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HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Colic in Horses » Large Colon Displacement, and Twists » |
Discussion on Surgical success, then failure | |
Author | Message |
New Member: txgf |
Posted on Saturday, Jan 10, 2009 - 2:17 am: Dr. O,I have a few question regarding a situation I experienced with one of my horses. To start, let me say that I am not "second guessing" the care given...just trying to understand more. This past year, my mare gave birth to a healthy foal. Her gestation and foaling was uneventful and cleared a post foaling exam (baby included) with flying colors. 11 days after foaling, my mare showed signs of mild colic that progressed quickly to severe distress. On directive of my vet, Banamine was given IV until she could arrive. This did little to alleviate her pain. My vet did a quick exam and palpation then prepared my mare for transport with sedation, pain meds, and NG tube placement. I took her to the local veterinary university. Once there, my mare was evaluated in the ICU. Shortly after, on their recommendation, she was taken into surgery where she had an enterotomy and correction of a 180 degree torsion of the large bowel. For all intense purposes, she did great. Was kept in ICU and then released 6 days later. Discharge instructions included slow introduction of grain, free choice hay/alfalfa, and hand walking/grazing several times a day, and monitoring her surgical site. All instructions were followed strictly. 2 days after coming home, 2 areas on the suture site developed drainage. Consultation with the university docs and my general vet were done. My mare had no fever, but was tender to the area. A few staples were removed to assist drainage. The consensus was that no further action was required. I took her TPR twice daily, and all remained normal. However my mare was painful (to touch) and ventral edema was not reducing so the docs put her on Tucoprim BID. Within @ 48 hours, she appeared more comfortable and the edema was reducing (but still there). Still being rather nervous, I kept in VERY close contact with all the doctors, almost daily. At 20 days post surgery, the staples were removed. Surgical site swelling still was present and the only way I know to explain it, was it was like a "shelf". No drainage at the time, and I was told to hyDrO the area. My mare was handling the confinement and handwalkings. She was being fed grain in small portions 3 times daily. Manure production was plentiful. Several days later, she showed signs of mild colic. No thrashing or sweating, only pawing. The vet was out within 30 minutes. On palpation, the vet was uncomfortable with the distention of the large bowel, so we (vet and I) decided it was best to return to the university. Once again, my mare was given pain meds, sedation and a NG tube. We were immediately taken into the ICU. Getting off the trailer, my girl was bright, alert, and not painful. The vets set a catheter, ran fluids, bloodwork, palpated, rectal and abdominal ultrasound, re-tubed her. All tests were wnl. I was there, and they didn't skip steps or miss a beat. No holds bar care. We all took a breath of air. Vets choked it up to a bad gas colic and gave me several options for care. The only thing they weren't peachy happy with was the existing swelling at the surgical site. I requested that my mare stay overnight in the ICU for continued monitoring/aggressive care and then be re-evaluated in the morning by the internal med specialist/surgeons for incision site swelling. They were thrilled with this, and I left the ICU a little while later with parting words being "no new is good new, get some rest". An 1 & 1/2 hour later, I got a call from the ICU stating that my mare's condition had deteriorated. Fortunately, I had taken my time going home and was not that far away and quickly turned around. Conversations between the ICU, myself, and my regular vet ensued until I got there. Basically, I was informed that my mare's prognosis was extremely guarded and they felt she had a strangulating torsion. Only option was surgery with removal of the large bowel and/or tack-down or euth. She was completely unresponsive to large doses of pain medication and sedation. The vets had begun trocharization to relieve gastric distention. I was also advised heavily that due to her rapidly declining state, that multiple complications were anticipated (peritonitis, suture line failure, etc) and that odds were not favorable. I really was floored and had a hard time with the information (processing it under such constraint). I told them to prepare for surgery and once they opened her up we would make decisions together(continue or euthanasia). When I arrived, my mare was down, a surgeon at her head, and countless others working. She had apparently gone down when they were removing her from the stall. She was grossly bloated/compressed. It wasn't a good moment. I was advised that they were unable to relieve the worsening gastric compression and the consequences were high. Discussion about odds, surgical options, complications went on. What it came down to, was that even if my mare survived her odds of having a decent life as a pasture puff seemed low. She was quickly euthanized, leaving behind her filly. It is still hard for me to understand how we could have lost her given timely, veterinary care. But, even I know that these things can and do happen. I have reviewed the entire section of articles. My questions: 1. Could you discuss the mechanics and use of trocharization? Is failure of decompression such as the above common? 2. Your experience in repeat torsions so quickly after an initial surgery? Any factors that contribute? 3. Is there any reason to be concerned about a genetic predisposition to torsion? I am now worried about potential future problems for my filly. 4. Prevention, is it possible? My mare had no history of colic, post foaling issues. No changes in environment or diet, etc. I apologize for the extended post, and know it's a lot to go over. I appreciate any thoughts you could contribute. |
Moderator: DrO |
Posted on Monday, Jan 12, 2009 - 8:57 am: Welcome TXGF,Taking your questions in order: 1) A trochar can be used when there is life threatening bloat to release the gas buildup in the bowel. Bloat can be life threatening because it interferes with expansion of the diaphragm preventing a horse from breathing. If your trochar cannot reach the distended bowel or if there is too much ingesta that can plug the trochar it will fail. 2) Repeat of a surgically corrected large bowel torsion is not uncommon. The still distended abdomen of the recent pregnancy contributes to this potential for retorsion. There is more on repeat surgeries under the "Retrospective" subtopic of the article. 3) No not that we are aware of. 4) We give a list of items that increase the incidence of colic in horses at Diseases of Horses » Colic, Diarrhea, GI Tract » Colic in Horses » An Overview of Colic. Not on that list is pregnancy and its association with an increase in large bowel torsion post-foaling. Not breeding would greatly reduce your potential for this problem. DrO |
New Member: txgf |
Posted on Thursday, Jan 15, 2009 - 12:08 am: Dr. O.Thank you for going over my questions. Your explanation regarding the trocar & complications does help shed light. The inability to relieve her compression quickly led to respiratory/cardiac trouble. All happened within a short period of time and the surgeon would not even discuss survival odds. That spoke volumes to me. Hard to hear, but necessary nonetheless. After the initial surgery, we all (vets & myself) were so pleased with her recovery...not expecting a secondary catastrophic event. I guess, sometimes when you win, you lose. Once again, thank you. |
Member: frances |
Posted on Thursday, Jan 15, 2009 - 10:47 am: Hi TXGF,I'm so sorry to hear of the loss of your mare - it must have been shattering after the initial surgery appeared to have gone so well. Things happen so fast when horses are involved. How old is the filly, and how is she doing now? |
New Member: txgf |
Posted on Friday, Jan 16, 2009 - 11:25 pm: LL,Thank you, and yes...shattering is an accurate description. Her filly is now about 10 months old and is thriving . That, I am certainly thankful for! |
Member: frances |
Posted on Saturday, Jan 17, 2009 - 9:02 am: That's good news at least! Any pictures? |