMALS 9 adult horses.
PROCEDURES Horses were sedated and restrained in a standing position and then subjected to IVRLP (2 g of amikacin sulfate diluted to 60 mL with saline [0.9% NaCl] solution) by use of the cephalic vein. A pneumatic tourniquet was placed 10 cm proximal to the accessory carpal bone. Perfusate was instilled with a peristaltic pump over a 3-minute period. Synovial fluid was collected from the DIP joint 5, 10, 15, 20, 25, and 30 minutes after IVRLP; the tourniquet was removed after the 20-minute sample was collected. Blood samples were collected from the jugular vein 5, 10, 15, 19, 21, 25, and 30 minutes after IVRLP. Amikacin was quantified with a fluorescence polarization immunoassay. Median Cmax of amikacin and Tmax in the DIP joint were determined.
RESULTS 2 horses were excluded because an insufficient volume of synovial fluid was collected. Median Cmax for the DIP joint was 600 μg/mL (range, 37 to 2,420 μg/mL). Median Tmax for the DIP joint was 15 minutes.
CONCLUSIONS AND CLINICAL RELEVANCE Tmax of amikacin was 15 minutes after IVRLP in horses and Cmax did not increase > 15 minutes after IVRLP despite maintenance of the tourniquet. Application of a tourniquet for 15 minutes should be sufficient for completion of IVRLP when attempting to achieve an adequate concentration of amikacin in the synovial fluid of the DIP joint.
To determine the median time to maximum concentration (tmax) of amikacin in the synovial fluid of the tarsocrural joint following IV regional limb perfusion (IVRLP) of the drug in a saphenous vein of horses.
7 healthy adult horses.
With each horse sedated and restrained in a standing position, a 10-cm-wide Esmarch tourniquet was applied to a randomly selected hind limb 10 cm proximal to the point of the tarsus. Amikacin sulfate (2 g diluted with saline [0.9% NaCl] solution to a volume of 60 mL) was instilled in the saphenous vein over 3 minutes with a peristaltic pump. Tarsocrural synovial fluid samples were collected at 5, 10, 15, 20, 25, and 30 minutes after completion of IVRLP. The tourniquet was removed after collection of the last sample. Amikacin concentration was quantified by a fluorescence polarization immunoassay. Median maximum amikacin concentration and tmax were determined.
1 horse was excluded from analysis because an insufficient volume of synovial fluid for evaluation was obtained at multiple times. The median maximum synovial fluid amikacin concentration was 450.5 μg/mL (range, 304.7 to 930.7 μg/mL), and median tmax was 25 minutes (range, 20 to 30 minutes). All horses had synovial fluid amikacin concentrations ≥ 160 μg/mL (therapeutic concentration for common equine pathogens) at 20 minutes after IVRLP.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that, in healthy horses, maintaining the tourniquet for 20 minutes after IVRLP of amikacin in a saphenous vein was sufficient to achieve therapeutic concentrations of amikacin in the tarsocrural joint.
Objective—To evaluate the outcome of horses with
large fragments of the extensor process of the distal
phalanx that were removed by use of arthrotomy.
Animals—14 horses with large fragments of the
extensor process of the distal phalanx.
Procedure—Medical records for horses with large
fragments of the extensor process that were
removed by use of arthrotomy were reviewed. Data
retrieved from medical records included signalment,
use of horse, affected limb, lameness history, lameness
examination findings, radiographic findings, surgical
technique, and outcome. Follow-up evaluation
was obtained by telephone interview.
Results—Most affected horses were < 5 years old
and had a history of chronic lameness. Lameness
grade ranged from 1/5 to 4/5. Fragments involved 20
to 45% of the dorsopalmar articular surface of the distal
phalanx. Eight of 14 horses had a successful outcome.
Outcome was not associated with age, duration
or severity of lameness, or fragment size.
Conclusions and Clinical Relevance—Despite
involvement of a large portion of the articular surface
and use of arthrotomy, joint instability and permanent
soft tissue injury was not a problem in most horses.
Outcome may be improved by selection of horses
with lameness of < 2 years' duration and careful management
after surgery. A fair prognosis may be anticipated
for removal of large fragments of the extensor
process via arthrotomy. (J Am Vet Med Assoc 2000;
Objective—To determine the outcome of penetrating injuries to the central region of the foot in equids and identify factors that may affect treatment and outcome.
Design—Retrospective case series.
Animals—63 equids (61 horses, 1 pony, and 1 mule).
Procedures—Records of equids incurring puncture wounds through the frog (cuneus ungulae) or collateral sulci of the foot between 1998 and 2008 were reviewed. Evaluated factors that were hypothesized to affect outcome included signalment, degree of lameness, foot affected, duration between injury and admission, and treatment. Injuries were graded from 1 (< 1 inch; involving superficial corium only) to 4 (involving a synovial structure) on the basis of severity of penetration as determined by radiographic evidence or findings on synoviocentesis at the time of admission.
Results—Overall, 60% (38/63) of equids returned to soundness. Thirteen equids were euthanized on the basis of synovial structure involvement and financial constraints. Of 35 equids that were treated conservatively, which may have included undergoing a surgical procedure with the horse standing, 32 (91.4%) returned to their previous level of soundness. Fifteen equids underwent surgical treatment under general anesthesia, of which 6 (40%) became sound for intended use. Ten of 34 (29%) equids with synovial structure involvement regained soundness. Equids treated earlier after injury had a better prognosis. Equids with a hind foot injury had a more favorable outcome than those with a forefoot injury.
Conclusions and Clinical Relevance—Results suggested that penetrating injuries located centrally in the foot of equids without involvement of a synovial structure have a favorable prognosis, especially if managed early. Penetration of a synovial structure provided a poor prognosis.
OBJECTIVE To describe clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography.
DESIGN: Retrospective case series.
ANIMALS 25 horses.
PROCEDURES Medical records of horses that underwent transabdominal ultrasonography between 2003 and 2010 were reviewed. Horses were included if the wall of the large intestine was ≥ 9 mm thick in any of 6 abdominal zones.
RESULTS Median age was 13 years (range, 3 to 28 years). Horses were initially examined because of colic, diarrhea, inappetence, weight loss, lethargy, fever, or hematuria. Severe large intestinal thickening (range, 9 to 46.6 mm; mean ± SD, 18.8 ± 6.8 mm) was the primary ultrasonographic finding in all horses. Thickened large intestine was more likely to be detected in ventral versus upper (ie, combined paralumbar and intercostal) abdominal zones and in right versus left zones. Eleven horses survived and had resolution of clinical signs, including the l horse treated surgically for colon torsion. An additional horse survived but continued to have intermittent colic. Ten horses were euthanized or died, including 3 horses with neoplasia and 3 with colitis. Three horses were lost to follow-up, including 1 horse with a cecal mass and 1 with hepatosplenic lymphoma. Severity of thickening and number of zones affected were not significantly different between survivors and nonsurvivors.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in horses undergoing transabdominal ultrasonography, large intestinal wall thickness ≥ 9 mm may be detected in patients with a variety of conditions. Ultrasonographic examination of all abdominal zones was helpful to determine the extent of thickening and identify additional findings that helped prioritize differential diagnoses.