Hepaticojejunostomy for Treatment of Common Hepatic Duct Obstructions Associated with Duodenal Stenosis in Two Foals

Abstract

Two female Standardbred foals 2 and 3 months of age were presented with signs of gastroduodenal obstruction that was confirmed with contrast radiography and exploratory surgery. Ventral midline celiotomy was performed, showing stenosis of the duodenum proximal and distal to the hepatopancreatic ampulla. The common hepatic duct, the pancreatic duct, and the sigmoid section of the duodenum proximal to the stenosis were greatly dilated. To bypass the intestinal obstruction, a side-to-side duodenojejunostomy was performed. Obstruction of the common hepatic duct was relieved by side-to-side hepaticojejunostomy. In addition, jejunojejunostomy was performed distal to the other anastomoses. Both foals recovered. On admission, the foals' total bilirubin, aspartate aminotransferase, and gamma glutamyl transferase levels were greatly elevated. During the subsequent 6 to 8 months, they returned to normal. Six months after the first surgery, one foal was readmitted with an acute abdominal crisis. At surgery, there was greater than 360 degrees clockwise rotation of the mesenteric root involving most of the jejunum. At necropsy, the previously created stomas were patent. The liver and bile duct were grossly and histologically normal. The second foal continues to progress normally 12 months after surgery.