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Case Study: Sparky's Colic Surgery

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Case Study: Sparky’s Colic Surgery

Sparky is a 12-year old Hanoverian gelding that was found colicing by the farm caretaker late morning in October. He was assessed by their local veterinarian and treated with banamine, but continued to show signs of colic. He was referred to Tryon Equine Hospital for further evaluation.

Dr. Lindsey Boone, a board-certified surgeon at Tryon Equine Hospital, performed a physical evaluation of Sparky upon his arrival. During the examination, Sparky continued to display signs of colic such as kicking at his belly with his hind legs. She placed a tube in Sparky’s stomach through his nose in order to remove the fluid present on his stomach. "Four liters of fluid were taken out of his stomach," says Dr. Boone, "this was an abnormal amount of fluid to be present within the stomach and suggests that something is obstructing movement of fluid and/or feed from the stomach to the small intestine."  She performed a rectal examination on Sparky which revealed dilated loops of his small intestine.

A dilated small intestine is always an abnormal finding. There are three reasons the small intestine can become distended. 1.) The small intestine can become sick (inflamed) for various reasons and this can affect its motility. Inflammation of the small intestine is called enteritis. Without proper motility, fluid builds up the small intestine, and into the stomach. 

"These horses typically show other signs of illness such as malaise and fever. 2.) Another reason the small intestine can become distended is due to an obstruction. This obstruction can be strangulating (affecting the blood supply to the small intestine) or non-strangulating (the blood supply to the small intestine is unaffected)," explained Dr. Boone, "a non-strangulating obstruction is most commonly caused by an impaction usually the result of accumulation of is feed in the lumen of the small intestine. It can also occur secondary to a colon displacement, causing extra-luminal compression of the small intestine. A strangulating obstruction can be caused by the small intestine twisting on itself, the small intestine getting stuck in a natural hole within the abdomen or a hole/tear that is created in the abdomen, or something getting wrapped around the small intestine such as a fatty tumor or lipoma."

Dr. Boone recommended that a sample of fluid be obtained from Sparky’s abdomen to help determine which kind of obstruction of the small intestine was occurring. The fluid obtained from his abdomen was blood tinged (serosanguinous). "Blood leaks into the fluid within the abdominal cavity during a strangulating obstruction because the vessels become engorged and leaky due to obstruction. This means that severely compromised or dead small intestine may be present within the abdomen and must be removed surgically in order to save the life of the horse," says Dr. Boone.

Sparky underwent surgery, which was performed by Dr. Boone. "During surgery, we discovered that Sparky's small intestines was entrapped in a small tear of the gastrosplenic ligament. This ligament holds the spleen to the stomach in the horse," explained Dr. Boone, "once unentrapped, we found six feet of dead small intestine which had to be removed. Healthy bowel was sutured together making a new connection for the small intestine, this is called a resection and anastomosis." Sparky also had a displacement of his small intestine that was corrected during surgery. Sparky woke up from surgery well.

"Post-operatively horses that have dead small intestine and have to have a new connection made are at an increased risk of complications such as problems with the new connection, bowel that doesn’t want to work right away causing buildup of fluid in the stomach called post-operative reflux, and/or development of scar tissue (adhesions) of the small intestine," says Dr. Boone. Due to this risk, "Sparky was held off feed for 24 hours then re-introduced to feed slowly. He tolerated refeeding well and was discharged from the hospital 6 days after surgery," says Dr. Boone.