Retrograde intussusception of the descending colon secondary to multiple colonic hamartomas in a neonatal foal

Abstract

A neonatal Thoroughbred filly presented with a 3-h history of abdominal pain and distention that failed to respond to medical treatment. Diagnostic evaluation, including abdominal ultrasound, barium enema and proctoscopy, was suggestive of atresia coli. Exploratory laparotomy revealed a pedunculated mass in the wall of the diaphragmatic flexure of the ascending colon. The mass, subsequently diagnosed as a hamartoma, was attached to a smaller hamartoma by a fibrous pedicle originating from the descending colon. The descending colon had intussuscepted retrograde into the ascending colon along the fibrous band. The filly was euthanised due to poor prognosis.

Retrograde intussusception of the descending colon in a neonatal foal

“…The mechanism by which the intussusception developed in this case can only be presumed, but I question whether abnormal motility was responsible (Mejia et al . 2021). The large colon of the adult horse is capable of propulsion and retropulsion, motility patterns designed to retain solid particles in the colon for microbial digestion (Sellers et al .…”

“…The authors did not propose any surgical correction in this case, presumably because the intussusception was irreducible for reasons that could only be learned through hindsight (Mejia et al . 2021). Even with the benefit of hindsight, surgical options would seem limited, although some might be worth consideration.…”

“…Resection of the hamartomas would depend on the extent of attachment of the lesions to the colon walls, and this information was not clear. Apparently, the same cord that connected the masses to each other also provided attachment to the intestinal segments (Mejia et al 2021). In a previously reported hamartoma in the small colon of a foal, the mass was attached to the mucosa by a long slender cord (Colbourne et al 1996) that would be amenable to transection with a haemostatic method.…”

“…Some readers might not share the authors' view that colic surgery in foals carries a relatively guarded prognosis (Mejia et al 2021), based on a more recent study than those cited (MacKinnon et al 2013). In that study, the outcome in those foals treated surgically was similar to those treated medically for different types of colic (MacKinnon et al 2013).…”

“…The report of a retrograde intussusception of the descending colon in a neonatal foal and the thorough review of related topics by Mejia et al (2021) describes a highly unusual case. Small colon intussusceptions are rare in horses and are then reported usually in post-partum broodmares, possibly related to stage 4 rectal or small colon prolapse (Ross et al 1988).…”