Equine Emergency Surgery

Question 1

What are the most common emergency surgeries?

Answer 1

Colic
Dystocia
Trauma
Synovial sepsis
Fracture repair

Question 2

Define colic.

Answer 2

Broad term for abdominal discomfort in horses
Body systems potentially involved: GI tract, liver, urinary tract, reproductive organs

Question 3

What equipment is needed for a colic assessment?

Answer 3

Drugs - sedation, NSAIDs, Buscopan
Clippers
Sterile prep solution
Catheters
Blood tubes
Lactate reader
NG tube
Rectal gloves and lubricant
Fluids (isotonic / hypertonic)
Ultrasound machine

Question 4

What does a colic work-up entail?

Answer 4

Physical exam - demeanour/signs of pain, TPR GI borborygmi, CVS status, abdo distension
Rectal exam
Pass NG tube
Bloods - PCV, TP, lactate
Abdo ultrasound
Abdominocentesis - TNCC, TP, lactate

Question 5

What signs indicate surgical colic over medical colic?

Answer 5

Congested MMs, CRT >3s, HR >60-80bpm, poor pulse quality
Uncontrollable pain
Distension/displacement of small/large intestine
>2L reflux on nasogastric intubation
Amotile, distended loops of small intestine on u/s
High blood/peritoneal fluid lactate

Question 6

How do we prepare a horse for colic surgery?

Answer 6

Ensure IV catheter present and patent
Ensure stomach decompressed/NG tube left in
Start clipping abdomen/remove shoes if safe!
Place urinary catheter
Surgical prep and scrub

Question 7

What equipment is needed for colic surgery?

Answer 7

Warmed fluids
Carboxymethylcellulose (CMC) - lubricant to prevent adhesions post-op
2x surgical kit
Fresh gloves/gowns in case of contamination/enterotomy/resection
Lots of drapes
Hose
Colon table and dump drum

Question 8

How is colic surgery carried out?

Answer 8

Ventral midline incision (>20cm long)
Whole GI tract assessed for distension, thickening, viability, displacement
Any non-viable intestine needs to be resected and anastomosed
Displacements of large intestine - do not require resection, contents dumped via enterotomy

Question 9

What general post-op care can we provide to colic patients?

Answer 9

IVFT +/- lidocaine CRI
Analgesia
Antimicrobials
Incision care
Nutrition

Question 10

How do we reintroduce food to different colic patients?

Answer 10

Large intestinal displacements - can gradually refeed once awake/alert
Small intestinal resections/anastomosis - no food for 48hrs
Usually start with small amounts of fibre nuts +/- handfuls of grass (hay last to be added in)

Question 11

What possible post-op complications can we see with colic patients?

Answer 11

Endotoxaemia
Ileus
Colitis
Jugular thrombophlebitis
Peritonitis
Incisional infection

Question 12

Describe endotoxaemia in colic patients.

Answer 12

Caused by bacteria leakage from gut/contamination during surgery
IVFT
Flunixin +/- Polymixin B +/- hyperimmune plasma
Can cause laminitis so pre-empt - ice boots, deep bed, frog supports

Question 13

Describe ileus in colic patients.

Answer 13

NG tube intubation regularly - gastric decompression
Pro-motility drugs - lidocaine, erythromycin, metoclopramide
IV fluids
Nil by mouth
Monitor by ultrasound

Question 14

Describe colitis in colic patients.

Answer 14

Can be fatal in itself
IVFT!
Isolation - can shed salmonella
Gastroprotectants e.g. misoprostol, sucralfate

Question 15

Describe jugular thrombophlebitis in colic patients.

Answer 15

Not uncommon
Remove catheter
Local anti-inflammatory treatment
Consider anti-thrombolytics - do not want to risk bleeding from other sites

Question 16

Describe peritonitis in colic patients.

Answer 16

Diagnosed by abdominocentesis
Broad spectrum antimicrobials e.g. penicillin, gentamycin, metronidazole

Question 17

Describe incisional infection in colic patients.

Answer 17

Not uncommon - painful!
Often develop marked oedema/cellulitis
Antimicrobials if horse is systemically unwell
Swab for culture and sensitivity, encourage drainage

Question 18

What should we monitor post-op for colic patients?

Answer 18

Complete clinical exam every 2-4hrs
Demeanour
GI borborygmi, faecal output/consistency, appetite
Jugular vein (heat, swelling, pain, patency)
Feet (comfort, digital pulses)
Incision (oedema, discharge)
Ensure geldings not urinating on belly bandage

Question 19

How can we begin to rehabilitate colic surgery patients?

Answer 19

Gradual reduction of analgesia
Gradual refeeding
Box rest 4-6 weeks + walks to grass
Paddock rest 1 month
Turn out 1 month
Then gradual return to previous work

Question 20

What is red bag delivery?

Answer 20

Premature separation of placenta (placenta provides foal with oxygen)
Instead of amnion appearing at vulva - chorioallantois appears first (deep red colour)
Chorioallantois must be ruptured immediately and assisted delivery of foal

Question 21

What can cause dystocia?

Answer 21

Incidence 1-10%
Usually foal malposition
Occasionally due to foal abnormalities e.g. limb deformities

Question 22

How is a caesarean section carried out?

Answer 22

Ventral midline incision
Uterine horn located and exteriorised
Hysterotomy incision 35-40cm (allow for feet and hocks)
Umbilical cord clamped and transected
Foal lifted out (two person job!)
Foal transferred to separate team

Question 23

What is the role of ‘team mare’ during a C-section?

Answer 23

Two people scrubbed in
One person running the room
One anaesthetist

Question 24

What is the role of ‘team foal’ during a C-section?

Answer 24

Two people min. to resuscitate foal
Is foal normal/abnormal?
O2 supplementation, IV catheter placement, umbilicus management etc.

Question 25

What are some possible dystocia complications?

Answer 25

Reproductive tract trauma - perineal lacerations, uterine rupture
Retained placenta
Delayed uterine involution
Metritis
Peritonitis
Uterine/bladder prolapse
Arterial haemorrhage