Large Colon Volvulus Research Articles

Prevalence of gastric squamous ulceration in horses with abdominal pain

Prevalence of gastric ulcerations differs widely according to breed and circumstances of management. Further study of the biological variables involved is required in order to identify more exactly the reasons for the reported range. The objectives of this present study, which do not appear to have been addressed previously in the literature, were 1) the prevalence of gastric ulceration in horses with abdominal pain. 2) difference in prevalence in horses responding to medical therapy and those requiring surgical intervention. 3) whether gastric ulceration is associated with any particular gastrointestinal tract lesion. Horses were included in the study if gastroscopy was performed within 24 h of presentation. The presence and grade of gastric ulceration was recorded together with the medical records. Data were analysed categorically using a Fisher's exact test or Chi-squared test. One hundred horses met the selection criteria. Forty-nine percent (49/100) of horses had gastric ulceration, 63% (63/100) responded to medical therapy and 37% (37/100) to surgical intervention, and prevalence was higher in the former (59%) than the latter (32%). Horses with duodenitis-proximal jejunitis (DPJ) had a trend towards higher prevalence of gastric ulceration compared to those with other GI lesions. Sixty-eight percent (13/19) of horses diagnosed with DPJ, 32% (8/25) with a large colon impaction and 14% (1/7) with large colon volvulus had gastric ulceration. The presence of gastric ulceration in all horses with abdominal pain was moderate. Horses responding to medical therapy had a higher prevalence of gastric ulceration compared to horses requiring surgery and there was a trend towards higher prevalence in cases of DPJ compared to other GI lesions. There was not a statistically significant difference in gastric ulceration detected between specific lesions, including large colon impactions and large colon volvulus. The clinical relevance of ulceration is still unclear and further studies are required to differentiate between incidental and clinically important gastric ulceration.

Use of ultrasound to evaluate outcome following colic surgery for equine large colon volvulus

The post operative response of the large colon wall after a surgically corrected large colon volvulus (LCV) has not been investigated. To use transabdominal ultrasound to monitor the post operative change in large colon wall thickness following surgical correction of LCV. A prolonged period to colon wall involution is correlated with an increased rate of post operative morbidity and mortality. A prospective clinical study including horses that presented to the North Carolina State University Veterinary Teaching Hospital for colic between September 2006 and March, 2008, had surgically diagnosed and corrected LCV (at least 360 degrees ) without resection and recovered from anaesthesia. Ultrasound of the ventral large colon was performed at the time of anaesthetic recovery and every 6-8 h until the colon wall returned to normal thickness (< or = 5 mm). Outcome was evaluated using a one-way ANOVA to compare average time to colon wall involution between: 1) survivors and nonsurvivors; and 2) horses that developed multiple organ dysfunction syndrome (MODS) during the post operative period and those that recovered without evidence of MODS. Sixteen horses that recovered without evidence of MODS had a significantly shorter period to colon wall involution (< or = 5 mm) compared to those diagnosed with MODS (mean +/- s.e. 19.6 h +/- 2.5 and 39.7 h +/- 6.7 respectively, P = 0.006). There was no significant difference in mean period to colon wall involution between survivors and nonsurvivors (26.2 +/- 4.9 and 33.2 +/- 7.8 h, respectively). A shorter time to colon wall involution was associated with decreased post operative morbidity in horses presented for surgical correction of large colon volvulus without resection. Ultrasonographic monitoring of colon wall involution after surgical correction of LCV may aid in identifying those cases at risk of MODS. Further investigation of colon wall involution time using a larger number of horses is warranted.

Survival and Complications After Large Colon Resection and End‐to‐End Anastomosis for Strangulating Large Colon Volvulus in Seventy‐Three Horses

To report complications and survival after large colon resection and end-to-end anastomosis in horses with strangulating large colon volvulus. Retrospective case series. Horses (n=73) with strangulating large colon volvulus. Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow-up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short-term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long-term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self-limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long-term survival with minimal negative impact on quality of life and use.

Haemolytic anaemia as a complication following colic surgery in a 10‐year‐old Arabian stallion

SummaryImmune‐mediated haemolytic anaemia is rare in the horse. This case report discusses the clinical presentation and treatment of this condition in an Arabian stallion following abdominal surgery for large colon volvulus. On Day 10 of hospitalisation the stallion's PCV dropped by 10% whilst his total solids remained stable, consistent with haemolytic anaemia. The stallion was treated with whole blood transfusions and dexamethasone and recovered to be discharged on Day 42. This is an interesting example of immune mediated haemolytic anaemia associated with a complicated gastrointestinal condition. It demonstrates the wide variety of potential aetiologies underlying a haemolytic episode and the necessity for expedient treatment.

Obstrução estrangulada de jejuno como complicação pós-operatória de ressecção do cólon maior eqüino: relato de caso

Em uma égua, submetida à laparotomia para correção de vólvulo do cólon maior, realizou-se enterectomia próximo ao ligamento cecocólico seguida de enteroanastomose término-terminal. Nas primeiras 24 horas do período pós-operatório, houve piora dos sinais clínicos, com ocorrência de dor, refluxo enterogástrico e agravamento do quadro de endotoxemia. Frente ao prognóstico desfavorável, optou-se pela eutanásia. Durante a necropsia, não foram constatadas falhas na enteroanastomose ou sinais de peritonite séptica. Observou-se encarceramento de uma alça de jejuno, que se apresentava justaposta à extremidade livre da prega cecocólica e comprimida entre o corpo do ceco e o cólon ventral direito remanescente, caracterizando obstrução do tipo estrangulada. Esse achado foi compatível com o agravamento do quadro clínico observado no pós-operatório. Essa ocorrência sugere a necessidade de uma adaptação na técnica de ressecção do cólon maior, de forma a reduzir o espaço cecocólico e evitar um possível encarceramento de alças de intestino delgado.

Growth factor and receptor mRNA expression in the intestine of horses with large colon volvulus: a pilot study

Growth factors (GF) are important for maintenance and repair of intestinal mucosal structure and function, but there have been no studies investigating growth factor (GF) or growth factor receptor (GF-R) mRNA expression in the intestine of horses with large colon volvulus (LCV). (1) To determine mRNA expression for epidermal growth factor (EGF), EGF receptor (EGF-R), insulin-like growth factor-I (IGF), IGF receptor (IGF-R), vascular endothelial growth factor (VEGF) and VEGF receptor (VEGF-R) in the intestine of horses with an LCV compared to normal intestine. (2) To measure the correlation between histological intestinal injury and mRNA expression. In 5 horses, samples were collected from the mid-jejunum (small intestine, SI), pelvic flexure (PF) and right dorsal colon (RDC) prior to creation of the LCV (NORM), 1 h following creation of the LCV (ISCH) and 1 h following correction of the LCV (REPER). In 2 clinical cases of LCV, samples were collected from the PF and RDC. Samples were assessed histologically for the amount of intestinal injury. The mRNA expressions of growth factors and receptors were determined using qRT-PCR. VEGF and VEGF-R mRNA expression was greater in horses with an LCV compared to NORM. Expression of IGF-R mRNA increased in the SI during ISCH and REPER. The increase compared to NORM in VEGF and VEGF-R mRNA expression in horses with LCV may be important in early intestinal healing and may also explain, in part, the increase in vascular permeability in horses with a LCV. Expression of IGF and IGF-R in the SI warrants further investigation and may be important for understanding post operative complications in horses with SI lesions.

Use of Colonic Luminal Pressure to Predict Outcome After Surgical Treatment of Strangulating Large Colon Volvulus in Horses

To evaluate the relationship of colonic luminal pressure (CLP) measurements to outcome in horses with large colon volvulus (LCV) after either manual correction or large colon resection and anastomosis (LCRA). Retrospective study. Horses (n=57) that had LCV. Records for horses with LCV (March 1997-December 2003) were reviewed. Inclusion criteria were strangulating LCV proximal to the cecocolic ligament (>270 degrees), recorded CLP, and successful recovery from anesthesia. CLP measurements and survival/mortality rates were compared between horses that had manual correction (M) or LCRA (R). Of 57 horses, 27 had M and 30 had LCRA. For group M, CLP measurements had a sensitivity of 0.60 and specificity of 0.77 for predicting survival, whereas for group R, sensitivity was 0.50 and specificity was 0.54. In our LCV population, elevated CLP measurements had poor accuracy for predicting outcome in horses after surgical correction, especially after LCRA. CLP measurements based on a single hospital population of horses with LCV should be used with caution for other hospital populations of LCV. CLP may be only one of many variables needed for predicting outcome of horses with strangulating LCV, especially after LCRA.

Use of ultrasonography to diagnose large colon volvulus in horses

To describe the use of ultrasonography to diagnose large colon volvulus (LCV) in horses. Descriptive report. 4 horses with clinical signs of abdominal pain. Each horse was administered analgesic agents for pain control and placed in stocks. Ultrasonographic evaluations were performed with a 3.5-MHz sector scanning transducer that was placed parallel to the long axis of the horse (longitudinal imaging) over an area of the left ventral aspect of the abdomen. The boundaries of the evaluated region included the ventral midline, 2 vertical lines at the level of the left 10th and 17th intercostal spaces, and a horizontal line between the 2 vertical lines at the level of the costal arch of the left 10th intercostal area. In all horses, nonsacculated large colon was identified ultrasonographically in the left ventral portion of the abdomen; this finding was considered indicative of LCV. In 3 horses, the LCV involved intestinal rotation of 180 degrees, whereas in 1 horse, the LCV involved intestinal rotation of 540 degrees. As confirmed by surgical or postmortem findings, the degree and location of the volvulus were correctly estimated from ultrasonographic images. In horses, this method of diagnosis of LCV appears to be of value regardless of the location at which the rotation of the large colon occurs. Ultrasonographic findings may aid in the earlier diagnosis of LCV in horses, especially at an early stage of the disease when other clinical signs are equivocal.

Mares admitted to a referral hospital for postpartum emergencies: 163 cases (1992–2002)

AbstractObjective:To identify and describe the physical, historical, and clinicopathologic characteristics of diseases requiring emergency treatment in postpartum mares, and to evaluate the utility of these characteristics in making an accurate diagnosis in these mares.Design:Retrospective study.Setting:University large animal hospital.Animals:One hundred and sixty‐three mares admitted for emergency treatment within 30 days following parturition between the years 1992 and 2002.Interventions:None.Measurements and main results:Information obtained from the medical records included age, breed, date of admission, sex of the foal from this parturition, time from parturition to admission, duration of clinical signs prior to admission, and any report of dystocia or normal attended delivery, physical examination and clinicopathologic findings and diagnosis. Urogenital hemorrhage and large colon volvulus were the most common diagnoses, comprising 16.6% and 15.9% of total cases, respectively. Older mares were more likely to have a diagnosis of urogenital hemorrhage than younger mares. Mares with urogenital hemorrhage had a median age of 13 years and were admitted to the hospital significantly closer to parturition than mares with other diagnoses. Anemia, hypoproteinemia, and hypofibrinogenemia were significantly associated with a diagnosis of urogenital hemorrhage and occurred in 32%, 36%, and 26% of the mares with urogenital hemorrhage, respectively. Dystocia was more commonly reported (70%) in mares with metritis. Leukopenia was more common (88%) in mares with uterine tears.Conclusions:Careful evaluation of clinicopathologic data can aid the emergency clinician in making a correct diagnosis in postpartum mares with emergent problems.

Coagulation profiles in 27 horses with large colon volvulus

AbstractObjective:The objective of this study was to evaluate coagulation profiles in horses with surgical treatment of large colon volvulus (LCV), and determine if an association exists between hemostatic dysfunction and outcome.Design:Prospective clinical investigation from February to December 2000.Setting:Large animal intensive care unit in a veterinary teaching hospital.Interventions:Blood was collected from horses intra‐operatively, 24, and 48 hours following surgical treatment for LCV.Measurements:Coagulation profiles, thrombin–antithrombin (TAT) levels, and D‐dimer concentrations were determined for each time point. The number of tests abnormal in the standard coagulation profile, defined as the degree of hemostatic dysfunction, was determined for each horse for the duration of the study period. The association between each test and outcome, as well as the degree of hemostatic dysfunction for each horse and outcome, was determined using univariate analysis and logistic regression. TAT levels and D‐dimer concentrations were compared to the results of the standard coagulation profile and to patient outcome using univariate analysis and logistic regression.Main results:Seventy percent of horses evaluated with surgical treatment of LCV had evidence of hemostatic dysfunction (3/6 tests abnormal). Only 18% of those patients had clinical signs recognized by the attending clinician as a coagulopathy. There was an association between the development of a coagulopathy and outcome, with horses with 4/6 tests abnormal being more likely to be euthanized, and those with 3/6 tests abnormal having a prolonged hospital stay. Platelet count, prothrombin time, and TAT levels may be helpful in predicting outcome in horses with LCV.Conclusions:Hemostatic function should be evaluated in horses with surgical treatment of LCV to detect subclinical coagulopathies and direct subsequent intervention.

Diseases and Surgery of the Large Colon

Displacements and intraluminal obstructions of the large colon carry a good to excellent prognosis for long-term recovery, and surgery for these diseases is rarely followed by short-term or long-term complications. Entrapment of the large colon over the renosplenic ligament is amenable to medical therapies so that surgery can be avoided in many cases. However, preoperative diagnosis of all nonstrangulating diseases of the large colon can be difficult. Vascular diseases of the large colon, such as thromboembolic diseases and large colon volvulus, are more difficult to treat and carry a poorer prognosis for survival.

Large Colon Resection

Strangulating large colon volvulus presents the surgeon with the dilemma of determining the extent of compromise to the affected tissue and the most appropriate surgical treatment of this tissue. This decision is complicated because there is a significant volvulus recurrence rate. Large colon resection and anastomosis is the most aggressive treatment option but prevents recurrence and may provide an alternative to euthanasia for some horses.

Colopexy

Colopexy is a surgical procedure designed to create an adhesion from the ventral colon to the body wall to prevent recurrence of large colon volvulus or displacement, and is a useful technique to prevent recurrence of this disease. Colopexies usually are reserved for broodmares, because this is the population of horses that is most predisposed to recurrence of large colon volvulus.

Effect of high-molecular weight dextran macromolecules on low-flow ischemia and reperfusion of the large colon in horses

Abstract Objective To evaluate the effect of high-molecular weight (MW) dextran macromolecules on low-flow ischemia and reperfusion of the large colon in horses. Design Horses subjected to low-flow ischemia and reperfusion of the large colon were treated with either 0.9 NaCI (group 1, n = 6) or high-MW dextran (group 2, n = 6) solutions. Animals 12 adult horses. Procedure Horses were subjected to 3 hours' low-flow ischemia followed by 3 hours' reperfusion. A dose of either 0.9% NaCI or a 6% solution of high-MW (250,000) dextran (10 ml/kg of body weight) was administered IV, 30 minutes prior to reperfusion. Hemodynamic variables were recorded at 30-minute intervals. Systemic arterial and colonic venous blood were collected for determination of PCV, plasma total protein, and whole blood lactate concentrations, and for blood gas and oximetry analyses. Histologic examination of large-colon biopsy specimens was performed. Results Mean arterial pressure was greater in group-2 horses, compared with group-1 horses, from 3 to 3.25 hours, but there were no significant differences between groups for any of the other hemodynamic variables. Compared with baseline values, colonic blood flow was significantly lower from 0.5 to 3 hours and was significantly greater from 3.25 to 6 hours. Arterial and colonic venous PCV were significantly lower than baseline values from 3 to 3.25 hours, and at 3 hours, respectively, in group-2 horses. These values were significantly lower in group-2 horses, from 3 to 6 and 3 to 5 hours, respectively. There was significant mucosal necrosis, hemorrhage, edema, and neutrophil infiltration in horses of both groups; however, there were no significant differences between the 2 groups. Conclusions High-MW dextran did not protect the colonic mucosa from low-flow ischemia and reperfusion; there were no deleterious effects on colonic mucosa or on systemic hemodynamic or metabolic variables. Clinical Relevance Reperfusion with high-MW dextran solution probably would not protect the large colon from ischemia-reperfusion injury associated with large-colon volvulus. (Am J Vet Res 1996;57:1067–1073)

Colonic luminal pressure in horses with strangulating and nonstrangulating obstruction of the large colon.

Colonic luminal pressure (median, range) measured during ventral midline celiotomy in 69 horses with strangulating obstruction (SO) of the large colon (SO; > or = 270 degrees large colon volvulus; 27 cm H2O: 2 to 80 cm H2O) was greater (P = .0023) than that measured in 37 horses with nonstrangulating obstruction (NSO) of the large colon (NSO; < or = 180 degrees volvulus or a nonstrangulating displacement; 18 cm H2O; 6 to 46 cm H2O). Sixty-five percent (45 of 69) of horses with SO and all horses with NSO survived. Survival analysis was restricted to 59 horses with large-colon SO that survived to hospital discharge or met the criteria specified for classification as nonsurvivors. Colonic luminal pressure in nonsurvivors (48.5 cm H2O; 34 to 80 cm H2O) was higher (P =.0001) than that measured in survivors (18 cm H2O; 2 to 50 cm H2O) of SO. From response operating characteristic curves, a luminal pressure of 38 cm H2O optimized the distribution of horses with SO into survivor and nonsurvivor groups. Sensitivity, specificity, and positive and negative predictive values for a colonic luminal pressure greater than 38 cm H2O in predicting nonsurvival were 0.89, 0.91, 0.72 and 0.97, respectively. Measurement of colonic luminal pressure may be useful for predicting survival in horses with colonic volvulus.

Colopexy in broodmares: 44 cases (1986-1990)

Summary Colopexies were performed in 44 broodmares requiring abdominal surgery for large colonvolvulus or right dorsal displacement of the large colon. Colopexies were performed by suturing the lateral bands of the left and right ventral colon to the ventral abdominal wall. Forty-seven percent of the mares in which a colopexy was performed had previous surgery for a large colon volvulus or right dorsal displacement of the large colon. Postoperative complications considered directly associated with the colopexy procedure were intermittent abdominal pain in 7, reoperation in 5, subcutaneous fistulous tracts in 1, and catastrophic rupture of the left ventral colon in 2 horses. Thirty-six horses survived &gt; 6 months after colopexy, 34 of which had complete follow-up examinations. Twenty-seven mares have foaled at least once subsequent to the colopexy procedure, totalling 40 foals. Colopexy was considered a viable technique to prevent recurrence of large colon displacement or volvulus in selected predisposed populations.

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 &lt; 0.05. Approximately 20% of the 289 horses has serum tnf activity greater than that found in clinically normal horses (&gt; 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 &lt; 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.