Colic Surgery Flashcards
Which parts of the GiT can we access?
Where can we get intestinal obstructions ?
What does relief of impactions involve? (steps)
- Enterotomy
- Evacuation of obstruction
- Lavage
- Closure of enterotomy
What is the most common site of impaction?
Pelvic flexure
How do we do large colon evacuation?
Enterotomy (temporary hole) made at pelvic flexure to evacuate gut contents
Describe sand impactions
- Increasing prevalence
- Peri-urban horses/ponies
- Large impaction of RDC (Right Dorsal Colon)
Descirbe small intestinal enterotomy?
- Less common but possible
example: Impaction of haynet thay been eaten by horse mid-jejunal obstruciton
How do we close SI enterotomy
Inverting suture pattern
Small colon obstruction - what is common?
Faecoliths / Enteroliths (cannonball of mineral material)
What Intestinal DISPLACEMENTS can we see?
- Right dorsal displacement
- Nephrosplenic entrapment/LDD
- Pelvic flexure retroflexion
- Partial colon torsion
How do we correct colon displacements?
- Decompress gas
- Evacuate ingesta
- Manipulate and re-position
Describe Nephrosplenic entrapment
colon trapped due to splenic ligament
How do we manage nephrosplenic entrapment ?
- Starvation & patience (if not too painful)
- Gentle exercise e.g. trotting
- Phenylephrine (40mg in 1L saline) and lunge
- GA and roll
- GA and laparotomy
Rolling a NSE case?
Massaging in dorsal recumbency (not common now)
How does large colon torsion happen?
VERY SEVERE; LIFE THREATENING
twisting more than 360° -> cuts off BS
What appositional / inverting suture patterns can we use?
adhesions!
What intestinal strangulation can we see?
- Pedunculated lipomas
- epiploic foramen entrapment
- Mesenteric tears
- Gastro-splenic ligament
- Volvulus nodosus
- Intussuception
What problems/ risks with strangulation?
- Ischaemic gut
- Endotoxaemia!!
- Distention proximally
How do we go about an intestinal resection?
- Ligate mesenteric vessels
- Cut mesentery
- Section aborally
- Decompress via ischaemic gut
- Section orally
- anastamosis
End to end anastamosis TECHNIQUE N°1
- equal diameter ends
- Two layer technique -> Mucosal continuous THEN intverting oversew
- 3M absorbable material
- ## Close mesentery
End to end anastamosis TECHNIQUE N°2?
Side to side (stapled)
- Jejuno-caeal anastamosis
- Minimises risk of contamination
- Time saving?
- Reinforce ends with sutures
- can perform hand-sewn equivalent
Aims of resection?
- Remove ischaemic gut
- Secure ligation of mesenteric vessels
- anastomosis of healthy bowel
- Restore continuity of gut
How much Si intestine can u resect?
50-60%
Consider euthanasia if >60% necessary
Intestinal biopsy (laparoscopy)?
Acute colic
- Equine grass sickness
- Eosinophilic enteritis
- Neoplasia
- Assessment of gut viability?
Chronic dx
- Infiltrative dx
- Malabsorption
What does Eosinophilic enteritis look like?
Limitation sof colic surgery?
Adhesions & abscesses
Inaccessible regions (stomach, duodenum, caecal base)
Motility disorders
Recurrent displacements
Advanced endotox
Issues with colic surgery?
- Managing expectations
- Communication
- At the hospital
- Timeline
- Post op care
- Convalescence
- Cost
Convalescence ?
8 weeks box rest
8 weeks small paddock turn-out
