Strangulating obstruction of the small intestine by a fibrous band originating on the nephrosplenic ligament

Abstract

Summary During a laparotomy for colic signs in a 2‐year‐old male Thoroughbred, a portion of approximately 7 m of the jejunum was found entrapped in a fibrous band originating from the nephrosplenic ligament. The entrapped jejunum was necrotic and was removed. Two months after the first surgery, a laparoscopy was performed to close the nephrosplenic space and it was possible to identify several fibrous bands bridging from the renal capsule to the splenic capsule and a fibrotic plate over the spleen. This is the first report of a strangulating obstruction of the jejunum in the nephrosplenic space and of fibrous bands bridging from the nephrosplenic ligament to the spleen. The fibrous bands were likely due to inflammation caused by previous, multiple left dorsal displacements of the bowel, which resolved spontaneously.

Expanding the definition of nephrosplenic entrapment

“…In both of these horses, the bowel coursed in a cranial to caudal direction; an additional finding in one horse was a concurrent 180 degree volvulus of the affected jejunum. The nature of the entrapment was not identified in the current case (Gandini et al 2021). Interestingly, in the horses described anecdotally by Wheat (1972) with nephrosplenic entrapment of the small intestine, the bowel passed in a caudal to cranial direction, contrary to that reported by Goodrich et al (1997).…”

“…The median age of horses with nephrosplenic entrapment of the ascending colon has been reported as between 8 and 10.2 years and ranged from 7 months to 36 years (Barrell et al 2011;Lindegaard et al 2011;Nelson et al 2016;Gillen et al 2019;Ar evalo Rodr ıguez et al 2019). Horses in the case report by Goodrich et al (1997) describing small intestinal entrapment in the nephrosplenic space were 6 and 14 years of age, whereas the horse in the current report (Gandini et al 2021) was 2 years of age. Similar to ascending colon entrapment, there does not seem to be an age predilection, but the numbers are too low at this time to be definitive.…”

“…Similar observations were reported by Nelson et al (2016) in 29 horses with closure of the nephrosplenic space, with 86% of owners reporting less frequent colic signs than before surgery, and 97% reporting no further episodes of nephrosplenic entrapment. While a history of colic was not identified in the current case (Gandini et al 2021), the closure of the nephrosplenic space may help to prevent reoccurrence of colic, in general, and nephrosplenic entrapment specifically. However, it should not be indicated as a clear preventative measure for small intestinal nephrosplenic entrapment based on both the rarity of this condition, and the lack of a clear cause and effect.…”

“…Horses in the case report by Goodrich et al (1997) describing small intestinal entrapment in the nephrosplenic space were 6 and 14 years of age, whereas the horse in the current report (Gandini et al . 2021) was 2 years of age. Similar to ascending colon entrapment, there does not seem to be an age predilection, but the numbers are too low at this time to be definitive.…”

“…However, due to the degree of small intestinal distention in the current case, Gandini et al . (2021) were unable to palpate the nephrosplenic ligament to identify if the small intestine travelled dorsal to the structure. In the horse with small intestinal distention reported in Goodrich et al (1997), the spleen was not displaced, and the colon appeared to be heading towards the nephrosplenic ligament similar to the classic definition of ascending colon entrapment.…”