Robin M. Dabareiner

Prevention of ischaemia‐induced small intestinal adhesions in foals

REASONS FOR PERFORMING STUDY Treatments addressing variously theorised pathophysiological mechanisms of small intestinal adhesions have been reported. This study applied those classes of treatments to the most clinically relevant aetiology of post operative adhesions. HYPOTHESIS Treatments addressing the pathophysiology of ischaemia-reperfusion induced adhesions would accordingly reduce the incidence of adhesions from this model. METHODS Four classes of treatments were administered for 72 h to 16 foals subjected to complete ischaemia followed by reperfusion to create peritoneal adhesions. These groups were: 1) FPG group--flunixin meglumine (1.1 mg/kg bwt i.v., divided q.i.d.), potassium penicillin G (22,000 iu/kg bwt i.v., q.i.d.) and gentamicin (2.2 mg/kg bwt i.v., t.i.d.); 2) HEP group--heparin (80 iu/kg bwt subcut., b.i.d.); 3) DMSO group--dimethylsulphoxide (DMSO) (20 mg/kg bwt [diluted in 500 ml normal saline] i.v., b.i.d.); and 4) SCMC group--sodium carboxymethylcellulose (500 ml 3% sterile solution intraperitoneally, administered only at the beginning of surgery). RESULTS Post operative intestinal obstruction did not occur in any foal. After 10 days, necropsy revealed bowel-to-bowel adhesions in none of the FPG or DMSO groups, in 2/4 of the SCMC group, in 3/4 of the HEP group and 5/6 foals subjected to the procedure without treatment (UIR group). CONCLUSIONS Inhibition of the inflammation associated with ischaemia and reperfusion in foals treated with FPG or DMSO decreased small intestinal adhesions in foals. POTENTIAL RELEVANCE Although anti-inflammatory therapy was shown to eliminate bowel-bowel adhesions in this controlled study, it must be remembered that clinical cases are without control. These therapies are advised to improve the result but are unlikely to eliminate the problem.

Treatment of Impaction Colics

Impactions have been reported in the stomach and all segments of the intestine. Impactions predominately occur just oral to sites of intestinal narrowing or active pacemakers. The most common sites of impaction are in the ileum, the cecum, and the large colon pelvic flexure. The treatment of gastrointestinal impactions depends on the segment affected and the amount of bowel damage which has occurred from distension. Many impactions respond to appropriate administration of analgesics, cathartics, and oral or intravenous fluids. The prognosis for impactions treated medically is better than for those which require surgery.

Diseases and Surgery of the Cecum

The cecum is an important site of water and electrolyte absorption, as well as microbial digestion of soluble and insoluble carbohydrates. These functions of the cecum and ascending colon require that ingesta be mixed constantly and retained long enough to complete the digestion of cellulose. Parasites, changes in regional blood flow, diet, and various pharmacologic agents are associated with alterations in normal cecal motility patterns.

Evaluation of Carolina Rinse solution as a treatment for ischaemia reperfusion of the equine jejunum.

REASONS FOR PERFORMING STUDY Ileus and peritoneal adhesions are the most common complications following surgery for small intestinal obstruction. Carolina Rinse (CR) has been shown to decrease reperfusion injury in intestine and other organs. HYPOTHESIS CR decreases intestinal inflammation and subsequent scarring associated with reperfusion injury. METHODS CR was infused intra-arterially and applied topically just prior to reperfusion in jejunum exposed to experimental ischemia. Vascular permeability, neutrophil accumulation and serosal scarring were compared in treated and untreated intestine. RESULTS CR maintained a normal osmotic reflection coefficient and decreased migration of neutrophils into the serosa during reperfusion. After 10 days, treated intestine was normal in appearance with a trend toward less serosal scarring and fibroblast proliferation. There was a significant decrease in fibroplasia at biopsy sites in treated intestine. CONCLUSIONS Arterial perfusion combined with topical application of CR during jejunal ischaemia decreases immediate reperfusion injury and limits post operative scarring. POTENTIAL RELEVANCE CR should be used as a local perfusate rather than a systemic treatment; it may best be applied topically and intraluminally to avoid damaging mesenteric arteries. CR should be considered an adjunct treatment as part of overall surgical management and post operative care.