Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses

Abstract

BackgroundIn jejunocaecal anastomosis leaving a necrotic ileal stump has been implicated in complications and poor outcomes. Elective inversion of the necrotic stump using a nasogastric tube has been previously described, although this procedure can be cumbersome and can cause caecocolic orifice occlusion.ObjectiveTo describe the use of a new device for elective inversion of necrotic ileal stumps.Study designCase report.MethodsDetails of the four horses that underwent intestinal resection and anastomosis with elective inversion of the ileal stump were retrieved from their medical records. For each case, a device was constructed by securing 0.7 m of hemp tape to a 0.5 m long electrical cable puller. The device was inserted into the ileum and passed through the caecum. The ileal lumen was closed using sutures or staples, and the tape was simultaneously secured to the intestine. The ileum was then resected. A small typhlotomy was performed at the proposed site for jejunocaecal anastomosis. The device was retrieved, the hemp tape was cut, and jejunocaecal anastomosis was completed.ResultsThe device was easily secured to the intestines. Small enterotomies were sufficient for device insertion and removal. In four clinical cases the procedure was effective in inverting the stump, and three out of the four horses recovered uneventfully and were discharged from the hospital. One horse was euthanised due to colic 27 months following discharge.Main limitationsSmall number of cases admitted to single tertiary hospital.ConclusionsThe device was effective in inverting the ileal stump in the included clinical cases. By leaving a short, inverted stump, this method may help improve the prognosis for jejunocaecal anastomosis, possibly avoiding certain undesired effects of the procedure. Further studies with large numbers of cases are required.

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“…64 Case reports have been used to describe genetic markers in equine diseases 63,65 and highlight new approaches to treatment and diagnosis of rare conditions where it is unlikely to be feasible to assemble large case series such as surgical removal of pheochromocytoma, 66 transluminal angioplasty for jugular vein stenosis, 67 GnRH immunisation for granulosa theca cell tumour 68 and diagnostic approaches for ovarian conditions. 69 Case reports can be used to introduce new technology which is likely to be of interest to other clinicians, 70 and they are particularly appropriate for communicating adverse events where the authors are seeking to share the benefit of their experience in the hope that it will be helpful to others unfortunate enough to encounter the same challenge. Excellent examples of this use of case reports are accounts of successful solutions for complications during equine anaesthesia 71,72 and a description of the management of a horse which was accidentally given formalin via nasogastric tube due to misidentification of the contents of storage containers.…”