In a nor­mal horse, the spleen is im­me­di­ately ac­ces­si­ble through this in­ci­sion, but in cases of nephros­plenic en­trap­ment, the spleen is pushed out of po­si­tion and a sur­geon will first en­counter the dis­placed large colon.

EQUUS - - Casereport -

horse un­der gen­eral anes­the­sia in a padded room and then roll and jos­tle his body man­u­ally in an at­tempt to dis­lodge the colon. This pro­ce­dure may re­solve the en­trap­ment, but plac­ing a horse un­der gen­eral anes­the­sia car­ries other risks, in­clud­ing in­jury as he scram­bles back to his feet upon wak­ing. In ad­di­tion, phys­i­cally rolling a large, un­con­scious horse can be dif­fi­cult.

A third op­tion is a stand­ing pro­ce­dure. The cor­rec­tion for a nephros­plenic en­trap­ment is the only colic surgery that can be per­formed with the horse still con­scious and un­der heavy se­da­tion. “Typ­i­cally, in colic surgery, you need the horse to be un­der gen­eral anes­the­sia and po­si­tioned on his back so you can make an in­ci­sion along the mid­line to ac­cess the source of the prob­lem,” says Krueger. “But in th­ese en­trap­ments the trou­ble spot is near the ab­dom­i­nal wall, high up on the left flank.”

Another ad­van­tage of this type of surgery is that it re­quires only a small in­ci­sion that is un­der much less ten­sile stress than one in the mid­line of the belly. This fac­tor dra­mat­i­cally short­ens

Nan­tucket was se­dated and placed in stocks that would help to sta­bi­lize him if he be­came un­steady on his feet. His left flank was then clipped and scrubbed with Be­ta­dine and his body cov­ered in ster­ile drapes.

“You start this pro­ce­dure by mak­ing a 15- to 20-cen­time­ter [six- to eight­inch] in­ci­sion on the left flank, be­tween the last rib and hip,” says Krueger. “It’s not very large, just long enough for a sur­geon’s arm to fit in.”

In a nor­mal horse, the spleen is im­me­di­ately ac­ces­si­ble through this in­ci­sion, but in cases of nephros­plenic en­trap­ment, the spleen is pushed out of po­si­tion and a sur­geon will first en­counter the dis­placed large colon.

Krueger slowly pushed her arm into the in­ci­sion, care­fully feel­ing her way around to ori­ent her­self to the place­ment of or­gans. “If you feel mul­ti­ple is­sues or even some­thing you can’t quite iden­tify, you don’t want to con­tinue with the horse stand­ing,” she says. “At that point, you back­track to go to gen­eral anes­the­sia.”

Feel­ing con­fi­dent that the en­trap­ment was Nan­tucket’s only is­sue, Krueger cupped her hand un­der­neath the colon and gen­tly pressed the spleen to­ward the floor of the ab­domen. “This al­lowed me to lift the colon up over the spleen, to­ward the out­side of the horse and then let it drop,” she says. “The nephros­plenic lig­a­ment acts like a coat hook, and you have to lift the colon up and off the hook.”

Free­ing the colon was only the first step. Still work­ing en­tirely by feel,

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.