Small Intestinal Obstruction due to Epiploic Foramen Entrapment in a Miniature Horse, with Secondary Enterolithiasis

Small Intestinal Obstruction due to Epiploic Foramen Entrapment in a Miniature Horse, with Secondary Enterolithiasis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Equine Veterinary Education This is a preprint and has not been peer reviewed. Data may be preliminary. 6 February 2025 V1 Latest version Share on Small Intestinal Obstruction due to Epiploic Foramen Entrapment in a Miniature Horse, with Secondary Enterolithiasis Authors : Carlos De la Torre Pérez 0009-0005-0395-7881 [email protected] and Andreas Klohnen Authors Info & Affiliations https://doi.org/10.22541/au.173885239.92403209/v1 316 views 147 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract A 14-year-old female miniature horse presented with mild colic signs. The owner reported a history of colic secondary to presumed gastric ulceration, treated with flunixin meglumine and omeprazole. On admission, physical examination demonstrated a normal TPR with reduced intestinal motility. Abdominal ultrasonography revealed distended, thickened small intestine loops (14 mm) in the right paralumbar fossa (Fig. [1](#fig-cap-0001)). Radiographs confirmed multiple enteroliths and sand accumulation. Routine bloodwork indicated dehydration (PCV 54%) and mild hyperlactatemia (3.79 mmol/L). As a results of abdominal ultrasound findings, an exploratory celiotomy was performed, revealing a strangulation obstruction of the distal jejunum and ileum due to epiploic foramen entrapment, along with multiple enteroliths. Approximately two feet of nonviable small intestine were resected, and a jejunocecostomy was created. Two enterotomies were performed to remove enteroliths and sand. Postoperatively, the miniature horse received IV fluids with lidocaine, NSAIDs, antibiotics, and omeprazole. By day seven, the miniature horse resumed a normal diet and was discharged on day ten. At an 18-month follow-up, the miniature horse remained healthy and fully active. This case represents the first reported instance of epiploic foramen entrapment in a miniature horse. Small Intestinal Obstruction due to Epiploic Foramen Entrapment in a Miniature Horse, with Secondary Enterolithiasis Carlos de la Torre, MVZ., Andreas Klohnen, DVM, Diplomate ACVS Chino Valley Equine Hospital Abstract A 14-year-old female miniature horse presented with mild colic signs. The owner reported a history of colic secondary to presumed gastric ulceration, treated with flunixin meglumine and omeprazole. On admission, physical examination demonstrated a normal TPR with reduced intestinal motility. Abdominal ultrasonography revealed distended, thickened small intestine loops (14 mm) in the right paralumbar fossa (Fig. 1). Radiographs confirmed multiple enteroliths and sand accumulation. Routine bloodwork indicated dehydration (PCV 54%) and mild hyperlactatemia (3.79 mmol/L). As a results of abdominal ultrasound findings, an exploratory celiotomy was performed, revealing a strangulation obstruction of the distal jejunum and ileum due to epiploic foramen entrapment, along with multiple enteroliths. Approximately two feet of nonviable small intestine were resected, and a jejunocecostomy was created. Two enterotomies were performed to remove enteroliths and sand. Postoperatively, the miniature horse received IV fluids with lidocaine, NSAIDs, antibiotics, and omeprazole. By day seven, the miniature horse resumed a normal diet and was discharged on day ten. At an 18-month follow-up, the miniature horse remained healthy and fully active. This case represents the first reported instance of epiploic foramen entrapment in a miniature horse. Case report A 14-year-old female miniature horse was presented to the hospital showing mild signs of colic since the early morning hours. The owner reported a previous history of colic secondary to presumed gastric ulceration, which was usually treated with flunixin meglumine and omeprazole (prescribed by the ranch veterinarian). Upon arrival at the hospital, the physical examination revealed a temperature of 99.5°F, heart rate 36 bpm, respiratory rate 40 rpm, capillary refill time of 3”, pink and tacky mucous membranes, and reduced bowel movements in all four quadrants. Abdominal ultrasonography was performed and revealed distended loops of small intestine with reduced motility in the ventral part of the abdomen. Further evaluation of the right paralumbar fossa region (between 14-15, 15-16 intercostal spaces) demonstrated distended small intestine loops with a thickened wall (14 mm) (See Fig.1). At the time, the miniature horse did not exhibit any signs of abdominal pain. However, given the previous history of signs of colic, abdominal radiographs were taken. The radiographs were interpreted to show enteroliths with sand (See Fig.2). Routine bloodwork was performed and demonstrated a PCV 54%, TP 5.8 mg/dl, Lactate 3.79 mmol/L and a Ca++ 1.33 mmol/L. All other parameters were within normal limits. As a result of the abdominal radiographs findings, the abdominal ultrasonography changes seen, and the previous signs of abdominal pain, an exploratory celiotomy was recommended. An IV catheter was placed and preoperative IV fluids (5 liters of LRS with 200cc of calcium gluconate) were administered. Additionally, 60 mg of n-butylscopolammonium bromide (buscopan) IV and 50 mg of xylazine + 5 mg of butorphanol IV were given to alleviate mild signs of abdominal pain (stretching, pawing and walking in circles). After the pre-operative IV fluids, the miniature horse was anesthetized and placed in dorsal recumbency. Exploration of the abdomen revealed a strangulation obstruction of the distal jejunum and ileum (epiploic foramen entrapment) with a large right dorsal colon enterolith and several small enteroliths (see fig.2 and 3). Approximately two feet of small intestine were nonviable and needed to be resected (the ileum was bruised/ purple, and the viability was questionable). The ileum was transected using a TA90 stapler. The tissue appeared to be very thickened was oversewn. The proximal jejunum was transected with a TA90, and all edges were oversewn using 3-0 vicryl in a Lembert pattern. A side-to-side (jejunocecostomy) anastomosis was created using a GIA-80 stapler. A pelvic flexure enterotomy was performed, to evacuate the large colon content, smaller enteroliths and sand. A right dorsal colon enterotomy was performed, to remove the large right dorsal colon enterolith. The body wall was routinely closed and a special full Elastikon bandage was applied for recovery. In the postoperative period, the miniature horse received routine treatment with antibiotics, IV fluids therapy and NSAIDS. A gastroscopy was performed after surgery and revealed 3/3 gastric ulcers, prompting the initiation of omeprazole treatment. To mitigate postoperative signs of ileus, the miniature horse received intravenous fluids infused with lidocaine for the subsequent 3 days. During this period, no instances of reflux were detected during regular four-hour monitoring. However, abdominal ultrasound revealed slightly distended loops of small intestine with decreased motility. Once the signs of post-operative ileus had resolved, the miniature horse began eating two cups of alfalfa leaves every 4 hours. The following days, this intake was increased to three cups every 2 hours, and she was allowed to graze. By the seventh day post-surgery, the miniature horse had fully resumed eating. On day ten, the staples were removed from the incision and the patient was discharged. 18 months after surgery, the miniature horse is alive, had no complications, and has returned to full exercise. Fig. 1. Loop of thick small intestine at the level of the right 14-15 intercostal space, suggestive of small intestinal strangulation obstruction. Fig. 2 Radiographic image of the abdomen revealing a large, circular, radiopaque shape consistent with an enterolith, along with several smaller enteroliths and the presence of sand. Fig. 3. Enteroliths removed from the right dorsal colon. This case report is the first to the author's knowledge, to describe an epiploic foramen entrapment of the small intestine in a miniature horse. Key words Horse, colic, strangulation obstruction of the small intestine, abdominal ultrasound, miniature horse, epiploic foramen entrapment. Key points • Strangulation obstructions of the small intestine in horses can be diagnosed with abdominal ultrasound. • Epiploic foramen entrapment of the small intestine normally occurs in Warmblood and Thoroughbred horses aged 7 to 13 years old. • It is very rare to find a strangulation obstruction of the small intestine in miniature horses. Supplementary Material File (image1.emf) Download 905.90 KB Information & Authors Information Version history V1 Version 1 06 February 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Equine Veterinary Education Keywords abdominal ultrasound colic epiploic foramen entrapment miniature horse strangulation obstruction of the small intestine Authors Affiliations Carlos De la Torre Pérez 0009-0005-0395-7881 [email protected] Chino Valley Equine Hospital View all articles by this author Andreas Klohnen Chino Valley Equine Hospital View all articles by this author Metrics & Citations Metrics Article Usage 316 views 147 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Carlos De la Torre Pérez, Andreas Klohnen. Small Intestinal Obstruction due to Epiploic Foramen Entrapment in a Miniature Horse, with Secondary Enterolithiasis. Authorea . 06 February 2025. DOI: https://doi.org/10.22541/au.173885239.92403209/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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