Background: Obstructive urinary tract disease in horses is a rare and low prevalence pathology in the species, but potentially severe. It is an emergency condition that presents variable clinical signs and depends on the anatomical location of the obstruction. The bladder calculus are the most common followed by the urethra and less commonly seen are the kidney or ureteral. The main crystalloid component of uroliths in horses is calcium carbonate. The higher prevalence of urolithiasis in male horses is justified by some anatomical differences between genders. The urethra of males is narrower and longer than that of females. The tissue injury is the most important factor for the development of uroliths in horses. Desquamation of epithelial cells, presence of leukocyte and necrotic cell debris are relevant contributors to crystal growth. Urinary stasis favors nucleation by increasing the chance of contact between crystalloid material and urinary epithelium. Once crystal growth has begun, the urine alkalinity of the equines favors the crystallization and further deposition of other components, especially calcium carbonate. Typical clinical signs of urolithiasis include tenesmus, dysuria, strangury and polaquiuria. Hematuria is often present, mainly observed after exercise and at the end of urination. In addition signs of colic are quite frequent in the acute bladder and urethral urolithiasis due to bladder distension. Upper urinary tract surgery may be technically challenging due to limited structural exposure, especially in adult horses The prognosis for horses with urolithiasis depends on the location of the urolith and the degree of renal injury that occurred.Case: This report aims to describe a rare case of obstructive urolithiasis in a 8-year-old castrated male horse with 24 h evolution. The horse was expressing signs of abdominal pain and during the transretal examination through palpation, it was possible to notice great distension and turgidity of the bladder, in addition to a high pain sensitivity to the palpation of the kidneys. Was perform urethral catheterization, but it was unproductive. The diagnosis was made through perineal ultrasonography and treated surgically by perineal urethrotomy. The animal presented an excellent evolution after being discharged after 10 days of hospitalization and did not present any complication or recurrence of the disease after one year of the procedure.Discussion: Urolithiasis in horses has a prognosis dependent on the location of the urolith and the degree of renal damage. Cases of obstructive urolithiasis in horses are rare and require prompt and appropriate intervention. Therefore, a rapid and accurate diagnosis is directly related to the success of the treatment. In the present case, the animal had characteristic clinical signs of an acute abdomen. Transrectal palpation, for evaluation of the intestinal portions, was important to diagnose an excessively distended urinary vesicle with no intestinal changes. Transcutaneous ultrasonography of the perineum allowed visualization of the calculus, and then a case of perineal urolithiasis was diagnosed. The choice for perineal urethrotomy was performed because of the ease of palpation of the calculus through the skin below the anus and because it is a non-invasive technique. The urethra was sutured to guide the cicatricial process and the urethral catheter was maintained, reducing the risks of occlusion of the urethral lumen.
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Background: Equine gastrointestinal colic cases represent one of the diseases with higher morbidity and mortality. Short and long term survivals are commonly correlated with the colic causes, being considered 50% the survival rate of horses referred to surgery because of small intestine strangulative causes. The jejuno-caecostomy technique is recommended in cases of ileum necrosis or ischemia that indicates ileum removal. The survival rate after this procedure is low, being even lower than others common terminal-terminal enteroanastomoses. This study reports a case of jejuno-caecostomy followed by tiflopexy and tiflostomy performed in a colic horse.Case: A 12-year-old mare, mangalarga breed, with a history of acute abdomen during 18 h was referred to the FZEA-USP equine hospital. According to the owner, the animal suffered previous episodes of colic that had been solved without treatment. On this occasion, the owner, without veterinary advice, had administered 10 mL of flunixin meglumine, but the animal did not show improvement. During the examination, the patient presented tachycardia, tachypnea, toxemic mucosa, a large amount of enterogastric reflux, and it was possible to observe distended small intestine during rectal palpation. The horse was referred to surgery; it was possible to identify necrosis of the ileum and 30 cm of the aboral segment of the jejunum, caused by strangulation due to a pedunculated lipoma localized in the medial band of the caecum. Latero-lateral jejuno-caecostomy was performed between the medial and dorsal bands of the caecum, using polyglactin 910, nº 2.0, potassium penicillin 30.000 IU / kg, every 6 h, gentamicin 6.6 mg / kg, every 24 h, flunixin meglumine 1.1 mg / kg, every 12 h and maintenance fluid therapy were performed post operatively. The animal had ileus and severe enterogastric reflux for five days postoperatively, showing severe signs of endotoxemia, and parenteral hydration seemed to be not enough. So it was decided to hydrate the animal through the caecum. It was performed a tiflostomy and the implantation of a Foley catheter, nº 24, followed by tiflopexy. During this procedure, it was possible to diagnostic, via intra-abdominal palpation, a significant type I cecal impaction. Immediately after the procedure, the animal presented no more enterogastric reflux and started to defecate pasty manure. Two days after the procedure, the animal died. During necropsy, the anastomoses region showed a great healing process, without folds or stenosis and the functional test of the region was performed, showing no leakage, ensuring the success of the anastomosis technique; the tiflopexy was adequate, and the other intestinal segments presented normal.Discussion: In this report it was possible to observe several postoperative complications such as enterogastric reflux, type I caecum impaction, ileus, and endotoxemia, which was determinant for the death of the animal. Probably the cecal impaction was responsible for the enterogastric reflux and ileus, contributing with the endotoxemia and hydro electrolytic imbalance. These facts evidenced the necessity of faster and more efficient actions in future cases with similar complications, such as the accomplishment of a tiflostomy more precociously avoiding the impaction of caecum and minimizing the electrolytic imbalances of the patients. It was concluded that the delay in the patient referral, followed by the advanced hydro electrolytic imbalance and endotoxemia were the main factors responsible for the treatment failure.
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