Atypical presentation of caecal perforation in two horses

Abstract

Summary This case report describes retroperitoneal and subserosal emphysema as the primary indication of a caecal perforation associated with an episode of colic. Feed contamination was not noted on repeated peritoneal fluid samples or within the peritoneal cavity at the time of surgery; however, subserosal and retroperitoneal emphysema at the base of the caecum was identified during surgical exploration, which later corresponded to retroperitoneal caecal perforation at necropsy examination.

Caecal perforation

“…due to external trauma (Metcalfe et al 2010) or a consequence of endoscopic procedures (Pannu and Fishman 2001) or underlying pathology of the intestinal wall including at locations of diverticulum (Juler et al 1969), ulceration (Sadatomo et al 2013), neoplasia (Marron et al 2006), infection or severe inflammation (Alvares et al 1997). In the 2 horses reported by Gray et al (2014), it is interesting to note that there was histopathological evidence of ulceration of the caecum in the area of the perforation which is not always a characteristic feature of perforation of the peritoneal portion of the equine caecum. The relevance of the ulceration to the retroperitoneal perforation of the caecum in the reported cases (Gray et al 2014) is uncertain.…”

“…In the 2 horses reported by Gray et al . (), it is interesting to note that there was histopathological evidence of ulceration of the caecum in the area of the perforation which is not always a characteristic feature of perforation of the peritoneal portion of the equine caecum. The relevance of the ulceration to the retroperitoneal perforation of the caecum in the reported cases (Gray et al .…”

“…The report by Gray and colleagues published in this issue (Gray et al . ) describes an unusual presentation of caecal perforation in 2 horses, where the perforation occurred in the retroperitoneal portion of the caecal base. This resulted in subserosal and retroperitoneal contamination and the development of septic peritonitis.…”

“…Colic surgery in horses has a major impact on both the horse and owner and there are important financial and ethical considerations to think about when undertaking surgical treatment of colic patients. As Gray and colleagues () rightly point out, attempted surgical treatment and recovery from anaesthesia of the second case in their report may have been undertaken had the senior clinician not had the prior experience of a similar case with retroperitoneal emphysema associated with caecal perforation; attempted treatment of this second case would, most likely, have been unsuccessful and would have exposed the horse to unnecessary suffering prior to death. For these reasons, it is important that clinicians continue to report uncommon conditions or infrequent manifestations of more common diseases.…”

“…The relevance of the ulceration to the retroperitoneal perforation of the caecum in the reported cases (Gray et al . ) is uncertain. Although there was no history or clinical evidence of trauma in the cases described by Gray and colleagues (), the possibility of unrecognised abdominal trauma can never be totally discounted.…”