Colic Surgery

Question 1

Which parts of the GiT can we access?

Answer 1

Question 2

Where can we get intestinal obstructions ?

Answer 2

Question 3

What does relief of impactions involve? (steps)

Answer 3

• Enterotomy
• Evacuation of obstruction
• Lavage
• Closure of enterotomy

Question 4

What is the most common site of impaction?

Answer 4

Pelvic flexure

Question 5

How do we do large colon evacuation?

Answer 5

Enterotomy (temporary hole) made at pelvic flexure to evacuate gut contents

Question 6

Describe sand impactions

Answer 6

• Increasing prevalence
• Peri-urban horses/ponies
• Large impaction of RDC (Right Dorsal Colon)

Question 7

Descirbe small intestinal enterotomy?

Answer 7

• Less common but possible
  example: Impaction of haynet thay been eaten by horse mid-jejunal obstruciton

Question 8

How do we close SI enterotomy

Answer 8

Inverting suture pattern

Question 9

Small colon obstruction - what is common?

Answer 9

Faecoliths / Enteroliths (cannonball of mineral material)

Question 10

What Intestinal DISPLACEMENTS can we see?

Answer 10

• Right dorsal displacement
• Nephrosplenic entrapment/LDD
• Pelvic flexure retroflexion
• Partial colon torsion

Question 11

How do we correct colon displacements?

Answer 11

• Decompress gas
• Evacuate ingesta
• Manipulate and re-position

Question 12

Describe Nephrosplenic entrapment

Answer 12

colon trapped due to splenic ligament

Question 13

How do we manage nephrosplenic entrapment ?

Answer 13

• Starvation & patience (if not too painful)
• Gentle exercise e.g. trotting
• Phenylephrine (40mg in 1L saline) and lunge
• GA and roll
• GA and laparotomy

Question 14

Rolling a NSE case?

Answer 14

Massaging in dorsal recumbency (not common now)

Question 15

How does large colon torsion happen?

Answer 15

VERY SEVERE; LIFE THREATENING

twisting more than 360° -> cuts off BS

Question 16

What appositional / inverting suture patterns can we use?

Answer 16

adhesions!

Question 17

What intestinal strangulation can we see?

Answer 17

• Pedunculated lipomas
• epiploic foramen entrapment
• Mesenteric tears
• Gastro-splenic ligament
• Volvulus nodosus
• Intussuception

Question 18

What problems/ risks with strangulation?

Answer 18

• Ischaemic gut
• Endotoxaemia!!
• Distention proximally

Question 19

How do we go about an intestinal resection?

Answer 19

• Ligate mesenteric vessels
• Cut mesentery
• Section aborally
• Decompress via ischaemic gut
• Section orally
• anastamosis

Question 20

End to end anastamosis TECHNIQUE N°1

Answer 20

• equal diameter ends
• Two layer technique -> Mucosal continuous THEN intverting oversew
• 3M absorbable material
• ## Close mesentery

Question 21

End to end anastamosis TECHNIQUE N°2?

Answer 21

Side to side (stapled)
- Jejuno-caeal anastamosis
- Minimises risk of contamination
- Time saving?
- Reinforce ends with sutures
- can perform hand-sewn equivalent

Question 22

Aims of resection?

Answer 22

• Remove ischaemic gut
• Secure ligation of mesenteric vessels
• anastomosis of healthy bowel
• Restore continuity of gut

Question 23

How much Si intestine can u resect?

Answer 23

50-60%
Consider euthanasia if >60% necessary

Question 24

Intestinal biopsy (laparoscopy)?

Answer 24

Acute colic
- Equine grass sickness
- Eosinophilic enteritis
- Neoplasia
- Assessment of gut viability?

Chronic dx
- Infiltrative dx
- Malabsorption

Question 25

What does Eosinophilic enteritis look like?

Answer 25

Question 26

Limitation sof colic surgery?

Answer 26

Adhesions & abscesses Inaccessible regions (stomach, duodenum, caecal base) Motility disorders Recurrent displacements Advanced endotox

Question 27

Issues with colic surgery?

Answer 27

- Managing expectations - Communication - At the hospital - Timeline - Post op care - Convalescence - Cost

Question 28

Convalescence ?

Answer 28

8 weeks box rest 8 weeks small paddock turn-out