Large Colon Enterotomy, Resection, and Anastomosis

Strangulating Large Colon Volvulus: A Diagnostic and Surgical Challenge in a Post-Partum Thoroughbred Mare

“…Previous clinical and experimental reports have shown that horses can endure a resection of up to 90% of the large colon well (13). Nevertheless, post-operative complications, such as persistent endotoxemia and peritonitis, are frequently encountered due to contamination during the surgery (11,12). An improper anastomotic technique leads to leakage and continued bowel devitalization, highlighting the importance of the surgeon's technique and decision to discern the extent of a devitalized bowel and perform a meticulous anastomosis (12).…”

“…Nevertheless, post-operative complications, such as persistent endotoxemia and peritonitis, are frequently encountered due to contamination during the surgery (11,12). An improper anastomotic technique leads to leakage and continued bowel devitalization, highlighting the importance of the surgeon's technique and decision to discern the extent of a devitalized bowel and perform a meticulous anastomosis (12). In these points, the good prognosis of this case is attributed to not only the early recognition and prompt surgical treatment but also the appropriate clinical decision during the surgery.…”

“…Strangulating large colon volvulus (LCV) is an important cause of fatal colic that progresses rapidly (11,12). The reported survival to discharge following surgical correction of a strangulating LCV is between 34.7% and 88% (1,3,5,8,9,17).…”

“…The prognosis is affected by the degree of colon involvement, early recognition, and prompt surgical treatment (1,8). Several surgical techniques for colectomy and anastomosis, such as a resection with side-to-side or end-to-end anastomosis have been described (11,12,17). Multiple objective parameters to determine the colonic viability and prognosis, including the peripheral lactate values and histopathology evaluation of pelvic flexure biopsies, have been studied (2,7,12,14,15).…”

“…Several surgical techniques for colectomy and anastomosis, such as a resection with side-to-side or end-to-end anastomosis have been described (11,12,17). Multiple objective parameters to determine the colonic viability and prognosis, including the peripheral lactate values and histopathology evaluation of pelvic flexure biopsies, have been studied (2,7,12,14,15). Nevertheless, the clinical decisions for a colectomy are most often made based on a subjective intraoperative assessment of the colonic viability, such as the appearance of the bowel wall, particularly the mucosa, because of the lack of availability and predictability of the objective measurements for intraoperative diagnosis to predict the outcomes of LCV surgery (6,7,14,17).…”