Unusual left colon displacement and clockwise torsion in a 10-month-old Arab filly: A case report

In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10-month-old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention. A 10-month-old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon's length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length. To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post-surgery and did not exhibit any complications during the recovery period.

Sales and race performance of juvenile Thoroughbreds with surgically corrected large colon displacements

BACKGROUND

Juvenile Thoroughbreds can be expensive to raise and train to race. Part of the economic return in these juveniles are the weanling, yearling and 2-year-old in training sales at which major surgeries must be declared.

OBJECTIVES

To determine if surgically corrected large colon displacements were associated with a reduction of sales price and racing performance. We hypothesised that the surgery would be associated with a reduced sales price but would not be associated with a reduction in race earnings or starts.

STUDY DESIGN

Retrospective cohort study.

METHODS

The medical, sales and racing records of horses less than 2 years old that had a surgical diagnosis of large colon displacement were examined (n = 110). Surgical cases were compared with a control group (n = 299) whose sales and racing data were evaluated.

RESULTS

There was no significant difference in median sale price overall between the two groups. Horses undergoing surgery had a reduced number of starts in the 2-year-old year (1 start; p < 0.001) when compared with control horses (2.32 starts), but no significant difference over the 2- to 4-year-old period. There was no significant association with surgery on earnings within the 2- to 4-year-old period of racing when compared with controls.

MAIN LIMITATIONS

The main limitations for this study were the retrospective design, relatively small number of horses and covering only the 2- to 4-year-old period of the horses' racing career.

CONCLUSIONS

Overall, the results of this study suggest that if the juvenile Thoroughbred requires surgery for a large colon displacement, there is minimal association with sales price or race performance compared with their siblings. With this information, it will be easier to make informed decisions to take young horses to surgery.

Evaluation of phenylephrine and exercise with or without trocarization for treatment of suspected nephrosplenic entrapment in horses

OBJECTIVE To report the outcomes of horses with suspected nephrosplenic entrapment (NSE) of the large colon treated by IV phenylephrine administration and exercise with and without trocarization (ie, medical management). DESIGN Retrospective, observational study. ANIMALS 134 horses. PROCEDURES Electronic medical records were searched to identify horses that underwent medical management for suspected NSE at a veterinary teaching hospital between 1995 and 2014. Demographic information, physical and ultrasonographic examination findings, treatment information (including the number of times the treatment was performed and patient response), surgical findings if applicable, complications, and patient outcome were recorded. Descriptive statistics were reported. RESULTS 72 horses had suspected NSE that resolved with medical treatment; 59 of 62 horses underwent laparotomy when medical management failed, and 3 were euthanized without surgery. Twenty-five of the 59 horses had confirmed NSE that was surgically corrected, and 34 had lesions other than or in addition to NSE. All horses that had surgically corrected NSE and 18 of 34 horses that had other lesions survived to hospital discharge. The odds of resolution of NSE with medical management were greater for horses that underwent ≤ 2 (vs > 2) treatments. The treatment success rate for horses that underwent trocarization was not greater than that for horses that did not have the procedure. CONCLUSIONS AND CLINICAL RELEVANCE Suspected NSE resolved with the described medical management for most horses. However, results indicated the potential for misdiagnosis was high. Timely surgical intervention is recommended for horses that fail to respond to medical treatment.

Meta-analysis of the Effect of Treatment Strategies for Nephrosplenic Entrapment of the Large Colon

A variety of treatment strategies for nephrosplenic entrapment of the large colon are reported, with conflicting evidence in the published literature as to the preferred treatment option. The aim of this study is to provide a systematic meta-analytical assessment of the efficacy of different treatment strategies in horses with confirmed or suspected nephrosplenic entrapment. This study involves meta-analysis including nonrandomized studies. A comprehensive literature search was performed from January 1970 to January 2017. Inclusion criteria were retrospective studies involving horses with confirmed and suspected nephrosplenic entrapment. A meta-analysis was performed using a random effects model, with the effect size calculated as an odds ratio (OR) with 95% confidence intervals. Statistical significance was P < .05. Out of 84 peer reviewed publications that met the search criteria, 19 relevant studies were identified. Using an OR as the effect size, the meta-analysis noted that the choice of medical or surgical therapy had no statistically significant effect on survival (P = .134). Patients treated via the rolling technique were no more likely to resolve with medical management than those treated via jogging (P = .187). Patients treated with phenylephrine were no more likely to exhibit medical resolution than patients that did not receive phenylephrine, either when all medical treatment methods were considered (P = .290), or when rolling under general anesthesia was used (P = .331). Treatment strategy, including medical versus surgical therapy, does not affect the likelihood of resolution of nephrosplenic entrapment. However, the lack of randomized trials means the results should be treated with caution and case selection remains important..