Search

Hypodynamic gastrointestinal disorders in horses and cattle that are thought to benefit from treatment with drugs restoring and coordinating gastrointestinal motility include postoperative ileus and large colon impaction in the horse and displacement of the abomasum and dilatation of the cecum in cattle. Important physiologic, pathophysiologic and pharmacologic mechanisms involved in the intrinsic control of gastrointestinal motility include cholinergic, adrenergic, dopaminergic, serotoninergic, and opioid-mediated pathways. Preliminary results suggest that cisapride, acting on 5-Hydroxytryptamine receptors, might be useful for treatment of idiopathic postoperative ileus and the alpha 2-adrenoceptor blocking agent yohimbine for endotoxic postoperative ileus. Naloxone, an opioid antagonist, and neostigmine, an acetylcholinesterase inhibitor, are thought to restore motility of the large colon in cases of large colon impaction in the horse. Bethanechol and neostigmine significantly increase myoelectric activity of the cecum and proximal loop of the ascending colon in healthy cows. Investigations of the effects of prokinetic drugs on displacement of the abomasum of cattle do not allow any conclusions because no results derived from controlled experimental disease models are available.

Endoscopic resection, including polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection, is the preferred treatment method of large colorectal polyps. Its safety and efficacy have been shown. Endoscopic removal techniques are important because they provide a resection specimen for precise histopathologic staging to further direct diagnosis, prognosis, and management decisions. Used according to its indications, it provides curative resection and obviates the higher morbidity, mortality, and cost associated with alternative surgical treatment.

Endoscopic resection of colonic polyps prevents death from colorectal cancer.1 Improvements in endoscopic technique and instrumentation now allow complete resection of large colon polyps with favorable safety and oncologic outcomes.2 Herein is a brief evidence-based video review of the endoscopic technique for submucosal lift-assisted polypectomy and clip closure of sessile colonic adenomas.

Foram revisados os casos de abdômen agudo de origem gastrintestinal em equídeos atendidos no Hospital Veterinário da Universidade Federal de Campina Grande, em Patos, Paraíba. No período de janeiro de 2001 a dezembro de 2010. Setenta (4,5%) do total de 1542 equídeos atendidos no período apresentaram quadro clínico de cólica, sendo 60 equinos, cinco muares e cinco asininos. A compactação de cólon maior foi a causa mais frequente de cólica, diagnosticada em 37,14% dos casos, seguida por compactação de cólon menor (10%) e corpo estranho de cólon menor (7,14%). Em quatro casos as cólicas foram causadas pela presença de fitobezoares no intestino grosso, sendo dois deles associados ao consumo de vagens de Prosopis juliflora. Em cinco casos foi observada a presença de corpos estranhos no cólon menor e em um caso os corposestranhos foram encontrados no cólon maior, sendo principalmente sacos plásticos. As lesões estrangulantes do intestino delgado foram observadas em quatro casos. Outras causas foram cólica espasmódica (dois casos por parasitose e dois por ingestão de resíduos domiciliares), sobrecarga gástrica (três casos) e deslocamento de cólon maior que foi diagnosticado em dois animais. Laceração de cólon menor, torção de ceco, compactação de ceco e timpanismo por consumo de Manihot esculenta foram diagnosticados em uma única ocasião. O principal fator de risco para o desenvolvimento de cólicas foi o consumo de Pennisetum purpureum, Brachiaria decumbens, Sorghum spp. ou Echinochloa polystachya picados manualmente ou em picotadeira ou triturados em forrageira (OR=4,03; P=0,007). Como resultado da baixa qualidade dos alimentos ingeridos, a frequência dos atendimentos de equídeos portadores de cólica foi significativamente maior no segundo semestre (época da seca na região estudada) (OR=2,61; P

O objetivo deste estudo foi investigar a ação da hidratação enteral (HET), da hidratação intravenosa (IV) e da sene, associada à hidratação intravenosa (SEN), no tratamento da compactação do cólon maior, em equinos. Foram utilizados 15 animais, divididos em três grupos de cinco, cada. Os animais eram portadores de compactação do cólon maior, induzida experimentalmente. O grupo HET recebeu solução isotônica poliônica enteral (8 mL kg^-1 h^-1,durante 48 horas); o grupo SEN foi tratado com sene (20 mg kg^-1, duas doses de 24/24 h), mais Ringer lactato i.v. (10 mL kg^-1 h^-1 12h^-1, durante dois dias) e ao grupo IV foi administrado Ringer lactato i.v. (16 mL kg^-1 h^-1 12h^-1, durante dois dias). O tratamento HET ocasionou maior amolecimento das fezes e desfez a compactação em menor tempo. Entretanto, foi observada hipomotilidade intestinal mais prolongada. O tratamento SEN normalizou mais rapidamente a motilidade intestinal, porém o tempo necessário para desfazer a compactação foi maior. Além disso, ocasionou o maior aumento na distensão abdominal e no grau da dor, assim como a menor capacidade para reverter a desidratação. O tratamento do grupo IV debelou a compactação, igualmente ao HET, e a hipomotilidade intestinal, em menor tempo, mas foi o que menos amoleceu as fezes. Concluiu-se que os tratamentos IV e HET foram os mais eficientes na terapia da compactação, induzida no cólon maior, em equinos. O grupo SEN foi eficiente, porém, foi o que apresentou os efeitos adversos mais importantes. The objective of this study was to investigate the effect of senna associated with intravenous fluid therapy (SEN), isotonic polionic enteral solution (PE) and intravenous fluid therapy (IV) alone in the treatment of experimental large colon impaction in horses. Fifteen horses with experimentally induced colon impaction were divided in three groups: Group PE received the isotonic polionic enteral solution (8 mL kg^-1 h^-1,during 48 h); Group SEN received senna (20 mg kg^-1, two doses with 24 h interval) + Ringer lactate i.v. (10 mL kg^-1 h^-1 12 h^-1, for two days); and Group IV received Ringer lactate i.v. (16 mL kg^-1 h^-1 12 h^-1, for two days). The treatment protocol of group PE increased fecal hydration and helped remove impaction faster; however, prolonged intestinal hypomotility were observed. The treatment protocol SEN normalized the intestinal motility faster; however the time required to remove impaction was higher and caused higher increase in abdominal distention and pain, as well as less capacity to revert dehydration. The treatment used for group IV removed the impaction, similarly to PE, and stimulated intestinal motility faster; however, it was the treatment that promoted less fecal hydration. The results showed that the treatments used in groups PE and IV were more efficient for the treatment of induced colon impaction in horses. The group SEN was also efficient, but showed the most important adverse effects.

In nonruminant herbivores, microbially derived AA could contribute to whole-body AA homeostasis and thus decrease predicted AA requirements. However, postileal capacity of AA uptake is currently unknown. Therefore, to test the hypothesis that Lys is transported across the large colon mucosal apical membrane with capacity similar to that of the small intestinal mucosa in the pony and pig, we examined Lys transport in vitro using brush border membrane vesicles (BBMV). Mucosa was collected from the distal jejunum (DJ) and proximal large colon (PLC) of growing pigs (n = 3) and ponies (n = 4), flash frozen in liquid nitrogen, and stored at -80°C. Jejunal and colonic BBMV were manufactured by Mg(2+) precipitation and used to determine initial rates and kinetics [the maximal transport rate (V(max)) and the Michaelis constant (K(M))] of l-Lys transport into apical epithelia by rapid filtration technique in Na(+)-gradient incubation buffer. Initial rates of total l-Lys uptake did not differ between the PLC and DJ in either the pig or the pony, or between the pony and the pig, at each l-Lys concentration. In the pig, compared with the DJ, l-Lys transport V(max) in the PLC did not differ (121 ± 26 and 180 ± 26 pmol•mg of protein(-1)•s(-1), respectively; P = 0.14) and l-Lys K(M) in the PLC tended to be greater (0.23 ± 0.22 and 0.89 ± 0.22 mM, respectively; P = 0.09). In the pony, compared with the DJ, l-Lys transport V(max) in the PLC was greater (62 ± 25 and 149 ± 25 pmol•mg of protein(-1)•s(-1), respectively; P = 0.04) and l-Lys K(M) in the PLC was greater (0.08 ± 0.22 and 1.05 ± 0.22 mM, respectively; P = 0.02). l-Lysine diffusion was not different between segments; however, total intestinal diffusion was greater (P = 0.03) in the pony than in the pig (115 ± 10 and 73 ± 10 pmol·mg of protein(-1)•s(-1), respectively). These results demonstrate that the large colon is capable of l-Lys transport across the apical epithelial membrane with greater capacity and less affinity than the jejunum, indicating that the large colon may play a significant role in l-Lys absorption and homeostasis in hindgut fermenters.

Objective To determine the success of medical management of suspected displacement of the ascending (large) colon in horses. Study Design Retrospective case series. Animals Horses (n = 127) with suspected large colon displacement. Methods Medical records (January 1998–September 2008) of horses admitted for colic were reviewed. Suspected large colon displacement was diagnosed from clinical examination and in some cases, subsequent surgical examination. Medically managed horses were exercised and administered intravenous fluids and analgesia. Horses with suspected left dorsal displacement (LDD) of the large colon were also administered phenylephrine. Results Medical management had a high success rate for treatment of suspected right dorsal displacement (RDD) (64%) and LDD (76%) of the large colon; 4 horses died (1) or were euthanatized (3) and 36 horses had surgery. Of 127 horses treated medically or surgically for a colon displacement, 94% survived to hospital discharge. Conclusions Horses with suspected RDD or LDD of the large colon may respond to medical management including exercise.

This study aimed to evaluate and compare physical and hematological alterations in equines submitted to an experimental model of intestinal obstruction. Twenty-four animals were divided into four groups: instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII), and large colon obstruction (GIV). Physical examination was carried out and blood samples were collected before surgery (T0), during the obstruction (T1i, T2i and T3i), and after unblocking procedures (T3r, T24r, T72r, T120r and T168r). Animals from GII, at T2i and T3i, and animals from GIII, at T1i, T2i, T3i and T3r, presented signs of abdominal pain, reduced gastrointestinal sounds and increased heart and respiratory rates, as well as leukopenia and neutropenia, which later (T24r and T72r) developed to leukocytosis, neutrophilia and left shifts. From T120r up, gradual and continuous decrease of leucocytes counts was observed indicating, similarly to Clinical characteristics, the resolution of organic dysfunction associated to obstruction. The results were associated to enteric injury from the obstruction model showing that some laboratorial alterations when analyzed, including physical examination, can be helpful at identifying which intestinal segment is blocked, drawing up the prognosis and following the evolution of the healing process. KEYWORDS: Equine, hemogram, colic, ischemia, reperfusion.

During a 28 month period, 82 horses with clinical signs of abdominal pain were examined for left dorsal displacement of the large colon (LDDLC) using percutaneous ultrasound. Left dorsal displacement of the large colon was diagnosed when a gas echo dorsal to the spleen obliterated the dorsal splenic border, or when the colon was observed lateral to the spleen. In 42 horses, ultrasound confirmed a diagnosis of LDDLC and 40 horses had no evidence of LDDLC. There were five false negative results and no false positives. In four horses with LDDLC, the colon was displaced between the spleen and body wall; three of these colic episodes resolved with medical therapy and the fourth required a celiotomy to relieve a sand impaction. The remaining 38 horses had a renosplenic entrapment; surgical correction was elected in 4 horses, 21 horses were corrected by a nonsurgical rolling procedure, 12 were corrected at surgery after an unsuccessful rolling attempt, and one was corrected by rolling but required surgery later because of an additional lesion. Percutaneous abdominal ultrasound was a valuable aid in the diagnosis of LDDLC and in confirming correction of the displacement after a nonsurgical rolling procedure.

To assess the effect of enteral fluid therapy (EFT) in horses with colic, 78 adult horses with colon impactions and 30 with left dorsal colon displacements received an isotonic electrolyte solution via a nasogastric tube at a rate of 8 to 10 l every two hours until resolution of clinical signs. Clinical progression was monitored closely, and plasma biochemistry was evaluated before, during and after treatment. Volume of fluids, time to resolution, and outcome were also recorded. EFT was well tolerated by 102 of 108 horses and was an effective method to resolve 99 per cent of colon impactions and 83 per cent of displacements. For both groups, the mean (sd) time to resolution was 20.2 (5.2) hours and the volume of fluid administered was 118.6 (34.5) l. No relevant abnormalities were observed in most plasma biochemistry parameters during treatment, except for a mild haemodilution effect in 63 per cent of horses.

Objective— To report inguinal herniation of the ascending colon in a Standardbred colt. Study Design— Case report. Animals— A 6-month-old Standardbred colt. Methods— The colt underwent surgical exploration of the hernia with large colon resection and anastomosis. Results— A successful large colon resection and anastomosis was completed, however, the colt was euthanatized at the end of surgery upon owner request. Conclusions and Clinical Relevance— Although uncommon, indirect inguinal herniation of the ascending colon can occur in young horses.

Objective—To determine how survival rates in geriatric horses (≥ 20 years old) undergoing abdominal exploratory surgery for colic compare with survival rates for younger (nongeriatric) horses. Design—Retrospective case-control study. Animals—56 geriatric horses and 487 nongeriatric horses undergoing exploratory celiotomy for colic. Procedures—Medical records of all horses undergoing emergency abdominal exploratory surgery for primary gastrointestinal tract lesions over a 10-year period were reviewed. Data retrieved included signalment, primary gastrointestinal tract lesion, whether the horse was discharged from the hospital alive, and reason (if applicable) for euthanasia or death either during surgery or prior to hospital discharge. Survival rates were calculated and compared between the geriatric and nongeriatric populations for strangulating and nonstrangulating small intestinal, cecal, large colon, and small colon lesions. Information on long-term outcome was obtained via telephone contact with owners or referring veterinarians. Results—Survival rate at the time of hospital discharge was 50% (28/56) for geriatric horses and 72% (352/487) for nongeriatric horses. Of horses that survived surgery and anesthetic recovery, 82% (28/34) of geriatric horses and 89% (352/396) of nongeriatric horses were discharged from the hospital alive. Seventy percent (14/20) of geriatric horses and 84% (108/129) of nongeriatric horses with long-term follow-up information survived > 1 year after surgery. Conclusions and Clinical Relevance—Survival rate at the time of hospital discharge was significantly lower for geriatric horses, compared with that for nongeriatric horses. The primary reason for this difference in survival rates between the 2 groups appeared to be related to the significantly higher number of geriatric horses euthanized during surgery.

HERNIATION through the inguinal ring is an uncommon complication of castration. Herniation has been reported to occur up to 12 days after castration but usually occurs within hours ([Hutchins and Rawlinson 1972][1], [Boussauw and Wilderjans 1996][2]). Draught breeds and Andalusian horses may be more

Summary Intestinal tissue samples were collected during routine post-mortem examinations from 12 aged donkeys. Six animals were euthanised due to impaction of the pelvic flexure of the large colon, while the remaining six were euthanised for non-enteric reasons such as dental or orthopaedic disease. Immunohistochemical labelling was performed to demonstrate the gastrointestinal pacemaker cells, the interstitial cells of Cajal (ICC), with polyclonal c-Kit antibodies. The distribution and density of the cellular networks were assessed qualitatively and semi-quantitatively. ICC networks are present in the donkey, with distribution similar to that of the horse, and they remain strongly immunoreactive in the older animal. There was no difference in the density and distribution of ICC in animals with or without intestinal disease.

A noninvasive blood test that could reliably detect early colorectal cancer or large adenomas would provide an important advance in colon cancer screening. The purpose of this study was to determine whether a serum proteomics assay could discriminate between persons with and without a large (≥1 cm) colon adenoma. To avoid problems of “bias” that have affected many studies about molecular markers for diagnosis, specimens were obtained from a previously conducted study of colorectal cancer etiology in which bloods had been collected before the presence or absence of neoplasm had been determined by colonoscopy, helping to assure that biases related to differences in sample collection and handling would be avoided. Mass spectra of 65 unblinded serum samples were acquired using a nanoelectrospray ionization source on a QSTAR-XL mass spectrometer. Classification patterns were developed using the ProteomeQuest® algorithm, performing measurements twice on each specimen, and then applied to a blinded validation set of 70 specimens. After removing 33 specimens that had discordant results, the “test group” comprised 37 specimens that had never been used in training. Although in the primary analysis, no discrimination was found, a single post hoc analysis, done after hemolyzed specimens had been removed, showed a sensitivity of 78%, a specificity of 53%, and an accuracy of 63% (95% confidence interval, 53-72%). The results of this study, although preliminary, suggest that further study of serum proteomics, in a larger number of appropriate specimens, could be useful. They also highlight the importance of understanding sources of “noise” and “bias” in studies of proteomics assays. (Cancer Epidemiol Biomarkers Prev 2008;17(8):2188–93)

Cases with a history of colic due to a large colonic impaction were recruited retrospectively to assess the treatment efficacy and complications of oral and parenteral fluid therapy regimes for correction of primary large colon impactions. Oral isotonic fluids had been administered at varying intervals following initial treatment with magnesium sulphate and water. There was no significant difference in complication rates between groups. Considering complication rates with impaction clearance, hourly administration of oral fluids appears to be the most appropriate treatment regime of those investigated.

The isthmus at the caecocolical junction in domestic equids is well described. Like another isthmus between the ansa proximalis coli (the colonic fermentation chamber or ‘large colon’) and the colon transversum (the distal or ‘small’ colon), this spot represents not only a potential anatomical feature contributing to particle ingesta retention but also an explicit predilection site for intestinal obstructions. The question whether this anatomical feature also occurs in wild equids is therefore of both physiological and medical interest but has not been addressed so far. In this paper, we report dissections of the large intestine of a domestic pony (Equus caballus f. dom.), a Przewalski horse (Equus przewalski) and a plains zebra (Equus burchelli). The intestinal tract section of all three animals were similar in length; each species displayed the caecocolical isthmus as well as the abrupt narrowing of the intestinal tract between the ‘large’ and the ‘small’ colon. Graphical descriptions of wild equid gastrointestinal anatomy should include these features.

Ten horses were euthanatized before, during, or after surgery to correct severe volvulus of the large colon. At surgery, the colonic serosa changed from blue-gray, blue or purple toward a more normal pink in seven horses after the volvulus was corrected. The mucosa consistently remained black or dark red. Results of postmortem colonic microangiography revealed perfusion of the serosa and the circular and longitudinal muscle layers, but mucosal perfusion was limited by thrombosis in the muscularis mucosae and submucosa. There was evidence of thrombosis of the mesenteric colic vessels in six horses. Damage to the colonic vascular system, especially thromboembolism in the submucosa, may be an important limitation to colonic viability after surgical correction of volvulus of the large colon.

Cecal dilatation and volvulus are common entities in dairy cattle, whereas cecal torsion is not often encountered. These diseases have been related to excessive volatile fatty acid production. Obstruction of the remainder of the large colon may be simple or strangulating in nature. These obstructions are relatively rare. Clinical signs, surgical management, and surgical complications of diseases of the cecum and large intestine are discussed.

Case Description—3 horses were examined and treated because of sudden onset of signs of abdominal pain. Clinical Findings—All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac. Treatment and Outcome—Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correction, no major postoperative complications developed, and all 3 horses have been free of signs of abdominal pain. Clinical Relevance—Horses with retrosternal hernias involving the diaphragm can develop clinical signs of intermittent obstruction of the large colon and chronic colic. In horses, retrosternal diaphragmatic hernias appear to develop exclusively in the right ventral aspect of the diaphragm and could represent an embryologic defect of diaphragm formation. Affected horses can be successfully treated with mesh herniorrhaphy or, in some instances, with conservative management.

Em uma égua, submetida à laparotomia para correção de vólvulo do cólon maior, realizou-se enterectomia próximo ao ligamento cecocólico seguida de enteroanastomose término-terminal. Nas primeiras 24 horas do período pós-operatório, houve piora dos sinais clínicos, com ocorrência de dor, refluxo enterogástrico e agravamento do quadro de endotoxemia. Frente ao prognóstico desfavorável, optou-se pela eutanásia. Durante a necropsia, não foram constatadas falhas na enteroanastomose ou sinais de peritonite séptica. Observou-se encarceramento de uma alça de jejuno, que se apresentava justaposta à extremidade livre da prega cecocólica e comprimida entre o corpo do ceco e o cólon ventral direito remanescente, caracterizando obstrução do tipo estrangulada. Esse achado foi compatível com o agravamento do quadro clínico observado no pós-operatório. Essa ocorrência sugere a necessidade de uma adaptação na técnica de ressecção do cólon maior, de forma a reduzir o espaço cecocólico e evitar um possível encarceramento de alças de intestino delgado. A mare subjected to laparotomy to treat a large colon volvulus had the large colon transected close to the cecocolic ligament followed by anastomosis using end-to-end technique. Despite intensive care, worsening of the clinical signs occurred during the first 24 hours after surgery including pain, enterogastric reflux and grievance of the endotoxemia symptoms. Euthanasia was performed. During necropsy, no signs of failure of the anastomosis and peritonitis were found but a strangulated segment of jejunum was observed adjacent to the cecocolic fold and compressed by the body of the cecum and the reminiscent rigth ventral colon. This finding was associated with the worsening of the clinical signs during the post-operative period. This report indicates that an adaptation in the large colon resection technique reducing the cecocolic space may be beneficial in avoiding such complication.

In the period from January 1993 to January 2003, 195 surgical procedures of equine acute abdomen were performed at the Service of Large Animal Surgery of the Veterinary Hospital of the School of Veterinary Medicine and Zootechnics of the University of São Paulo. From these 195 cases there were 30 enterolithiasis and seven foreign bodies located in the colon. Thirty-five out of 37 laparotomies were performed in dorsal recumbency, with access through the ventral midline and two were performed through the flank, with the animal in standing position. Of the 37 animals, 25 were male and 12 were females. Age varied from one to 18 years old with any average of eight years of age. Location of enteroliths and foreign bodies was as follows: 13 (35.14%) in large colon, 19 (51.35%) in small colon, 03 (8.10%) in transverse colon and 02 (5.41%) in both transverse and small colon. In regards to the clinical evolution, six were humenely eutmanized killed during surgery. From the 31 remaining, 23 (74,19%) were discharged, 6 (19,36%) died and 2 (6,45%) were killed eutmanized during the post-operative period. Among those animals with satisfactory evolution two animals stand out. One of them had seven enteroliths and in the other, the nucleus of the mass was the tip of a nail, which protruded from the mass and was in constant contact with the intestinal mucosa. In spite of the large incidence of obstruction caused by enteroliths or foreign bodies in comparison of other studies, the prognosis of post-operative recovery is favourable. No período de janeiro de 1993 a janeiro de 2003, foram realizados 195 procedimentos cirúrgicos de abdômen agudo em eqüinos, no Serviço de Cirurgia de Grandes Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. Dentre eles, foram diagnosticados 30 casos de enterolitíase e sete casos de corpo estranho, localizados em intestino grosso. Das 37 laparotomias, 35 foram realizadas em decúbito dorsal com acesso pela linha média e duas em estação com acesso pelo flanco. Os animais apresentaram idade variando de um a dezoito anos com média de oito anos, sendo 25 machos e 13 fêmeas. As formações e corpos estranhos apresentaram a seguinte localização: 13 (35,14%) em cólon maior, 19 (51,35%) em cólon menor, 03 (8,10%) em cólon transverso e 02 (5,41%) em cólon transverso e menor. Em relação à evolução, 23 (62,16%) receberam alta e 14 (37,84%) evoluíram para óbito (6) ou foram submetidos à eutanásia (8). Seis procedimentos de eutanásia foram realizados no período trans-operatório e dois no período pós-operatório. Dentre os animais que apresentaram evolução satisfatória, destacam-se um caso em que foram retirados sete enterólitos e outro em que a ponta de um prego que era o núcleo do enterólito se mantinha proeminente e em contato com a mucosa intestinal. Comparativamente às demais afecções do intestino grosso dos eqüinos e pela análise dos resultados obtidos neste estudo, conclui-se que os processos obstrutivos causados por enterólitos ou corpos estranhos apresentam prognóstico favorável.

In the year 2003, fi ve horses with signs of obstructive acute abdominal syndrome caused by gastrointestinal concretions were remitted to the Equine Hospital of the Department of Equine Medicine and Husbandry of the Faculty of Veterinary Medicine and Animal Husbandry-National Autonomous University of Mexico (DMZE-FMVZ-UNAM). Four of these cases (80%) came form the northeast region of Mexico City, and were horses used for pulling garbage carts in the dump areas. According to some studies, there are geographical regions where cases of enterolithiasis have more incidence; the cases reported in the studies include enteroliths as well as mineral concretions caused by foreign bodies. All of this cases have presented signs of partially obstructive acute abdominal syndrome (AAS) characterized by intermittent pain episodes, increased physiological frequencies, decreased abdominal sounds with presence of gas and constipation. Even though signs are not specifi c, assembled to the clinical history, they can be a very valuable key for diagnosis and prognosis of the patient. The defi nitive diagnosis is only made by enterotomy or necropsy. The prognosis of partial obstructive, acute abdominal syndrome caused by concretions is low vital, low functional in most of the cases, but there may be complications such as gastrointestinal rupture wich there may compromise the patient´s life, if the disease is not diagnosed and treated soon.

Objective—To compare the outcome of horses with nephrosplenic entrapment of the large colon (NSELC) treated surgically or medically by rolling, administration of phenylephrine hydrochloride (or both), and exercise. Design—Retrospective study. Animals—11 medically treated horses and 8 surgically treated horses with NSELC. Procedure—Medical records of horses with nephrosplenic entrapment between 1992 and 2002 were reviewed. Medically treated horses were included if diagnosis and outcome of treatment of nephrosplenic entrapment were confirmed via transrectal examination and ultrasonographic examination. Surgically treated horses were included if the diagnosis was confirmed by exploratory laparotomy. Horses in which the large colon was entrapped between the spleen and body wall were not included. Results—Significant differences in mean age, heart rate, and duration of colic prior to treatment were not detected between horses treated surgically or medically. Ten medically treated horses recovered without complications, and 1 died. In the surgically treated group, 6 of 8 horses recovered without complications and 2 died. Mortality rate did not differ between treatments. Duration of hospitalization for medically treated horses was significantly shorter and the cost significantly less than for surgically treated horses. Conclusions and Clinical Relevance—Results indicated that medical treatment of horses with NSELC via administration of phenylephrine hydro-chloride, rolling during general anesthesia, or both appears to be as effective as and less expensive than surgical treatment. (J Am Vet Med Assoc 2005;227:603–605)

Aim. To review the outcome of cases of left dorsal displacement of the large colon (LDDLC) treated with phenylephrine HCl and mild exercise. Methods. Physical parameters, laboratory data, ultrasonographic findings and outcome were analysed in a retrospective study of 12 horses with a confirmed diagnosis of LDDLC which were treated with phenylephrine HCl and mild exercise. Results. Administration of phenylephrine HCl and mild exercise resulted in the resolution of LDDLC in 11 of 12 treated horses. One horse failed to resolve the entrapment and required surgical correction. Conclusion. Administration of phenylephrine HCl appears to be an effective treatment for horses with confirmed diagnosis of LDDLC presented with mild to moderate colonic distention.

Avaliou-se ação da solução isotônica poliônica enteral da sene mais fluidoterapia intravenosa e da fluidoterapia intravenosa no tratamento da compactação no cólon maior em eqüinos. Foram utilizados 20 animais divididos em quatro grupos. Os animais dos grupos tratados eram portadores de compactação no cólon maior induzida experimentalmente. O grupo C, controle, não foi tratado, o grupo E8 foi tratado com solução isotônica poliônica enteral (8ml/kg/hora/48horas), o grupo SE recebeu sene (20mg/kg, duas doses de 24/24h) mais ringer lactato intravenoso (10ml/kg/hora/12horas, durante dois dias) e o grupo RL recebeu ringer lactato intravenoso (16ml/kg/hora/12horas, durante dois dias). O tratamento E8 provocou hipernatremia, hipercloremia e hiperglicemia. No grupo SE foi observada maior concentração dos valores de uréia, creatinina, osmolalidade e lactato plasmático. O tratamento RL não resultou em alteração no equilíbrio hidroeletrolítico e foi o mais eficiente para a correção dos valores bioquímicos em eqüinos com compactação do cólon maior, seguido pelo E8. O SE foi o menos eficiente na normalização das variáveis bioquímicas. The effects of isotonic polionic enteral solution, sene plus intravenous (IV) fluid therapy or fluid therapy IV only for the large colon impaction treatment in horses were evaluated. Twenty animals were divided in four groups. Animals of the treated groups had experimentally induced colon impactions. Group C (control) was not treated; group E8 received isotonic polionic enteral solution (8ml/kg/hour/48 hours); group SE received sene (20mg/kg, two doses with 24 hours interval) and ringer lactate IV (10ml/kg/hour/12 hour, during two days), and group RL received ringer lactate IV (16ml/kg/hour/12hour, during two days) only. Animals in the E8 group had hypernatremia, hypercloremia and hyperglycemia. Animals of the SE group had higher concentration of urea, creatinine, osmolality and plasmatic lactate. Ringer lactate IV only, group RL, did not cause alteration in the electrolytic equilibrium. In conclusion, intravenous fluid therapy with Ringer solution alone was the most efficient treatment for biochemical correction in horses with large colon impaction. Fluid therapy was also efficient in minor degree. Sene treatment associated with intravenous fluid therapy had the poorest results among the protocols to normalize biochemical variables.

Development of cutaneous metastases from colon cancer is a rare event, usually occurring in the setting of diffusely-disseminated disease and commonly carrying a dismal prognosis. Cutaneous and subcutaneous metastases in surgical scars occur extremely rarely, with only a few cases reported. We describe two cases of cutaneous metastases from colon cancer. A 62-year-old woman developed an 11-cm midline abdominal mass that slowly grew on the skin surface. The mass occurred at the scar site of her previous surgery performed 5 years prior for resection of a colon adenocarcinoma. A 46-year-old male presented with a subcutaneous 4.5-cm nodule in midline-abdominal scar, 3 years after resection of the primary colon cancer. These cases illustrate the pathological features and natural history of cutaneous metastases observed until the tumors have reached a very large size. Particular features of cutaneous scar metastases from colon cancer observed in our cases are a superficial pattern of spread, strong positivity for EGFR, low serum carcinoembrionic antigen, and long survival of the patients, possibly contributed to by the use of chemotherapy.

MA 01010. splenic ligament in some patients .z Besides palpating the colons trapped in the nephrosplenic space, pulling or pushing of the colon in the nephrosplenic area may produce a significant pain reaction. Misdiagnosis of LDDC by rectal exam has also occurred. Baird z reported 19/49 (39%) cases of LDDC were undiagnosed or misdiagnosed by rectal exam. Sivula a reported 5/33 (15%) false positive cases of LDDC diagnosed on rectal exam not confirmed at surgery or necropsy. Correction may occur during anesthesia and positioning for surgery.4 Percutaneous transabdominal J

Horses with large colon volvulus (LCV) often require intensive postoperative medical management. Although early referral and surgical intervention are critical for minimal postoperative complications and a successful outcome, this is often not possible for many reasons. Endotoxemia, extensive mucosal damage with subsequent severe hypoproteinemia, and focal ischemic necrosis are the major causes of postoperative morbidity and mortality. Although fluid therapy, flunixin meglumine, and antimicrobials are still the mainstay of perioperative management, synthetic colloids are being used to maintain plasma oncotic pressure, hyperimmune antiendotoxic plasma and polymixin B are being used for management of endotoxemia, and lidocaine and constant rate infusion of butorphanol can be used for postoperative analgesia. The use of heparin, dimethyl sulfoxide, and corticosteroids for management of LCV are still controversial. Future studies are required to investigate nutritional improvement and methods to manage cases after surgery to prevent recurrence.

A retrospective study was performed on 100 horses with incarceration of the small intestine through the omental (epiploic) foramen at the Faculty of Veterinary Medicine of Ghent University in Belgium during the period 1994-2001. Preoperative euthanasia was done in 10 horses for different reasons and an explorative laparotomy was performed in 90. Of these ninety horses, 1 died spontaneously during surgical intervention, 10 underwent euthanasia because of the extent of the lesions or a fatal hemorrhage, and surgery was completed on the other 79. A second intervention was necessary in 11 of these 79 horses. Simple reduction and reposition of the small intestine was possible in 35 of them, and a resection followed by an intestinal anastomosis was required in the other 44. Forty-four (49%) of the original 90 horses in which surgery was accomplished were discharged from the clinic. Six of these 44 were re-operated. The survival rate in the group of horses that under-went simple reduction was 60% and in the group that underwent resection and anastomosis it was 52%. After discharge from the clinic, 9 of the original 44 horses were lost for follow-up, and the remaining 3 5 survived for at least 9 months. During the follow-up period (I to 7 years), 16 horses had one or more bouts of colic, for which reason 5 of them (14%) underwent euthanasia. In this study the mean age of the horses with incarceration of the small intestine through the omental foramen was 9.46 years. Geldings, males and riding horses were clearly more represented. During surgical intervention a medio-lateral incarceration was observed in 98% of the horses. A negative correlation was observed between the survival rate and the length of the incarcerated intestinal segment, on the one hand, and between the survival rate and the distance to the clinic (duration after onset of symptoms) on the other.

See "Use of a Double-Channel Gastroscope Reduces Procedural Time in Large Left-Sided Colonic Endoscopic Mucosal Resections" by Evangelos Voudoukis, Georgios Tribonias, Aikaterini Tavernaraki, et al., on page 136-141 Most colon polyps are less than 1 cm in size. However, endoscopists often encounter large sessile colon polyps greater than 2 cm in practice. Removal of a large sessile colon polyp is difficult due to a high rate of procedure-related complications, such as bleeding and perforation. Therefore, patients with large sessile colon polyps are referred to a tertiary hospital for appropriate treatment. There are two usual endoscopic treatments for large sessile colon polyps: conventional endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). ESD using various knives was initially introduced for the treatment of early gastric cancer, but has recently, been used for large sessile colon polyps. Theoretically, ESD is preferable to en bloc resection for better pathologic evaluation. However, because of high complication rates, ESD is not widely used for the treatment of large sessile colon polyps. Despite the advent of gastric ESD, piecemeal EMR is more widely used than ESD in such polyps. In Western countries, because of the technical difficulty and longer procedure time of ESD, piecemeal EMR is still the gold standard therapy for large sessile colon polyps >20 mm in diameter.1 Although many endoscopists are performing colonic EMR, little attention has been paid to reducing the procedure time, which can be a very important issue in high-volume centers. Longer procedure times may influence the work of physicians and other personnel in the endoscopy room. One study reported that the total procedure time for EMR in patients with large sessile colon polyps (2 cm or larger) averaged 51.4 minutes (standard deviation, 25.6).2 The mean size of the polyps was 34.2 mm, the perforation rate was 1.1%, and the post-EMR bleeding rate was 7.3%. Procedure time was measured from endoscope insertion to examination completion. In another large-scale study on ESD for large colon polyps, the mean procedure time was 116 minutes, with a mean tumor size of 35 mm; perforation occurred in 4.9%, and postoperative bleeding in 1.5%.3 In this issue of Clinical Endoscopy, Voudoukis et al.4 present their experience with large (>2 cm) sessile or flat left-sided colon polyp resection, focusing on the benefits of the double channel (DC) gastroscope for EMR. In their retrospective series, they compared the procedure time using a DC gastroscope to that for a standard colonoscope or gastroscope (OS). They measured the EMR procedure time from first submucosal injection to just following polyp resection. This measurement method was different from that used by other researchers. The mean procedure time differed significantly between the DC group (33±21 minutes) and the OS group (58.7±20.6 minutes, p=0.015); in the subgroup of patients with polyps larger than 40 mm, the statistical difference in the mean procedural time between the two groups was even more pronounced (p=0.004). They suggest that use of a DC gastroscope for large non-pedunculated rectosigmoid lesions significantly reduces the procedure time. A DC scope is sometimes used in a difficult colonic EMR, but is not widely used in a routine procedure. The primary technique using a DC scope is the simultaneous insertion of a forceps, which can grasp polyp tissue and pull it into position for snare polypectomy5 or EMR; endoscopists can use the injection needle and snare at the same time with the DC scope. This might reduce the total operative time, and enable endoscopists to perform procedures without interruption. Nishizawa et al.6 called it the "two-sword fencing" technique in ESD, which also saves the time of changing endoscopic devices. The "two-sword fencing" technique allows mucosal resection just after injection, before the collapse of the submucosal cushion. However, endoscopists must be careful when snare EMR using forceps, because the proper muscle is held inside the forceps. It is difficult to keep the dissection plane horizontal to the intestinal wall with ESD using a DC gastroscope. Information on use of a DC gastroscope would be useful in EMR or ESD for large sessile colon polyps. This study has several important features. It is the first study in which the authors have compared the DC scope with single channel scopes in EMR for large sessile colonic polyps. However, as the authors state in their discussion, the number of patients was too small to be able to generalize the results of the study. In addition, the authors compared the DC gastroscope with single channel scopes. Upper endoscopy and colonoscopy were included in the single channel OS scope group, and should have been compared individually with the DC gastroscope. Finally, this retrospective study was conducted by a single experienced endoscopist. The procedure time might be dependent on the features of the endoscopist. A prospective study with multiple endoscopists will be needed.

BACKGROUND: Colonic lipomas (CL) are rare benign adipose tumours usually found incidentally during colonoscopy. Endoscopic resection of symptomatic large CL remains controversial, since significant rates of perforation have been reported. In recent years, a novel technique for removal of large CL has been described, consisting of looping and ligating the lipoma with a nylon snare. The aim of our study was to evaluate the safety and efficacy of the "loop and let go" technique for large colon lipomas in a large case series. ----- METHODS: Consecutive patients referred to our institution for colonoscopy were eligible for the study. The diagnosis of CL was confirmed endoscopically by "pillow" and "naked fat" signs. Following diagnosis, lipomas were looped and ligated by endoloop. Follow-up colonoscopies were scheduled at 1- and 3-months interval. ----- RESULTS: A total of 11 patients with large CL were enrolled in study. The indications for the colonoscopy included altered bowel habits (7 patients, 64%), screening for colorectal neoplasm (3 pts, 27%) and lower gastrointestinal bleeding (1 pts, 9%). The median lesion size was 3 cm (range 2,5-6 cm). Lesions were located at the hepatic flexure in 4 patients (36%), cecum and ascending colon (4 pts, 36%), rectosigmoid (2 pts, 18%) and transverse colon (1 pts, 9%). There were no immediate and late complications. On follow-up (median follow-up time 11.9 months, range 8-24), there was one small residual lipoma (

Objective— To document morphologic changes that occur in equine intestinal serosa after experimentally induced ischemia and subsequent reperfusion (jejunum, ascending colon) or after intraluminal distention and decompression (jejunum). Study Design— Morphologic effects of ischemia-reperfusion or intraluminal distention-decompression determined on the serosal layer of the equine jejunum. The large colon serosa was evaluated after ischemia-reperfusion injury. Animals or Sample Population— Seven adult horses. Methods— After induction of general anesthesia and ventral median celiotomy, ischemia was created by arteriovenous (AVO) and lumen occlusion of a 20-cm segment of jejunum and ascending colon for 70 minutes, followed by a 60-minute reperfusion period. Intraluminal distention (25 cm H2O) was created in a second 20-cm jejunal segment and maintained within the abdomen for 120 minutes, followed by a 120-minute decompression period. Seromuscular biopsies were obtained upon entering the abdomen and after the ischemic and reperfusion periods, and after the distention and decompression periods along with corresponding control seromuscular biopsies. Samples were processed and examined by light microscopy, transmission electron, and scanning electron microscopy. Results— Ischemia and reperfusion, and intraluminal distention and decompression, resulted in severe morphologic changes in the seromuscular layer of equine jejunum. A similar period of ischemia-reperfusion caused minimal changes in the ascending colon serosa. Conclusion— Adult equine jejunum sustains more serosal damage than the ascending colon after similar periods of ischemia-reperfusion injury. Intraluminal distention and subsequent decompression causes serosal damage in the equine jejunum. Clinical Relevance— The small intestine is more susceptible to seromuscular layer damage than the ascending colon.

A modified colon tray to perform large colon evacuations in horses was designed. A funnel-shaped accessory was constructed to create a mechanical separation between the sterile and nonsterile part of the tray. Sterile hooks were used to make a temporary and stabile colostomy. Thirty horses with surgical correction of nonstrangulating large colon obstruction underwent a large colon evacuation with this modified tray. The surgical procedure was uncomplicated and resulted in a positive outcome in 29 horses. This less labour-intensive way to evacuate the large colon results in minor contamination and makes extraluminal lavage becomes superfluous. This modified tray is a very efficacious and practical instrument for emptying the large colon in horses.

Summary This report describes the evaluation of uniformity of morphological injury of the large colon following severe colonic torsion in 17 horses presented to the Veterinary Medical Teaching Hospital. In 16 horses, twist occurred at the colonic base and in 1 at the sternal and diaphragmatic flexure. Eleven of the 17 horses were subjected to euthanasia at surgery and 6 of 17 following surgical correction within 4 days postoperatively. The objective of this study was to determine if the degree of histological changes present at the pelvic flexure were uniformly distributed throughout the regions of the colon involved in cases of severe colonic torsion.

Twenty-two horses with colic, referred to the University of Liverpool Equine Hospital (1992-1998), were found at laparotomy to have a partial obstruction of the large colon caused by a segmental mural lesion located in the left dorsal colon. The decision to take the horses to surgery was based on rectal examination findings of secondary impaction and mural oedema of the large colon and turbid peritoneal fluid containing large numbers of neutrophils obtained by paracentesis. The affected segment of colon showed oedema and serosal changes varying from erythema to well-defined necrosis. These pathological changes were considered to be sufficiently severe in 16 horses to merit partial resection of the left colon. Histology revealed varying degrees of mucosal necrosis, marked submucosal oedema and infiltration with large numbers of eosinophilic leucocytes. No cause was identified for the lesions. Sixteen of the 18 horses discharged from the hospital were alive 3 months to 7 years after surgery and have returned to their previous type of work and level of performance. The remaining 2 horses were subjected to euthanasia because of a recurrence of colic but no autopsy was performed.

This retrospective study consisted of 14 horses (age 6 weeks-12 years) with radiographically evident sand accumulations cranioventrally in the abdomen and clinical signs suggestive of sand enteropathy. The horses were treated medically and resolution of sand was monitored radiographically. Routine treatment consisted of psyllium mucilloid, combined with magnesium sulphate and/or mineral oilif needed. Initially, the number, size and shape of the sand accumulations showed large variation and the response to therapy was not predictable based on the initial appearance of the accumulation. In 2 foals, some of the sand was passed and the rest was mixed with other intestinal contents within 2-4 days. Even large accumulations disappeared in 2-4 days with psyllium alone or combined with mineral oil in 4 horses. In another 4 horses, the size of the accumulations decreased but varying amounts remained approximately at the same site, despite treatment for 1-4 weeks, and all these horses also had either gastric or large colon impaction. Three horses had a limited response to psyllium treatment, but the accumulation resolved with repeated doses of magnesium sulphate, with or without mineral oil. One horse did not respond to prolonged laxative treatment but the accumulation resolved on pasture. Clinical improvement was not necessarily related to the resolution of sand. Radiography of the cranioventral abdomen was found to be a useful means for monitoring the resolution of sand and confirming the effect of medical treatment in removing sand from the large colon in the horse.

In the period 1986-1994 a retrospective study was performed on 2,264 horses with colic at the Faculty of Veterinary Medicine of the Ghent University/Belgium. An exploratory laparotomy was performed in 1,069 horses. In this study the observed pathological conditions in the different parts of the gastrointestinal tract are thoroughly discussed in depth. The origin of colic symptoms was determined by rectal examination or exploratory laparotomy: it was localized in the ascending colon in 31% of the horses and in the small intestine in 25% of them. Less frequently observed localizations were the caecum (8%), the descending colon (3%), the stomach (3%) and the rectum (1%). The localization of colic pathology could not or not exactly be determined in 28% of the cases. Short time survival rates were used. The overall survival rate of conservative and surgical treatment of horses with pathology of the descending colon and pathology of the caecum and/or ascending colon was respectively 80% and 75%. The survival rate of horses with pathology of the small intestine, the rectum and the stomach was less favorable: 54%, 35% and 32% respectively. The risk of developing colic was statistically analyzed according to breed, gender and age. Foals less than I year old ran a significantly higher risk of small intestinal volvulus. Geldings and Warmblood horses had a higher incidence of incarceration through the foramen omentale (epiploicon), whereas females and foals had a lower incidence. An inguinal hernia was significantly more often observed in foals and stallions, and significantly less in mares and geldings. Horses aged 9-12 years showed a higher risk of caecal tympany, whereas ponies, males, foals and horses aged 1-4 years ran an increased risk of (ileo)caecal intussusception. Mares and horses aged 1-4 or 5-8 years had a higher incidence of pelvic flexure impaction. The incidence of right colonic displacement was lower in males and foals. Older horses and mares were at significantly greater risk of developing a colon torsion. A higher incidence of left dorsal displacement was observed in geldings and a lower incidence in females.

Objective— To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict outcome in horses with large colon torsion. Study Design— Clinical study. Animals— Fifty-four horses with large colon torsion. Methods— A full-thickness biopsy was collected from the pelvic flexure of the ascending colon after correction of naturally occurring colonic torsion. Morphologic changes were evaluated and graded for interstitial tissue to crypt ratio (I:C ratio), percentage loss of superficial and glandular epithelium, and the degree of hemorrhage and edema. These variables were then used to predict survival. Results— Morphologic variables could be used to correctly predict survival or death in 51 horses (P < .0001). This corresponded to a sensitivity of 95.1% (82.2%-99.2%; 95% CI) and a specificity of 92.3% (62.0%-99.6%; 95% CI). Of 6 horses that had colonic resection, 5 survived; an accurate prediction of outcome based on morphologic criteria was made for each horse. Conclusions— Interpretation of changes in colonic morphology can be used to accurately predict postoperative survival in horses with large colon torsion. Clinical Relevance— Use of frozen colonic tissue sections is a rapid, reliable, and relatively inexpensive method for assessing morphologic damage associated with large colon torsion during surgery. Intraoperative evaluation of pelvic flexure biopsies can aid in the prediction of survival and guide surgical judgment as to the need for colonic resection.