Stick­ing points

One of na­ture’s prick­li­est char­ac­ters turns out to be the source of in­testi­nal dam­age and re­sult­ing colic in a young filly.

EQUUS - - Eq Casereport - By Chris­tine Barakat

Luta was just 10 months old the first time she col­icked, and her owner Jody Ruther­ford spot­ted the trou­ble right away. Nor­mally, the An­dalu­sian filly was ac­tive and cu­ri­ous, Ruther­ford says: “She was a won­der­ful lit­tle baby. I couldn’t leave brushes around when she was lit­tle. She’d pick them up and run off with them.” But on the morn­ing of March 8, 2010, Luta was show­ing all the typ­i­cal colic signs. “She was turn­ing her head to look at her sides, shiv­er­ing and sort of hunched over,” Ruther­ford re­calls. “It was ob­vi­ous that she was in pain.”

Luta was one of three horses on Ruther­ford’s prop­erty just west of Saska­toon in the Cana­dian prov­ince of Saskatchew­an. “It was just Luta, her mother and my hus­band’s horse,” Ruther­ford says.

She called the field ser­vices of the Univer­sity of Saskatchew­an, and Kate Robin­son, DVM, ar­rived within a halfhour. After a full ex­am­i­na­tion turned up no clues as to why the filly was colick­ing, Robin­son gave her a dose of pain med­i­ca­tion. “I re­mem­ber her telling me that Luta looked like she was in a lot of pain, and if that didn’t change pretty quickly we’d have to re­fer her to the clinic,” says Ruther­ford.

Four hours later, with no sig­nif­i­cant change in Luta’s con­di­tion, Ruther­ford hooked up her trailer and headed to­ward the univer­sity.

When Luta walked off the trailer, “she looked even worse than when she’d got­ten on,” says Ruther­ford. Stacy An­der­son, DVM, MVSc, Dipl. ACVS-LA, and a team of tech­ni­cians and vet­eri­nary stu­dents im­me­di­ately be­gan a new phys­i­cal ex­am­i­na­tion---but they, too, turned up no im­me­di­ate an­swers.

“When you have a horse that age come into the clinic with colic, there are a few things you sus­pect,” says An­der­son. “There are some types of colic you’re more likely to see in a younger an­i­mal, like as­carid0 im­pactions or some sort of in­testi­nal ac­ci­dent like stran­gu­la­tion.” Dur­ing a rec­tal exam, how­ever, An­der­son couldn’t feel an ob­vi­ous ab­nor­mal­ity. Ul­tra­sound didn’t help much more. “On the ul­tra­sound we could see a few loops of small in­tes­tine that seemed a bit dis­tended, but noth­ing re­ally re­mark­able,” she said.

Un­der the knife

The next decision was whether to send the filly for ex­ploratory surgery. The di­ag­nos­tic workup at the clinic had in­cluded an ab­dominocen­te­sis, a pro­ce­dure that pulls a sam­ple of fluid from the ab­dom­i­nal cav­ity for anal­y­sis. “That fluid was very high in pro­tein and lac­tate,” says An­der­son. “Th­ese usu­ally in­di­cate a se­ri­ous colic and that the horse may be a good sur­gi­cal can­di­date.”

But the more com­pelling rea­son for send­ing Luta into surgery was her ex­treme, un­re­lent­ing pain. “One of our main de­ter­min­ers for send­ing a horse to colic surgery is a lack of con­trol of pain,” says An­der­son. “When we can’t make a horse com­fort­able with the usual drugs, it means we are deal­ing with some­thing se­ri­ous that is go­ing to re­quire surgery to cor­rect.”

Ruther­ford gave her ap­proval for the pro­ce­dure, and Luta was prepped. The sur­gi­cal team, led by Luca Panizzi, DVM, MVSc, Dipl. ACVS-LA, didn’t know ex­actly what they would be look­ing for, so they went in ready to per­form a stan­dard pro­to­col for ex­ploratory colic surg­eries that would en­tail ex­am­in­ing ev­ery inch of her in­testines. “What we do is start at the ce­cum, pretty much be­cause it’s right there in front of you when you open a horse up,” says An­der­son. “Start­ing from there you trace the small in­testines for­ward to the stom­ach, look­ing and feel­ing ev­ery inch for any­thing un­usual. After that you work back­ward through the large in­testines.”

Ruther­ford headed home as the surgery be­gan. “I didn’t watch,” she says. “I had other an­i­mals at home who needed to be tended to, so I left and waited for the phone call.”

When the call fi­nally came, Panizzi had an un­usual ques­tion for Ruther­ford: “He asked me, ‘Has this horse been around por­cu­pines lately?’”

The sur­gi­cal team had found two ad­he­sions formed by the omen­tum, the fatty, lacy struc­ture that lines the ab­dom­i­nal cav­ity and or­gans, stick­ing to the small in­tes­tine.

“The omen­tum sur­rounds the in­testines like a net,” says An­der­son, “and is very im­por­tant to ab­dom­i­nal heal­ing.” Ad­he­sions be­tween the omen­tum and in­testines oc­cur when some trauma or dam­age causes a very lo­cal­ized and overzeal­ous in­flam­ma­tory re­ac­tion and the over­pro­duc­tion of fib­rin, the tough, sticky pro­tein that helps cre­ate blood clots over wounds.

“Fib­rin is typ­i­cally laid down as part of the heal­ing process, but after it’s laid down, it’s then bro­ken down in ar­eas where it’s not needed,” says An­der­son. “Some­times, how­ever, that break­down doesn’t hap­pen ef­fi­ciently, and struc­tures end up get­ting stuck to­gether that shouldn’t be.”

Ad­he­sions that form on the in­testines may in­ter­fere with the func­tion of the gut, slow­ing or stop­ping the move­ment of in­gesta. The two omen­tal ad­he­sions were clearly the source of Luta’s colic, but why they had formed in a healthy young filly was still a mys­tery ---un­til Panizzi spot­ted a small hole in the cen­ter of one of the ar­eas. Nearby within the in­tes­tine, he found the cul­prit: a three-inch, yel­low­ish and brown­striped, very sharp por­cu­pine quill.

“The quill had made a hole through the small in­tes­tine, which the body tried to close up, form­ing the ad­he­sion,” says An­der­son. The sur­gi­cal team found a nearly iden­ti­cal hole at the sec­ond

ad­he­sion lo­ca­tion, but no ad­di­tional quill. “It’s pos­si­ble there was a sec­ond quill,” he says, “or it’s pos­si­ble that the one quill punc­tured both ar­eas.”

Apart from the quill holes, the rest of Luta’s in­tes­tine was healthy, so once they had Ruther­ford’s ap­proval, the sur­gi­cal team de­cided to per­form two sideby-side re­sec­tions and anas­to­moses, a pro­ce­dure in which the dam­aged length of in­tes­tine is re­moved and the two healthy ends sewed back to­gether. ‘We re­moved six inches from each area with an ad­he­sion,” says An­der­son, “so only about a foot to­tal, which isn’t much.”

The rest of the surgery went smoothly, and Luta re­cov­ered un­event­fully. But how she man­aged to swal­low a por­cu­pine quill will likely never be known. “We had shot two por­cu­pines a few months pre­vi­ously in the yard,” Ruther­ford says. “But they hadn’t got­ten near the horses, and we picked their bod­ies up and put them di­rectly in the trash.” Nor had Luta ever been found with a nose­ful of quills, as one might ex­pect if the cu­ri­ous filly had in­spected a pass­ing por­cu­pine a bit too closely. “Our best guess is that a por­cu­pine got killed by a mower and maybe just a few quills were baled with some hay,” says Ruther­ford.

Luta stayed at the univer­sity clinic to re­cover, re­main­ing on in­tra­venous flu­ids, an­tibi­otics and painkiller­s for sev­eral days. Ruther­ford vis­ited her daily. “The first time I saw her, she looked ter­ri­ble, with tubes hang­ing all over her,” she says. But the filly perked up with each pass­ing day and was soon her nor­mal, friendly self. “Ev­ery time I went to see her, she’d nicker at me.”

On the 10th day after surgery Ruther­ford ar­rived to bring Luta home. But that plan changed quickly: “I re­mem­ber it was about 5 p.m., and I was so ex­cited that she was com­ing home,” says Ruther­ford. “Then as I stood there, she started to lie down again and looked like she was in pain. The stu­dents watch­ing her called the sur­geon im­me­di­ately, and I knew in my heart it wasn’t good.”

Luta was colick­ing again, but this time the tim­ing of the episode pro­vided an im­por­tant clue about what was wrong: “When we do surgery on a horse we are ini­ti­at­ing an in­flam­ma­tory process that can lead to ad­he­sions,” says An­der­son. “Ad­he­sions are a par­tic­u­lar risk after anas­to­moses and in young horses. They form about three days after surgery, and if they are go­ing to in­ter­fere with the gut in any sig­nif­i­cant way, you usu­ally see signs of colic around

Ten days after surgery Ruther­ford ar­rived to bring Luta home. But that

plan changed quickly.

A se­ri­ous set­back

day 10.” Luta’s new colic was right on that sched­ule.

After con­firm­ing by ul­tra­sound that ad­he­sions were caus­ing the prob­lem, Panizzi ex­plained that fix­ing them would re­quire a sec­ond surgery. “He told me they might be able to do it la­paro­scop­i­cally, with­out hav­ing to put her un­der anes­the­sia, but he would have to check be­cause she might be too small,” says Ruther­ford. “He ex­plained that they needed some room be­tween her hips and ribs to in­sert the in­stru­ments, and she didn’t have much. Even as he told me this, I got the feel­ing he was pre­par­ing me for the fact that reg­u­lar surgery might be my only op­tion.”

Ruther­ford’s hunch was cor­rect, and Panizzi re­turned with the news that Luta would need gen­eral anes­the­sia and another tra­di­tional colic surgery. “She’s my baby and she was in pain,” says Ruther­ford. “I wasn’t go­ing to say no. On the drive home, though, I burst into tears and wor­ried about how we would af­ford it all, but my won­der­ful hus­band told me that we’d fig­ure some­thing out. He un­der­stands what she means to me.”

For the sec­ond surgery, the team opted to make a new in­ci­sion par­al­lel to the first. “This is an area of de­bate,” says An­der­son. “When you have to go back in, do you use the same in­ci­sion line? When­ever you do a re­peat surgery within two to four weeks and use the same in­ci­sion, you dis­rupt an im­por­tant stage of the heal­ing process, and there is an in­creased risk of a her­nia de­vel­op­ing as it heals up again. Ten days is sort of a gray zone.”

Their next decision was whether to re­sect the in­testines again---re­mov­ing another por­tion of the gut---or to sim­ply cut through and sep­a­rate the “stuck” tis­sues. “Sim­ply cut­ting through the ad­he­sions can open up the in­testines, and then you’ve cre­ated a very se­ri­ous prob­lem,” says An­der­son. But after ex­am­in­ing Luta’s new ad­he­sions, the team de­cided they could safely cut most of them away with­out re­sect­ing more in­tes­tine.

“There was one ad­he­sion that was pretty in­ti­mately in­volved with the in­tes­tine,” says An­der­son. “We did worry that cut­ting that would one cause prob­lems, but we were able to use a very neat sur­gi­cal sta­pling de­vice that re­duces the risk of breach­ing the in­tes­tine; it fires two rows of sta­ples then cuts in be­tween.” After they fin­ished, Luta’s sec­ond in­ci­sion was closed, and she headed to re­cov­ery once again.

“I got the call later that night

that ev­ery­thing had gone well,” says Ruther­ford. “But now I knew that we still had a ways to go.”

Be­cause Luta now had two side-by­side in­ci­sions, the vet­eri­nar­i­ans put her in a her­nia belt that would wrap se­curely around her belly to help support the pres­sure placed by the weight of the in­testines on her ab­dom­i­nal wall as the in­ci­sions healed. She would need to wear the belt con­stantly, hav­ing it re­moved only for ban­dage changes, un­til the in­ci­sions were com­pletely healed in about two months. Luta re­mained at the clinic for another 20 days, colic-free, be­fore she was sent home.

“We had to clean her in­ci­sion twice a day and change the ban­dages,” says Ruther­ford. “So they showed us how to put the her­nia belt on. It’s very sim­i­lar to a sad­dle.” Luta re­mained on stall rest for another month, then was grad­u­ally started on hand-walk­ing and re­turned to full turnout.

De­spite the her­nia belt, Luta did de­velop a small bulge on her sec­ond in­ci­sion line near her ud­der. “We were trai­ler­ing her back for reg­u­lar rechecks and they no­ticed it at the clinic,” says Ruther­ford. “You wouldn’t know it was there if you didn’t go look­ing for it, and they say it isn’t likely to af­fect her at all.”

Oth­er­wise, Luta re­cov­ered with a clean bill of health.

Luta has had three mild col­ics since her last surgery, and each in­ci­dent has passed with sim­ple med­i­cal treat­ment. Still, Ruther­ford doesn’t take chances: “We don’t mess around, we load her up im­me­di­ately and head to the univer­sity. We aren’t sure if th­ese col­ics are re­lated to what she went through, but she stays overnight so they can keep an eye on her.”

Now 5 years old, Luta is sched­uled to start train­ing this sum­mer, and Ruther­ford hopes to be able to ride her next year. “I’d like to do some dres­sage with her,” she says. “But we will see what hap­pens. I’m just happy she’s here.”

LOOK­ING GOOD: To­day, a quill-free Luta is healthy and ready to be­gin train­ing later this sum­mer.

por­cu­pine quills

SUP­PORT­IVE CARE: Dual ab­dom­i­nal in­ci­sions put Luta at a risk of a her­nia, so she wore a sup­port­ive belt for months.

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