lleocolostomy A Technique for Surgical Management of Equine Cecal Impaction

Abstract

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.

Outcome and long‐term follow‐up of 20 horses undergoing surgery for caecal impaction: A retrospective study (2000–2008)

“…This study is the largest to date to detail results and long‐term follow‐up of horses undergoing surgery for caecal impaction secondary to caecal dysfunction. The results for caecal bypass surgery in this case series are similar to those reported by previous authors (Craig et al . 1987; Dabareiner and White 1997; Mair and Smith 2005).…”

“…Caecal bypass procedure: In horses undergoing caecal bypass surgery, a typhlotomy, using the previously described technique, was performed initially to decompress the caecum. The ileum was transected and a side‐to‐side ileocolonic anastomosis was performed, as described by Craig et al . (1987).…”

Use of cecal bypass via side-to-side ileocolic anastomosis without ileal transection for treatment of cecocolic intussusception in three horses

“…4 We believed that complete bypass was not necessary because there was a natural obstruction of flow of ingesta by compression of the ileum in the intussusception (which does not occur in equine cecal impaction). However, occlusion of the lumen of the proximal portion of the ileum without ileal transection can be accomplished by placing 4 rows of staples across the lumen of the ileum adjacent and aboral to a jejunocolostomy site.…”

“…The ileum and colon were positioned in an antiperistaltic position, so that ingesta flowed in the opposite direction to normal. 4 Stab incisions (2 cm) were made through the antimesenteric border of the ileum and through the right ventral colon, close to the aboral stay suture. The arms of an intraluminal anastomosis stapler device a were passed through the stab incisions, and the anastomosis was created by activating the device once.…”

Caecal disease

“…Survival rates in the order of 77446% have been reported for complete ileocolostomy and jejunocolostomy (Craig et al 1987;Ross et al 1987;Gerard et al 1996;Dart et al 1997). These techniques have the potential to lead to recurrence of the impaction.…”