Surgical management of colic Flashcards
What are indication for colic surgery?
- Severe, unrelenting pain
- Recurrence of pain despite moderate – potent analgesia
- HR >60bpm
- Net reflux >2L
- Deteriorating CV parameters
- Reduced intestinal motility
- Increased abdominal distension
- Deteriorating peritoneal fluid values
What are common types of surgical colic?
- SMALL INTESTINE
- PEDUNCULATED LIPOMA
- EPIPLOIC FORAMEN ENTRAPMENT
- CAECUM
- LARGE COLON
- LARGE COLON DISPLACEMENTS
- LARGE COLON TORSION
- SMALL COLON
What factors influence a owners decision for surgery?
– Financial (insurance)
– Existing health issues (e.g. laminitis / OA)
– Emotional (dead / ill relative)
– Previous experience (good or bad)
– Advice from friends / peers / you
What should be discussed with owners?
- Discuss your findings and why you feel that surgery may be needed
- Discuss the possible causes of colic and likely costs of surgery
- In insured cases, check that the horse / pony is covered for colic surgery
- In some cases, surgery might not be an option but owners should be provided with EVIDENCE-BASED INFORMATION ON WHICH THEY CAN MAKE AN INFORMED DECISION
- If referral is declined at this stage, owners should be aware of the potential consequences
How would you perform an initial exploratory laparotomy?
- Midline incision in dorsal recumbency
- Caecum exteriorised + small intestine - palpate along duodenum + distal ileum
- Large colon exteriorised - palpate RVC + RDC
- Small colon exteriorised - palpate transverse colon to rectum
- Palpation of non exteriorisable organs - Stomach, diaphragm, nephrosplenic space, spleen, liver, bladder + ovaries / uterus
What should be done when assessing the small intestine?
- Assess thoroughly - avoid missing lesions
- Distension = primary / secondary
- Careful + efficient decompression
- Minimise trauma + inflammation = flush fluids on intestines to avoid drying out
What can go wrong with small intestinal resection?
- Leakage
- Mesenteric rent
- Lumen too narrow = obstruction
What can cause caecal colic?
- Less common for surgical lesion
- High tapeworm burdens = ileal impaction / caecal intussusception
- intussusception = resection of caecum
- impaction = surgical bypass
What are common sources of primary lesions in the large colon?
- Impactions
- Displacements
- Torsion
- Enteroliths - sand
- avoid colonic rupture - CAREFUL
What is pelvic flexure enterotomy?
- Pelvic flexure enterotomy is the most common site
- Removal of LC contents assists correction of torsions / displacements and can confirm sand colic
- We perform this immediately oral to the pelvic flexure itself to minimise the reduction in luminal diameter following closure
- Enterotomy can be performed in other locations e.g. where colon cannot be exteriorized
– Be careful to reduce the risk of haemorrhage - Careful closure important to ensure no leakage
How would you assess colon viability from torsion?
- Colour
- Thickness of wall
- Motility
- Change in above following correction of torsion
What do you need to eliminate with small colon problems?
- Impactions
- Lipomas
- Volvulus
- Mesocolon tears (broodmares)
** Good prognosis **
What is most important with abdominal closure?
- Closing the linea alba - muscle
What is most commonly used for analgesia?
- Flunixin meglumine
- if continued pain = considered early relaparotomy
What can be used for CV support?
- Crystalloids
- +/- colloids
- +/- Plasma / whole blood
