Use of a pneumatic device for intraluminal enterolith fragmentation in horses

Abstract

Summary Horses with enterolithiasis may develop clinical signs of colic due to partial or complete obstruction of the right dorsal, transverse or small colon. Laparotomy followed by enterotomy at the site of obstruction or mobilisation of enteroliths to intestinal segments deemed more appropriate for incision is indicated in these cases. However, surgical removal of enteroliths lodged in nonexteriorisable intestinal segments and/or not amenable to mobilisation may be labour intensive and dangerous. Pneumatic impact (or ballistic) lithotripsy is a potential tool for surgical resolution of simple and complex cases of enterolithiasis in horses. This study describes the use of a pneumatic lithotripsy device for intraluminal enterolith fragmentation in five cases of enterolithiasis. Seven calculi were successfully fragmented. In four cases, fragmentation was achieved at the site of obstruction and fragments exteriorised through an enterotomy incision created for device introduction or advanced towards the rectum and removed. In two cases, enteroliths were manipulated back to the pelvic flexure, fragmented and removed. Findings of this study suggest that intraluminal enterolith fragmentation can be used to avoid long enterotomy incisions and facilitate removal of calculi lodged in bowel segments that cannot be exteriorised. However, it is important to be aware of the risks of enterolith fragmentation in nonexternalisable bowel segments that cannot be visualised for intestinal viability assessment.

Strategies to relieve intraluminal obstructions in inaccessible segments of the ascending, transverse and descending colon

“…In another report of surgical management of enterolithiasis, mean surgery time was 128 ± 31 min (range 70-200 min) with 13% requiring 1 enterotomy, 83% of surgeries requiring 2 enterotomies and 4% requiring 3 enterotomies (Torrent Crosa et al, 2020). In this case series, mean surgery time was 135 min (range 120-145 min) with 4 cases requiring 1 enterotomy and 1 case requiring 2 enterotomies (Machado Amaral Rosa et al, 2023). This suggests that while the time advantage of pneumatic lithotripsy for enterolithiasis proposed by Machado Amaral Rosa et al (2023) may not be as profound as described.…”

“…In this case series, mean surgery time was 135 min (range 120-145 min) with 4 cases requiring 1 enterotomy and 1 case requiring 2 enterotomies (Machado Amaral Rosa et al, 2023). This suggests that while the time advantage of pneumatic lithotripsy for enterolithiasis proposed by Machado Amaral Rosa et al (2023) may not be as profound as described.…”

“…An ex vivo study comparing lithotripsy damage on urinary tract tissue found that tissue damage and risk of perforation was affected by the type of lithotripter, tissue type, probe force and duration of contact between probe and tissue (Sarkissian et al, 2015). While it is not known how this information extrapolates to equine intestine, equine surgeon experience is likely to be limited with this technique and it is important to be as careful when using pneumatic lithotripsy as the authors of this case series emphasise (Machado Amaral Rosa et al, 2023).…”

“…Machado Amaral Rosa et al (2023) stated that advantages of their pneumatic lithotripsy technique for the management of enteroliths include ability to use smaller enterotomies through sites that are remote to the site of obstruction and reduced surgical time. Comparisons for surgery time were made to an isolated case report describing a particularly difficult presentation of obstructive enterolithiasis (Barrett & Munsterman, 2013).…”

“…Pneumatic lithotripsy as described in this case series (Machado Amaral Rosa et al, 2023) is a useful tool for the surgeon to have in their toolbox when presented with obstructive enterolithiasis.…”