Emergency Exploratory Celiotomy Research Articles

Assessment and comparison of microcirculation and macrocirculation in horses undergoing emergency exploratory celiotomy versus elective surgical procedures.

To assess oral buccal microcirculation by hand-held videomicroscopy in horses during colic surgery, comparing microcirculation values with macrocirculatory parameters and with those of healthy elective surgical horses. Clinical prospective study. Client-owned horses (nine in the colic group; 11 in the elective group). In the colic group, buccal mucosal side stream dark-field microscopy (DFM) videos, cardiac output (CO), mean arterial pressure (MAP), and lactate were obtained at three timepoints under general anesthesia (30, 90, and 150 min after induction). Video analysis was used to determine total vessel density, proportion of perfused vessels, perfused vessel density, and heterogeneity index. Dark-field microscopy videos, MAP, and lactate were obtained at a single timepoint under general anesthesia (45 min after induction) in the elective group. There were no differences in microcirculatory parameters between colic and elective horses, nor was there a difference across timepoints in the colic group. There was a weak negative correlation between microvascular parameters and CO (rho = -0.23). The colic group did not have decreased microcirculation in comparison with the healthy elective group. Dark-field microscopy did not correlate well with macrocirculatory parameters in the colic group. Dark-field microscopy may not be a sensitive enough indicator to detect differences in microcirculation between colic and elective groups. The lack of difference in microcirculation may be due to sample size, probe location, or variation in disease severity.

Serum amyloid A and plasma fibrinogen concentrations in horses following emergency exploratory celiotomy.

Acute-phase proteins may help assess the nature and severity of lesions and outcome in horses undergoing colic surgery. To compare serum amyloid A and plasma fibrinogen concentrations ([SAA] and [fibrinogen]) in the immediate post-operative period after exploratory celiotomy and determine their value in assessment of post-operative complications and survival to discharge. Observational study. This study included horses over 1year of age undergoing exploratory celiotomy. Surgical procedures, lesions, post-operative care, complications and survival to discharge were recorded. [SAA] and [fibrinogen] were measured prior to surgery and 5days post-operatively. Statistical analyses included Yate's Chi-square test, linear mixed effects model, Mann-Whitney U test and logistic regression. Of 300 horses, 52.0% developed post-operative complications and 83.7% survived to discharge, with significantly reduced chance of survival in horses that developed post-operative complications (P<0.01). Median [SAA] at days 1, 2, 3, 4 and 5 and median [fibrinogen] at days 3, 4 and 5 were significantly different between horses that did and did not develop post-operative complications (P<0.05). Median [SAA] at days 1, 4 and 5 were significantly different between horses that did and did not survive to discharge (P<0.05). Logistic regression revealed post-operative complications to be associated with strangulating lesions (OR 2.35, 95% confidence interval [CI] 1.41-3.91, P≤0.001) and higher [fibrinogen] at admission (OR 1.21, 95% CI 1.00-1.45, P<0.05), and survival to discharge to be associated with lower [SAA] at 5days post-operatively (OR 0.965, 95% CI 0.94-0.99, P=0.002). A large variety of lesions and complications prevented detailed analysis of associations between inflammatory markers, lesions and complications. Horses that develop post-operative complications have acute-phase responses of greater magnitudes and durations compared with those that do not develop complications. This is also seen in horses that do not survive to discharge. Measuring [SAA] daily and [fibrinogen] at admission, may help predict the development of post-operative complications.

Effects of hyaluronate-carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy.

To determine the influence of hyaluronate-carboxymethylcellulose (HA-CMC) membranes applied to intestinal anastomoses or enterotomies on postoperative complications after emergency exploratory celiotomy. Multicenter retrospective case-controlled series. Adult horses (59 in the HA-CMC group and 91 controls). Medical records from 4 referral hospitals were searched for horses ≥1 year of age, treated between 2008 and 2014 with emergency exploratory celiotomy, and surviving at least 24 hours postoperatively. Horses receiving repeat celiotomy during the same hospitalization were excluded. Horses who received HA-CMC were matched with controls who did not receive HA-CMC but had similar intestinal lesions and procedures at the same referral hospital. Postoperative complications (colic, nasogastric reflux, fever, incisional infection, and septic peritonitis), duration of hospitalization, and survival were compared between groups. Data were compared between horses by t test, Wilcoxon signed rank test, and χ2 test. The volume of nasogastric reflux at admission (P = .02) and the duration of administration of lidocaine after surgery (P = .02) were greater in horses with HA-CMC membranes than in controls. No difference in postoperative complications or survival was detected between groups: 48 of 59 (81%) horses treated with HA-CMC survived until discharge from the hospital compared with 80 of 91 (88%) horses in the control group (P = .27). Fifteen of 21 horses treated with HA-CMC and 30 of 43 horses in the control group survived >12 months after hospital discharge. Application of HA-CMC membranes to anastomoses or intestinal incisions did not influence postoperative complications or survival after emergency celiotomy compared with controls. The safety and efficacy of HA-CMC membrane application to intestinal sites during colic surgery in horses is equivocal.

Perioperative trends in plasma colloid osmotic pressure in horses undergoing surgery.

To compare perioperative trends in plasma colloid osmotic pressure (COP) between horses undergoing orthopedic and colic surgery. Prospective clinical study September 2009-January 2011. Veterinary university teaching hospital. Thirty-three healthy, client-owned horses presenting for orthopedic surgery (non-GI) and 85 client-owned horses presenting for emergency exploratory celiotomy (GI, gastrointestinal). None. Data relating to the horse's parameters on presentation, surgical lesion, post-operative management and survival were extracted from computerized clinical records. Heparinized blood samples were taken on presentation (PreOp, pre-operative), on recovery from anesthesia (T0), at 12 (T12) and 24 (T24) hours post recovery. COP was measured within 4 hours of collection. There was no significant difference in PreOp or T0 COP between groups. Both groups had a significant decrease in COP during anesthesia. When compared to their respective pre-operative values, horses in the non-GI group had significantly increased COP at T12, whereas those in the GI group had significantly reduced COP. This trend was continued at T24. Horses in the GI group placed on intravenous crystalloid isotonic fluids post-operatively had a significantly lower COP at T12 and T24. Horses in the GI group that did not survive had significantly lower post-operative COP values at T24. Horses undergoing exploratory celiotomy had significantly lower COP post-operatively than those horses undergoing orthopedic surgery. This difference was more marked in those horses receiving isotonic crystalloid intravenous fluid therapy post-operatively and in those that did not survive to discharge. In the non-GI group an increase in COP post-operatively was common.

Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18‐year‐old mare

SummaryAn 18‐year‐old Arabian‐mix mare was presented with a history of severe colic. Emergency exploratory celiotomy revealed diaphragmatic hernia, with a large rent in the left dorsal aspect of the diaphragm and large colon volvulus. Attempts to close the defect in the diaphragm in dorsal recumbency were unsuccessful. Therefore, a thoracic approach through lateral thoracotomy was elected, and a mesh was attached to the diaphragm using skin staples. While in dorsal recumbency, the mare suffered from significant respiratory acidosis. Thus, the mare was tilted into reverse Trendelenburg (30° head upward) and ventilation improved markedly. The mare recovered uneventfully, and was doing well 5 years after surgery.

Identification, management and outcome of postoperative hemoperitoneum in 23 horses after emergency exploratory celiotomy for gastrointestinal disease.

To investigate postoperative hemoperitoneum in a population of horses that had surgery for colic. Retrospective case series. Horses (n = 23). Preoperative, intraoperative, and postoperative information was obtained from medical records (1985-2012) of horses with postoperative hemoperitoneum after emergency exploratory celiotomy. Pre-existing hemoperitoneum during surgery and nonsurgical hemoperitoneum were excluded. Of 4520 horses that had emergency exploratory celiotomy for gastrointestinal disease, 23 horses met inclusion criteria; an incidence of 0.5%. Horse signalment approximated the colic population, although Thoroughbreds were significantly overrepresented. Hemoperitoneum was significantly associated with intestinal resection. Postoperative hemoperitoneum was recognized a mean (± SD) of 1.0 ± 0.7 days after surgery and associated with tachycardia, decreasing hematocrit, incisional drainage, or ultrasonographic identification of swirling, echogenic abdominal fluid. Primary treatments included intravenous fluid therapy (n = 23), colloid support (20), blood transfusion (13), and antifibrinolytic agents (11). Fifteen horses (65%) survived to discharge, which was associated with admission lactate and days of hospitalization. Postoperative hemoperitoneum is a rare complication of exploratory celiotomy in horses that should be considered when there are signs of abdominal discomfort and declining hematocrit in the early postoperative period. Prognosis is guarded because of potential sequelae of septic peritonitis and adhesion formation.

Anaesthetic management of a 10-month-old white rhinoceros (&lt;i&gt;Ceratotherium simum&lt;/i&gt;) calf for emergency exploratory celiotomy

A 10-month-old, 580 kg, hand-reared white rhinoceros (Ceratotherium simum) calf was presented for emergency exploratory celiotomy. Anaesthesia was safely induced with three successive intravenous (IV) boluses of diazepam (10 mg) and ketamine (100 mg) until the trachea could be intubated. Anaesthesia was adequately maintained with isoflurane-inoxygen (mean end-tidal isoflurane concentration of 1.1% ± 0.2%) on a circle anaesthetic machine with carbon dioxide absorption and an intravenous infusion of ketamine and medetomidine at a mean rate of 0.02 mg/kg/min and 0.02 µg/kg/min, respectively. Mean values recorded during anaesthesia and surgery were heart rate (56.9 ± 11 beats/min), mean arterial blood pressure (6.16 kPa ± 1.75 kPa), end-tidal carbon dioxide concentration (6.23 kPa ± 0.30 kPa). Abdominal gas distension contributed to hypoventilation that resulted in hypercapnoea, confirmed by arterial blood gas analysis (PaCO2 14.69 kPa), which required controlled ventilation for correction. Blood volume was maintained with the intravenous infusion of a balanced electrolyte solution at 10 mL/kg/h and blood pressure supported with a continuous infusion of dobutamine and phenylephrine. Duration of anaesthesia was 3.5 h. It was concluded that anaesthesia was safely induced in a compromised white rhinoceros calf with a combination of diazepam and ketamine. A constant-rate infusion of medetomidine and ketamine allowed for a reduction in the dose of isoflurane required during maintenance of anaesthesia and improved intra-operative blood pressure management.

Nifedipine-Induced Hypotension and Mesenteric Ischemia

We have presented a case in which nifedipine-induced hypotension in a patient receiving beta blocker and nitrate therapy precipitated mesenteric angina, leading to emergency exploratory celiotomy. Although paradoxic angina is an unusual complication of this antianginal therapy, it should be considered in any patient who has acute abdominal pain and hypotension while receiving this therapeutic regimen.