Loop colostomy for management of rectal tears and small-colon injuries in horses: 10 cases (1976-1989)

David E. Freeman From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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Dean W. Richardson From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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Eric P. Tulleners From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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James A. Orsini From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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William J. Donawick From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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John B. Madison From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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Michael W. Ross From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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Gregory A. Beroza From the Department of Clinical Studies, New Bolton Center, George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA 19348-1692.

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Summary

Loop colostomy was performed in 10 horses as treatment for grade-III rectal tears (n = 6 horses), small-colon infarction (n = 2 horses), perirectal abscess and stenosis (n = 1 horse), and small-colon stricture (n = 1 horse). In 7 horses, the colostomy was constructed through a single incision low in the left flank, with closure of the incision around the stoma (single-incision technique). In 3 horses, 2 of which had colostomy performed as a standing procedure, the selected segment of small colon was placed from a flank incision into a separate, small incision low in the left flank (double-incision technique).

Five horses underwent colostomy reversal (at 18 to 63 days) and 2 of these horses, both with grade-III rectal tears, recovered completely. Of 8 horses that did not survive, 6 died from the primary disease or associated complications. Technical problems associated with colostomy accounted for death of 2 horses. One horse had gastric rupture attributable to suture occlusion of the small intestine after colostomy reversal, and another horse had complications of incisional infection after repair of a peristomal hernia. Small-colon prolapse through the stoma necessitated premature reversal of the colostomy in a horse that was euthanatized because of worsening laminitis. Minor complications of the colostomy procedure were partial stomal dehiscence (n = 4 horses), partial dehiscence of the flank wound after colostomy reversal (n = 2 horses), and small ventral midline hernia after colostomy reversal (n = 1 horse).

Loop colostomy may be of benefit to horses with rectal tears, provided it is done soon after the tear occurs. The double-incision technique for loop colostomy is recommended, because it appeared to reduce the risks of peristomal herniation and stomal prolapse. Other recommendations are made to reduce complications of colostomy and facilitate reversal.

Summary

Loop colostomy was performed in 10 horses as treatment for grade-III rectal tears (n = 6 horses), small-colon infarction (n = 2 horses), perirectal abscess and stenosis (n = 1 horse), and small-colon stricture (n = 1 horse). In 7 horses, the colostomy was constructed through a single incision low in the left flank, with closure of the incision around the stoma (single-incision technique). In 3 horses, 2 of which had colostomy performed as a standing procedure, the selected segment of small colon was placed from a flank incision into a separate, small incision low in the left flank (double-incision technique).

Five horses underwent colostomy reversal (at 18 to 63 days) and 2 of these horses, both with grade-III rectal tears, recovered completely. Of 8 horses that did not survive, 6 died from the primary disease or associated complications. Technical problems associated with colostomy accounted for death of 2 horses. One horse had gastric rupture attributable to suture occlusion of the small intestine after colostomy reversal, and another horse had complications of incisional infection after repair of a peristomal hernia. Small-colon prolapse through the stoma necessitated premature reversal of the colostomy in a horse that was euthanatized because of worsening laminitis. Minor complications of the colostomy procedure were partial stomal dehiscence (n = 4 horses), partial dehiscence of the flank wound after colostomy reversal (n = 2 horses), and small ventral midline hernia after colostomy reversal (n = 1 horse).

Loop colostomy may be of benefit to horses with rectal tears, provided it is done soon after the tear occurs. The double-incision technique for loop colostomy is recommended, because it appeared to reduce the risks of peristomal herniation and stomal prolapse. Other recommendations are made to reduce complications of colostomy and facilitate reversal.

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