Jejunum and Ileum

Freeman, David E.

doi:10.1016/b978-0-323-48420-6.00035-1

Cited by 27 publications

(81 citation statements)

References 261 publications

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“…Meckel’s diverticula (MD) are a congenital disorder of the gastrointestinal tract found in several species like humans, pigs and horses [ 1 , 2 , 12 ]. In rare cases the vitelline duct (partially) fails to atrophy during embryonic development and a tube-like diverticulum remains, called a Meckel’s diverticulum [ 2 , 3 , 8 ]. This blind ending branch of small intestine is located at the distal end of the jejunum or proximal ileum, has a lumen and can vary in length from 10 to 35 cm [ 1 , 3 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

“…Just like a Meckel’s diverticulum, a mesodiverticular band is a kind of vitelline anomaly [ 20 ]. A mesodiverticular band is a remnant of a vitelline artery, usually the left, and its associated mesentery [ 6 , 8 , 21 ]. This creates a triangular fold between the intestinal mesentery and attaching to the anti-mesenteric side of the distal jejunum [ 8 , 10 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, to prevent reoccurrence of a strangulation or other complications caused by the diverticulum (e.g. impaction), the decision was made to perform ‘en bloc’ resection of the anomaly and the associated jejunum of approximately 1 m. An end-to-end jejuno-jejunostomy single-layer anastomosis as described by Freeman (2019) [ 8 ] was performed. Vessels in the mesentery were ligated with polyglactin 910 (Vicryl I ) USP 0.…”

Section: Case Presentationmentioning

confidence: 99%

“…As the yolk regresses and the placenta takes over, the vitelline duct and paired vitelline arteries atrophy [ 3 , 5 ]. In case of an incomplete obliteration, a mesodiverticular band, a vitelline duct cyst or a Meckel’s diverticulum may remain [ 2 , 3 , 5 – 8 ]. Vitelline remnants can be an incidental finding during exploratory laparotomy, but they may as well lead to small intestinal strangulation for which surgical intervention is needed [ 1 , 3 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

et al. 2020

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Background Meckel’s diverticula are a rare cause of small intestinal strangulation, diagnosed at laparotomy or necropsy. This congenital anomaly of the gastrointestinal tract originates from a remnant of the vitelline duct. In reported equine cases, they present as a full-thickness diverticulum on the antimesenteric border of the distal jejunum or proximal ileum. Case presentation On laparotomy a Meckel’s diverticulum positioned at the mesenteric side was found to be the cause of small intestinal strangulation. This position is very uncommon and to the best knowledge of the authors there is no unambiguous description of another case. Conclusions Meckel’s diverticula should be on the list of differential diagnoses in cases of small intestinal strangulation. As in humans, equine Meckel’s diverticula can have the standard antimesenteric as well as a more exceptional mesenteric location. This case adds to the series of anecdotal reports of anomalies with regard to Meckel’s diverticula in the horse.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

et al. 2020

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“…Nasogastric reflux at admission may reflect the proximity of the SI obstruction to the stomach, the completeness of the obstruction, and the duration of the obstruction (ie, an incomplete obstruction or an obstruction of the distal jejunum and ileum may not result in nasogastric reflux for numerous hours) . Because many SI strangulating lesions are complete and affect the distal jejunum and ileum, the presence of admission reflux may represent the duration of obstruction and the duration and degree of distension of the SI proximal to the obstruction. Prolonged SI distension of the proximal SI leads to intestinal injury and inflammation, potentially contributing to POR as well as other complications …”

Section: Discussionmentioning

confidence: 99%

Clinical findings associated with development of postoperative reflux and short‐term survival after small intestinal surgery in geriatric and mature nongeriatric horses

2019

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Objective To determine risk factors, especially age, associated with postoperative reflux (POR; >2 L of reflux present upon intubation), high‐volume POR (≥20 L in 24 hours), and short‐term outcome after small intestinal (SI) surgery. Study design Retrospective case‐control study. Sample population Horses aged ≥16 years (geriatric; range, 16–30; n = 44) and <16 years (mature; range, 2–15; n = 39) with an SI surgical lesion that survived general anesthesia and did not have a second exploratory celiotomy during the same visit. Methods Medical records (2009–2015) were reviewed; perioperative variables were evaluated for associations with outcomes by using multivariable logistic regression. Results Postoperative reflux was associated with an increasing packed cell volume at admission (odds ratio [OR], 1.08; 95% CI, 1.00–1.16; P = .042) and presence of nasogastric reflux at admission (OR, 4.61; 95% CI, 1.3–15.69; P = .014). High‐volume POR was associated with an increasing glycemia at admission (OR, 1.19; 95% CI, 1.01–1.40; P = .041), presence of nasogastric reflux at admission (OR, 10.05; 95% CI, 2.21–45.74; P = .003), and SI resection (OR, 10.52; 95% CI, 1.81–61.25; P = .009). Increasing surgical time (OR, 2.50; 95% CI, 1.16–5.29; P = .019) and high‐volume POR (OR, 6.37; 95% CI, 2.12–19.12; P = .001) were associated with nonsurvival. Conclusion Age, considered as both a continuous variable and a categorical variable, was not associated with the development of POR, high‐volume POR, or nonsurvival. Clinical significance Age does not influence the occurrence of POR and should not negatively impact an owner's decision to pursue surgery in aged horses.

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Caecal impactions: Diagnosis, management and prognosis

Álvarez

Hanson

Schumacher

2020

Equine Veterinary Education

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Summary A caecal impaction can be caused by an accumulation of dry ingesta (type I) or abnormal caecal motility resulting in a feed impaction of fluid consistency (type II). Horses that develop a caecal impaction have often been administered a nonsteroidal anti‐inflammatory drug (NSAID) during hospitalisation for treatment of a painful condition such as an ocular or orthopaedic disease. Clinical signs of caecal impaction can be mild, and progress to more moderate to severe signs of abdominal pain as the impaction enlarges. Since an impacted caecum has a high risk of rupture, early diagnosis and treatment are important. Horses with a caecal impaction can be treated medically or surgically, and treatment decisions are based on clinical signs, results of transrectal palpation, character of peritoneal fluid and response to medical management. For type I caecal impaction, medical management consists of aggressive fluid therapy, both intravenous and enteral, to soften ingesta. Fluid therapy can be combined with laxatives, motility‐enhancing drugs and analgesic drugs. Surgery is indicated if results of transrectal abdominal examination indicate that the impaction is unchanged or has enlarged, signs of abdominal pain increase, or if there is cardiovascular deterioration. Horses with type II caecal impaction have a greater chance of survival if managed surgically. Using a ventral mid‐line celiotomy approach, a caecal impaction can be resolved via a typhlotomy. When caecal motility is poor, or there are signs of chronic caecal dysfunction, a caecal bypass procedure (jejunocolostomy or ileocolostomy) should be considered. Although the prognosis for horses with a caecal impaction is claimed to be fair to good, choice of treatment is controversial and may influence prognosis. If the affected horse survives to discharge from the hospital, the long‐term prognosis is generally good. Many retrospective studies of cases of caecal impaction are weakened by failure to distinguish between types I and II.

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Jejunum and Ileum

Cited by 27 publications

References 261 publications

An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

Clinical findings associated with development of postoperative reflux and short‐term survival after small intestinal surgery in geriatric and mature nongeriatric horses

Caecal impactions: Diagnosis, management and prognosis

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