Ileal Impaction Research Articles

Retrospective analysis of postoperative complications following surgical treatment of ileal impaction in horses managed with manual decompression compared to jejunal enterotomy.

The objective of this study was to compare the occurrence of post-operative complications and survival to discharge in horses with ileal impactions resolved by manual decompression compared with jejunal enterotomy. A total of 121 client-owned horses undergoing surgical correction of an ileal impaction at three teaching hospitals. Data from the medical records of horses undergoing surgical correction of an ileal impaction was retrospectively collected. Post-operative complications, survival to discharge, or post-operative reflux present were evaluated as dependent variables and pre-operative PCV, surgery duration, pre-operative reflux, and type of surgery were evaluated as independent variables. Type of surgery was divided into manual decompression (n = 88) and jejunal enterotomy (n = 33). There were no significant differences in development of minor complications, development of major complications, presence of post-operative reflux, amount of post-operative reflux, and survival to discharge between horses that were treated with manual decompression and those treated with distal jejunal enterotomy. Pre-operative PCV and surgery duration were significant predictors of survival to discharge. This study showed that there are no significant differences in post-operative complications and survival to discharge in horses undergoing distal jejunal enterotomy versus manual decompression for correction of ileal impaction. Pre-operative PCV and duration of surgery were found to be the only predictive factors of survival to discharge. Based on these findings, distal jejunal enterotomy should be considered earlier in horses with moderate to severe ileal impactions identified at surgery.

Standing jejunal enterotomy for resolution of an ileal impaction

SummaryA 22‐year‐old American Quarter Horse gelding was referred to the JT Vaughan Large Animal Teaching Hospital at Auburn University, College of Veterinary Medicine for moderate signs of abdominal pain responsive to sedation. A presumptive preoperative diagnosis of ileal impaction was made based on physical examination, ultrasonography of the abdomen and clinical pathological data. Despite appropriate medical therapy and improvement in the diagnostic and clinical parameters, the gelding continued to be uncomfortable. A standing right flank laparotomy facilitated access to the ileum which contained approximately 80 cm of consolidated ingesta from the ileocaecal orifice extending orally. The distal jejunum was exteriorised and an enterotomy performed, permitting lavage of the ingesta and resolution of the impaction. The gelding was discharged 6 days after surgery. Two weeks after surgery, the gelding re‐presented for surgical treatment of an incisional abscess. At 4‐month follow‐up, the gelding was reportedly doing well. The described surgical technique may be a viable option for resolution of ileal impactions in horses non‐responsive to medical management when exploratory celiotomy under general anaesthesia is not possible due to financial constraints, the health of the horse or other reason.

Ileal impaction resolution in a horse with colic via a standing right flank laparotomy ˗ case report

ABSTRACT This report describes a horse presenting ileal impaction that went through a right flank laparotomy procedure while standing. The decision to use this technique was made under the influence of several factors: the patient exhibited a calm temperament and demonstrated responsiveness to the analgesic treatment for pain control; the abdominal lesion was amenable to correction by a standing right flank approach. Also, the owner reported financial problems. Ileal obstruction was relieved successfully, and the horse recovery was satisfactory. This case highlights that, in specific cases of colic syndrome, the use of surgical procedures in the standing position might be a viable option and promote fast recovery.

Vlaslemen versus stro als risicofactor voor ileumobstipaties bij paarden met koliek: Retrospectieve analyse van 2336 gevallen tussen 2008 en 2017

Terwijl ileumobstipatie bij paarden in het zuidoosten van de Verenigde Staten voornamelijk geassocieerd wordt met de sterk lignine-houdende vezels van het mature bermudagrashooi, wordt ileumobstipatie in Europa anekdotisch geassocieerd met het huisvesten van paarden op vlaslemen. Het doel van deze retrospectieve studie was het bestuderen van het verband tussen ileumobstipatie en het gebruik van vlaslemen of stro als stalbodembedekking bij paarden aangeboden voor koliek. De medische dossiers van 2336 paarden aangeboden met koliek op de dienst Inwendige Ziekten van de Grote Huisdieren, Universiteit Gent tussen januari 2008 en mei 2017 werden geanalyseerd. Uit de medische dossiers werd informatie verkregen met focus op diagnose, het moment van aanbieden, ras, geslacht, lichaamsgewicht en stalbedding. Door middel van logistische regressie werd de associatie tussen ileum- obstipatie en elke individuele variabele bepaald. Variabelen met P < 0,2 werden opgenomen in een multivariabel cox-regressiemodel en door middel van de Wald’s test werd de significantie van de para-meters bepaald. Verder werd voor de paarden met ileumobstipatie het verband tussen het overlevings-percentage en de bodembedekking of de behandelwijze (medisch of chirurgisch) bepaald. Van de met koliek aangeboden paarden werd 11,3% op vlaslemen gehuisvest. De totale prevalentie van ileumobstipatie in de bestudeerde populatie was 4,2%. In de vlasgroep was de prevalentie van ileumobstipatie 9,4%, terwijl deze in de strogroep 3,6% bedroeg. De odds-ratio voor het ontstaan van ileumobstipatie bij paarden gehuisvest op vlaslemen ten opzichte van op stro gehuisveste paarden bedroeg 2,8 (95% CI 1,7-4,7; P < 0,001) in het multivariabel regressiemodel. Er kon geen significant verband aangetoond worden tussen ileumobstipatie en het moment van aanbieden, leeftijd, geslacht of lichaamsgewicht. Trekpaarden hadden een zes keer hoger risico (OR 6,3; 95% CI 2,4-16,4; P < 0,001) op het ontstaan van ileumobstipatie dan warmbloeden in het multivariabel regressiemodel. Er kon geen significant verband worden aangetoond tussen het overlevingspercentage en de stalbodembedekking of de behandelwijze. De resultaten van deze retrospectieve studie suggereren dat op vlaslemen gehuisveste paarden met koliek een hoger risico hebben op het ontstaan van ileumobstipatie dan paarden gehuisvest op stro.

Analysis of clinical and perioperative findings in 576 horses subjected to surgical treatment of colic

Colic was treated surgically in 576 horses (545 individuals). Twenty-seven horses were subjected to surgery twice and two horses three times during the period of this study. A total of 371 horses (64.4%) were discharged from the hospital, 205 animals (35.6%) died or were euthanised; 16 of them died during anaesthesia, 102 horses were subjected to euthanasia during surgery, 24 patients did not recover from anaesthesia after surgery completion, and 63 horses did not survive the postoperative period. Ileus of the small intestine was diagnosed in 267 cases (46.4%), affection of the large colon in 239 cases (41.5%), lesion of the small colon in 22 cases (3.8%), lesion of the caecum in 19 cases (3.3%), and affection of stomach and rectum in four and one cases, respectively. In 14 animals (2.4%), lesions were located at two different sites of the gastrointestinal tract. In four horses, the cause of colic was located outside the gastrointestinal tract. Three animals were affected by diffuse peritonitis. No gastrointestinal lesion could be identified during surgery in three horses with recurrent colic. The most common causes of small intestine ileus included incarceration in inguinal hernia (50 of 267 horses, 18.7%), hernia of the omental foramen (31 of 267 horses, 11.6%), anterior enteritis (19 of 267 horses, 7.1%), mesenterial volvulus (18 of 267 horses, 6.7%), and ileal impaction (18 of 267 horses, 6.7%). The most common caecal disorder was acute constipation/dysfunction (5 of 19 horses, 26.3%). Frequent causes of the large colon colic were torsion (63 of 239 horses, 26.4%), left dorsal displacement (36 of 239 horses, 15.1%), and right dorsal displacement (23 of 239 horses, 9.6%). The small colon was most often affected by focal obstruction/constipation (9 out of 22 horses, 40.9%). Surgical treatment of colic of the small intestine, caecum, large colon, and small colon was successful in 59.6%, 36.8%, 73.3%, and 63.6% of the cases, respectively.

Ileal impaction in 22 cows

The clinical signs, diagnosis, treatment and outcome of 22 cows with ileal impaction were investigated using the medical records of bovine patients referred to the Department of Farm Animals, Vetsuisse Faculty, University of Zurich from 1993 to 2003. Only 15 of the cows had signs of colic, which were subtle but slowly increased in severity in some patients. The results of haematological and biochemical analyses were mildly abnormal in only few animals. There was no correlation between the duration of the disorder before admission, the severity of symptoms and the results of the haematological and biochemical analyses. Dilated loops of small intestine in the right dorsal quadrant of the abdomen could be palpated transrectally and imaged via ultrasonography. A definitive diagnosis of ileal impaction was made during exploratory laparotomy by finding the impaction and ruling out other abnormalities. In 19 cows, the obstructing food mass was easily massaged into the caecum, and in three animals an enterotomy was carried out. All cows had an uneventful recovery with no recurrence of the disorder. It is concluded that the cause of the impaction was most likely due to seasonal influences and winter-feeding with a hay based ration. The short and long-term prognosis after surgical intervention was good.

Anoplocephala perfoliata coproantigen detection: a preliminary study

Anoplocephala perfoliata has a prevalence as high as 60% in some geographical areas and has been associated with increased risk for serious conditions in the horse including bowel irritation, ileal impaction, and spasmodic colic. Identification of infected animals based upon detection of eggs in feces is labor intensive and unreliable. This study involved the development of a test for A. perfoliata coproantigen using an antigen capture enzyme linked immunosorbent assay (ELISA) and correctly distinguished between infected and uninfected animals in a trial with a small sample size.

Factors associated with development of ileal impaction in horses with surgical colic: 78 cases (1986–2000)

Deal impaction is prevalent in the south-eastern USA, where feeding of Coastal Bermuda hay has been implicated as a risk factor. Alternatively, infection with the tapeworm Anoplocephala perfoliata has been identified as a risk factor for ileal impaction in the UK. We hypothesised that feeding Coastal Bermuda hay and failure to administer routinely an anthelmintic with efficacy against tapeworms would place horses at risk of developing ileal impaction in the USA. Seventy-eight horses, with surgically confirmed ileal impaction and 100 horses admitted for colic that did not have an ileal impaction, were selected retrospectively for logistic regression analysis. Using odds ratios (OR) as an index of risk, feeding Coastal Bermuda hay (OR = 2.9) and failure to administer a pyrantel salt within 3 months of admission (OR = 3.1) placed horses at risk of development of ileal impaction. This study confirms the belief that feeding Coastal Bermuda hay places horses at risk of ileal impaction, although the quality of the hay may also play a role. Periodic administration of anthelmintics with efficacy against tapeworms should be considered to reduce risk of ileal impaction.

Investigation of an outbreak of tapeworm-associated colic in a training yard.

A novel serological assay which measures IgG(T) specific for a 12/13 kDa protein of the equine tapeworm Anoplocephala perfoliata was used as part of a colic outbreak investigation. A training/rehabilitation yard for Thoroughbreds and Arabs was found to have an increasing incidence of colic over a 5 year period, culminating in a peak incidence of 1.15 episodes/horse year at risk. Four animals suffered from ileal impaction colic which necessitated surgical management. A case-control study design suggested a strong association between tapeworm infection and colic, with evidence of a dose-response relationship. Intervention, in the form of anticestode anthelminthics, coincided with a decrease in the incidence of colic and a fall in anti-12/13 kDa IgG(T) antibody levels of 8 horses monitored post-treatment. This study demonstrates that anthelminthic regimens, using exclusively ivermectin, may lead to an increase in tapeworm infection intensity which may in turn lead to an increased incidence of colic. Furthermore, it provides support to the hypothesis that the risk of ileal impaction colic and spasmodic colic increases with tapeworm infection intensity. The practical application of the anti-12/13 kDa IgG(T) ELISA is demonstrated by this study.

Surgical reduction of ileal impactions in the horse: 28 cases.

To evaluate the seasonal influence, signalment, type of hay consumed, clinical examination findings, and outcome after surgery for horses with ileal impaction. A retrospective study. Between 1988 and 1993, 28 horses had surgical correction of ileal impaction. There was a significantly higher rate of ileal impaction during the Fall (September-November, P = .0041 ). Mean duration of clinical signs of abdominal pain before referral was 15 hours. Transrectal palpation was used to localize the impaction in 11 horses. The ileal impaction was reduced by extraluminal massage aided by admixing of intestinal fluid oral to the impaction or injection of fluids intraluminally and then movement of the ingesta into the cecum alone in 24 horses. A total of 26 horses recovered from surgery; 24 horses were discharged from the hospital and eventually returned to previous use. Two horses had fatal postoperative complications: jejunocecostomy dehiscence and development of extensive small intestine adhesions after manual reduction of the impaction. One horse initially treated by manual reduction required jejunocecostomy twice for management of recurrent ileal impaction. Follow-up information was obtained for 21 horses, of which 20 were alive 1 year or longer after surgery. A total of 27 of 28 horses were fed Coastal Bermudagrass hay as the primary type of hay consumed. A total of 9 horses continued to be fed Coastal Bermudagrass hay as the only roughage source, whereas 6 horses were fed Coastal Bermudagrass with at least 50% other hay, and in 6 horses, Coastal Bermudagrass hay was entirely eliminated from the diet. Ileal impactions can be successfully reduced by celiotomy and extraluminal massage and injection techniques to soften the ingesta for passage into the cecum without enterotomy or bypass techniques in most horses. Changes in weather and feeding practices in the Fall may account for an increased risk of ileal impaction in horses in the southeastern United States at that time of year.

Tapeworm infection is a significant risk factor for spasmodic colic and ileal impaction colic in the horse.

The association between the equine intestinal tapeworm Anoplocephala perfoliata and specific types of intestinal disease was investigated by matched case-control study using coprological and serological diagnosis. We have previously shown that the host IgG(T) response to 12/13 kDa antigens of A. perfoliata correlates well with infection intensity, therefore this antibody response was used to investigate the risk of colic at different levels of parasite infection intensity. One hundred and three spasmodic colic cases with an equal number of controls matched for age, breed and gender, and 20 ileal impaction cases each with 2 similarly matched controls were obtained. Cases of spasmodic colic were much more likely (odds ratio = 8.0) to be associated with A. perfoliata infection detected coprologically than controls. Serological diagnosis revealed an increasing risk of spasmodic colic with increasing infection intensity. Calculation of an aetiological fraction suggests that 22% of spasmodic colic cases in this study were tapeworm associated. No significant association was found between colic and strongyle egg count. Conditional logistic regression analysis demonstrated that the relationship between colic and A. perfoliata infection intensity was not confounded by strongyle egg count and there was a linear relationship between infection intensity and the log-odds of spasmodic colic. For cases of ileal impaction, a strong association was found between colic and A. perfoliata as diagnosed by coprological means (odds ratio of 34.0). Serological diagnosis also revealed a strong association that increased with higher levels of infection intensity (odds ratio = 26.0). The aetiological fraction for the ileal impaction data suggests that 81% of the ileal impaction cases in this study were tapeworm associated. This study concludes that A. perfoliata is a significant risk factor for spasmodic colic and ileal impaction colic in the horse; and that the risk of spasmodic colic increases with infection intensity.

Medical treatment of horses with ileal impactions: 10 cases (1990–1994)

Objective To evaluate clinical and laboratory findings for horses treated medically for ileal impactions. Design Retrospective case series. Animals 10 horses with primary ileal impaction that were treated successfully with medical treatment alone. Procedure Medical records were reviewed for all horses with naturally developing ileal impaction seen at our hospital between 1990 and 1994. Results Transrectal palpation revealed an impaction in the midabdominal area in all horses. Generalized distention of the small intestine was evident in 6 horses, whereas 4 horses were examined early in the course of the condition and did not have intestinal distention. Treatment consisted of intravenous administration of a balanced electrolyte solution, nasogastric intubation and siphonage, and administration of analgesics. Mineral oil was administered after gastric reflux had ceased. Mean time for resolution of ileal impaction was 11.7 hours. Clinical Implications Medical treatment may be a viable alternative for horses that cannot have surgery, provided persistent signs of severe pain or progressive gaseous distention of the small intestine are not features of the condition. Improvement of cardiovascular status, reduction in signs of abdominal pain, decrease in distention of loops of small intestine during repeated transrectal examination, softening of the impaction, and decreases in amounts of gastric reflux were indicative of a response to medical treatment. (J Am Vet Med Assoc 1996;208:898–900)

Serum tumor necrosis factor activity in horses with colic attributable to gastrointestinal tract disease

SUMMARY Over a 24-month period, serum tumor necrosis factor (tnf) activity was determined in 289 horses with colic attributable to gastrointestinal tract disease. Serum tnf activity was quantitated by use of a modified in vitro cytotoxicity bioassay, using WEHI 164 clone-13 murine fibrosarcoma cells. Causes for colic, determined by clinical and laboratory evaluation, exploratory celiotomy, or necropsy included: gastrointestinal tract rupture (gtr); ileal impaction; small intestinal strangulating obstruction (sio); proximal enteritis (pe); transient small intestinal distention; large-colon displacement; large-colon vovulus; large-colon impaction; colitis; small-colon obstruction; peritonitis; and unknown. Each diagnosis was placed into 1 of 3 lesion categories: inflammatory disorders (gtr, pe, colitis, peritonitis); strangulating intestinal obstruction (sio, large-colon volvulus); and nonstrangulating intestinal obstruction (ileal impaction, transient small intestinal distension, large-colon displacement, large-colon impaction, small-colon obstruction, unknown). The prevalence of high serum tnf activity and/or mortality were evaluated. Differences were tested at significance level of P < 0.05. Approximately 20% of the 289 horses has serum tnf activity greater than that found in clinically normal horses (> 2.5 U/ml). Twenty-three horses (8%) had marked increase in serum tnf activity (≥ 10 U/ml) which was more prevalent among horses with sio and pe than in horses of other diagnostic groups, except those with gtr. Mortality and marked increase in serum tnf activity were greater in horses with intestinal inflammatory disorders or strangulating intestinal obstruction than in horses with nonstrangulating intestinal obstruction. Similarly, a greater proportion of the horses that died had markedly high serum tnf activity than did horses that lived. Mortality of horses with serum tnf ≥ 10 U/ml was greater than that of horses with serum tnf activity < 10 U/ml. Results indicate possible association between colic and serum tnf activity in horses and that high mortality may be associated with horses with markedly increased serum tnf activity.

Abdominal adhesions after small intestinal surgery in the horse.

One hundred thirteen of 172 horses (66%) undergoing exploratory celiotomy for a small intestinal lesion survived 4 or more days after surgery. Intra-abdominal adhesions causing clinical problems requiring additional surgery or euthanasia were documented in 25 horses (22.1%). Problems developed in significantly more males than females. The most common initial small bowel lesion was ileal impaction (12 horses); 21 horses underwent small intestinal resection or bypass. However, there was no significant difference in the incidence of intra-abdominal adhesions between horses that underwent intestinal resection or bypass and those that did not. Only 4 of the 25 horses (16%) with problems associated with postoperative adhesions survived. The mean interval between surgical procedures or between the initial procedure and euthanasia for all horses was 84 days (range, 7-512 days; median, 25 days). However, 70% of the subsequent celiotomies were performed within 60 days of the previous surgery. The mean interval between celiotomies was 221 days (range, 9-512 days) for the survivors and 61 days (range, 7-358 days) for the nonsurvivors. These results indicated that most of the problems related to postoperative intra-abdominal adhesions occurred within 2 months of the initial small intestinal surgery. Furthermore, the earlier development of postoperative adhesions was associated with a poorer prognosis for survival.

Antibody titres to core lipopolysaccharides in horses with gastrointestinal disorders which cause colic.

Serum immunoglobulin (Ig) titres to core lipopolysaccharide (LPS) were determined in 102 horses admitted to a university referral hospital during a 12-month period for evaluation of colic. Serum samples were collected again 10-14 days later from 84 of the horses. Titres to core LPS were quantitated by an indirect enzyme-linked immunosorbent assay (ELISA), utilising the J-5 mutant of Escherichia coli 0111:B4 as the solid-phase antigen. All horses had natural antibodies to core LPS at the time of admission and the titre was not affected significantly by age, sex or type of gastrointestinal disorder. The geometric mean titres to core LPS increased significantly within 14 days of admission in those horses with large colon displacement (25), ileal impaction (13), small intestinal strangulating obstruction (11) and small colon obstruction (4). Twenty four (28.6 per cent) of the horses had at least a 4-fold rise in titre (seroconversion) to core LPS within 14 days of admission. The incidence of seroconversion to core LPS was significantly greater (P < 0.05) in horses with disorders requiring surgical intervention (35.8 per cent) than in those with disorders (proximal enteritis, colitis, large colon impaction and unknown) which only required medical treatment (16.1 per cent). Seroconversion rate was not statistically different between groups of horses with diseases of the small intestine which required surgical or medical treatments. The results of this study indicate that gastrointestinal disorders that cause colic in horses result in IgG production to core LPS, and the latter is more prevalent in disorders requiring surgery.