Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse

Cypher, E.; Kendall, Anna; Panizzi, Luca; Stewart, Allison J.; Taylor, Sarah L.; Bodaan, Christa; Riley, Christopher B.; Gordon, Stuart; Whitfield, LK

doi:10.2460/javma.247.1.98

Cited by 10 publications

(13 citation statements)

References 27 publications

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“…Cypher et al described rib resection and the removal of a necrotic portion of the liver in an adult horse, which, together with appropriate medical management, resulted in a successful outcome, with the horse returning to its previous level of performance. 8 In our case, the intervention was less invasive, and percutaneous drainage may be considered if the abscess is accessible. Even if not all of the contents of the abscess(es) can be removed, it seems likely that the removal of some of the contents will increase the chances of resolution with antimicrobial treatment and/or decrease the necessary duration of antimicrobial treatment.…”

Section: Discussionmentioning

confidence: 64%

“…Hepatic abscesses may also result from hepatic lobe torsion and the associated tissue hypoxia and necrosis. 8 The (long-term) use of proton pump inhibitors has been shown to decrease the diversity of the intestinal bacterial flora in man 13 and there are concerns that their use may predispose to bacterial infection and sepsis, particularly in patients with liver cirrhosis. 14 Although findings suggestive of bacterial sepsis were already seen in the biopsy obtained on the day after admission, it cannot be completely ruled out that the administration of proton pump inhibitors contributed to the bacterial spread.…”

Section: Discussionmentioning

confidence: 99%

“…Serial ultrasonographic evaluation and bloodwork can help monitor the resolution of hepatic inflammation. 8 In horses or ponies with increased liver enzymes and evidence of inflammation, hepatic ultrasound should be performed to evaluate the hepatic parenchyma and try to determine if hepatic abscesses are present. Supportive care and broad-spectrum antimicrobial treatment must be initiated and, if possible, as much as possible of the contents of an abscess could be drained percutaneously, under ultrasound guidance, and submitted for bacteriological culture and sensitivity testing.…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of a hepatic abscess in a pony by percutaneous drainage and antimicrobial therapy

Witt

Siegers

Restrepo

et al. 2021

Vet Record Case Reports

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A 4-year-old Welsh pony mare presented with anorexia and colic of several days' duration. The mare showed gastric reflux for several days with clinicopathological evidence of inflammation and markedly increased hepatic parameters. Treatment consisted of supportive care and broad-spectrum antimicrobials. Ultrasound revealed hepatopathy and liver biopsy was consistent with bacterial hepatitis. Two weeks later, multiple abscesses could be imaged and the largest abscess was drained percutaneously, under ultrasound guidance. Bacterial culture of the aspirated purulent material yielded Escherichia coli and antimicrobial therapy was switched to oral enrofloxacin for another 2 weeks. The pony made a full clinical recovery and ultrasound revealed improvement in hepatic structure. Two years after discharge from the hospital the pony was reported to be healthy and performing at the expected level.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful treatment of a hepatic abscess in a pony by percutaneous drainage and antimicrobial therapy

Witt

Siegers

Restrepo

et al. 2021

Vet Record Case Reports

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“…In a retrospective study evaluating the use of metronidazole in 200 horses with various infectious processes, including 39 cases of peritonitis and / or abdominal abscess, anorexia was observed in 4/200 animals as an adverse effect and whose resolution occurred after discontinuation of treatment (Sweeney et al, 1991). Cypher et al (2015) described the use of metronidazole (25 mg/kg -VO -TID) for the treatment of hepatic abscess in a horse for 10 days; however, it was discontinued after signs of anorexia. No previous studies reported the occurrence of diarrhea after prolonged metronidazole therapy.…”

Section: Discussionmentioning

confidence: 99%

Association of intraperitoneal ceftriaxone, intravenous gentamicin and oral metronidazole in the treatment of an abdominal abscess and peritonitis in a horse

Alonso¹,

Ávila²,

Apolonio³

et al. 2020

Braz. J. Vet. Res. Anim. Sci.

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Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response

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“…The use of oral DXC in horses has been anecdotally reported as an efficacious treatment of intra‐abdominal or cutaneous abscesses (Cypher et al, 2015; Saqib et al, 2012). Oral DXC has also been used for the treatment of neuroborreliosis (Chang et al, 2005; Divers et al, 2018; James et al, 2010; Wagner et al, 2011), granulocytic ehrlichiosis, neorickettsiosis, and leptospirosis (Bernard, 1993; Davis et al, 2006; Palmer, 1993).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and pharmacodynamics of doxycycline in a Streptococcusequi subsp. zooepidemicus infection model in horses

Chapuis

Smith

Uehlinger

et al. 2021

Vet Pharm & Therapeutics

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The objectives of this study were to investigate the pharmacokinetics (PK), pharmacodynamics (PD), and the efficacy of oral administration of doxycycline (DXC) in horses with Streptococcus zooepidemicus tissue infections. Tissue chambers (TC) were implanted subcutaneously in the cervical region of 7 horses and inoculated with a single S. zooepidemicus isolate with a minimum inhibitory concentration (MIC) of 0.25 µg/ml, determined by agar dilution. Doxycycline hyclate (10 mg/kg, orally, q 12 h, for 5 days) mixed with poloxamer gel was started following inoculation. The TC fluid was sampled prior to and following inoculation for cytology analysis, quantitative culture, and DXC determination. Plasma DXC concentrations were measured over 48 h following the last dose of DXC administered. The mean plasma peak concentration (Cmax) of DXC was 0.32 µg/ml, and concentrations above the MIC were only reached in 3 TC samples. In plasma, mean T > MIC was 2.4 h, mean Cmax/MIC was 1.30, and mean AUClast/MIC was 11.63 h. These PK/PD indices did not reach the suggested targets for DXC treatments of infections, and the TC abscessed in all horses. This is the first study to evaluate the recommended dose of DXC in horse in an infection model.

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Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse

Abstract: Rib resection in standing sedated horses, together with appropriate medical management, should be considered an option for removal of well-encapsulated cranially located intra-abdominal abscesses that are adherent to the ventrolateral aspect of the body wall in horses.

Cited by 10 publications

References 27 publications

Successful treatment of a hepatic abscess in a pony by percutaneous drainage and antimicrobial therapy

Successful treatment of a hepatic abscess in a pony by percutaneous drainage and antimicrobial therapy

Association of intraperitoneal ceftriaxone, intravenous gentamicin and oral metronidazole in the treatment of an abdominal abscess and peritonitis in a horse

Pharmacokinetics and pharmacodynamics of doxycycline in a Streptococcusequi subsp. zooepidemicus infection model in horses

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