Parainguinal laparotomy as an alternative surgical approach for removal of an enterolith in the small colon of a horse

Abstract

SummaryThis report describes the use of a parainguinal approach to the abdomen to remove an obstruction in the small colon that could not be removed using an initial ventral midline approach. The use of a parainguinal approach should be considered for removal of an obstruction in the distal portion of the small colon.

Secondary approaches to the abdominal cavity for horses with signs of colic may be key to successful resolution of an either very proximal or very distal small colon obstruction

“…The reports by Anderson et al . (), Klohnen and Panizzi () and the case report by Barrett and Munsterman () demonstrated that a nontraditional (off midline) approach to the abdominal cavity is not more prone to incisional complications or hernia formation compared to a ventral midline approach.…”

“…). Although the use of standing enemas to resolve palpable small colon obstructions and small colon impactions as described in the report by Barrett and Munsterman () have been mentioned in the literature, the risk of secondary complications (rectal tears) is very high and they are often not performed in adult horses.…”

“…Occlusion of the small colon by the surgeon's hand with subsequent distention of the small colon next to the enterolith, via a controlled enema, may aid the surgeon in the manipulation of the small colon enterolith via the transverse colon back into the right dorsal colon or into a more accessible location for a small colon enterotomy outside the abdominal cavity. In the article by Barrett and Munsterman (), the enterolith was located very distal in the small colon and could not be manipulated into a section of the small colon that could be exteriorised via a midline celiotomy. As a result of the inaccessibility of the enterolith, a parainguinal approach (similar to bladder stone removal [Beard ; Watts and Fubini ] or cryptorchid castration [Wilson and Reinertson ]) was used in order to remove the distal small colon enterolith via a small colon enterotomy.…”

“…Parainguinal approaches to the abdominal cavity were first described for the removal of retained (intra‐abdominal testicles) by Wilson and Reinertson () and Beard () for removal of uroliths from the bladder. Barrett and Munsterman () described in the accompanying article, a right parainguinal approach for the removal of a distal small colon enterolith via a small colon enterotomy. The amount of intra‐abdominal fat in the inguinal region and length of the distal mesocolon will dictate the limitation to fully exteriorise the distal small colon via a parainguinal approach.…”

“…Parainguinal approaches to the abdominal cavity have previously been extensively used in horses in order to gain access to the bladder for bladder stone removal (Beard ; Watts and Fubini ). The accompanying article by Barrett and Munsterman () describes a parainguinal laparotomy approach for the removal of an enterolith in the distal small colon of a horse. Abdominal exploration via an initial ventral midline approach identified a complete, luminal obstruction of the distal small colon but the small colon could not be exteriorised for removal of the obstruction via a small colon enterotomy.…”