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Laparoscopic Surgery May Prevent Recurrence of Nephrosplenic Entrapment

Nephrosplenic entrapment is a type of colic that occurs when a horse's colon shifts and settles over the nephrosplenic ligament, trapping the colon and its contents, which causes distention and pain. Nearly 9 percent of colic cases seen in equine clinics are caused by nephrosplenic entrapment.

Though it's unclear what makes some horses more prone to the condition, it's suspected that a large abdomen, abnormalities in how a horse's colon moves and the shape of the nephrosplenic space may play a role.

There are several treatments for nephrosplenic entrapment, including administering medication to shrink the spleen and then working the horse to try to get the colon back to a normal position. Anesthetizing a horse and rolling him back and forth to try to free the colon can also be done. Finally, surgery may be performed to manually free to the colon.

Though most horses with nephrosplenic entrapment recover, nearly 21 percent of survivors will experience another entrapment. The University of Pennsylvania's New Bolton Center found that a surgical procedure to close the nephrosplenic space can prevent the entrapment from occurring again.

Veterinarians can tack surgical mesh over the top of the spleen, which keeps the colon from slipping into the space. This can be done laparoscopically in about 30 minutes and has no risk of failure. Veterinarians looked at the records of 26 horses that had experienced nephrosplenic entrapment that had the space closed with mesh: not one horse had a recurrence during the follow-up period, which was up to seven years.

Common Colic Myths Debunked

The signs of colic are well-known to many horse owners: abdominal discomfort shown by pawing, kicking at the belly, repeatedly rolling, sweating and increased heart and respiration rate. Though colic is unfortunately common in horses, only about 10 percent of colic cases require surgical intervention to resolve.

Colic surgery can seem scary, but improvements in the past few decades have lessened the chance of a negative outcome, reports The Horse. Yet, myths regarding colic surgery remain. Dr. Jacqueline Hill, who practices at Littleton Equine Medical Center in Colorado, dispels some of the most common colic surgery myths.

Myth 1: A horse will never return to pre-surgery performance levels. Though colic surgery is a major surgery with a long recover period, horses can go back to their pre-surgery performance levels. A study that used over 200 horses of different breeds found that 84 percent of the horses returned to their discipline after colic surgery and that 79 percent were performing at or above the level they were at before the surgery.

Myth 2: A horse can be “too old” for colic surgery. The life expectancy for horses, like humans, has lengthened in the last few decades, with many horses ridden well into their 20s. A recent study from the University of Pennsylvania compared horses between 4 and 15 years old that had colic surgery with horses that were over 20 that had colic surgery. They found that both categories had similar post-operative complications and survival rates.

Myth 3: A horse is never the same after having a resection. Horses tend to fare differently depending on the section of intestine that has been resected: horses that have had their small intestine resected tend to fare better than those that have had the end of the intestine resected. It was recently reported that horses that have had their large colon resected have 65 to 75 percent long-term survival rates; small-intestine only resections see up to 75 percent of patients with long-term success.

More evidence is needed to resolve the myth that horses that have had colic surgery are more prone to colicking again. Studies have reported that between 0 to 35 percent of post-surgical horses have another colic episode within 12 months of a colic surgery. Factors that appear to affect this include what portion of the bowel was affected and what surgical procedure was used. Generally, if a horse doesn't colic in the first year after surgery, his risk of colicking again is similar to a horse that didn't have surgery.

Diarrhea: Deadly Or Just A Drag?

Equine enthusiasts are taught early in their foray into horse ownership that any type of abnormal hgorse stool is a concern—whether that means the horse has diarrhea or is not passing manure at all. Though no passing of manure is of great concern, diarrhea can be as well.

Changes in diet are the No. 1 cause of diarrhea; they can also be hardest to identify—and rectify. If a horse's diarrhea is bad enough to call the vet, there are two main possibilities: that the horse has a chronic issue that will be very hard to find and treat or that the horse is very sick and could infect other horses in his barn or pasture.

Diarrhea occurs when the digestive tract is not working properly; in particular, when there is a disruption in the large intestine. The large intestine can absorb as much as 30 gallons of water a day; when it can't absorb the water, it is excreted in manure.

Diarrhea is a symptom, not a disease—it can occur when a horse eats too many carbohydrates or when he has ingested too much sand. Diarrhea can be a symptom of something minor to life-threatening. But how to tell which is which? Questions to help decide if the horse's health is at risk include:

Is he uncomfortable? If the horse is pawing or looking at his flanks and acting colicky, the situation may be serious.
Does the horse have a fever? This could indicate he has an infection, which is more serious.
How long has the horse had diarrhea? Acute-onset diarrhea is more concerning that a low-grade diarrhea that's been present for months.
Has he been around another horse that has diarrhea? This increases his risk of infection.
Does lab work show a low white cell count or a decrease in proteins? These are concerning.

If the vet doesn't feel that his condition is life threatening, she may suggest adjusting the horse's diet. Many vets believe horses are susceptible to orchard grass hay and suggest eliminating it from the horse's diet to see if the diarrhea clears up. Removing NSAIDs and antibiotics from a horse's management can also help (if possible).

Proper parasite control is key, and investigating the use of prebiotics or probiotics won't hurt. Additionally, protecting the tissue of the affiliated horse's intestinal tract is also important: Using products designed sooth tissues, like those that contain smectite clay or bismuth subsalicylate, are worth investigating to try to get his diarrhea under control.

New Colic Pain Scale Assesses Discomfort Quickly

Two equine hospitals have trialed a pain scale to assess the level of discomfort of 237 horses referred to the clinics for colic. The veterinarians concluded that the sale was reliable, easy to use and fast.

Drs. Yamit Maskato, Alexandra Dugdale, Ellen Singer, Gal Kelmer and Gila Sutton created the Equine Acute Abdominal Pain Scale (EAAPS) in 2013. The scientists report that the scale requires no training, can be used easily in hospital settings and can improve equine welfare.

They suggest that the EAAPS now be tested in the field by veterinarians, as well as by horse owners and farm caretakers who lack medical training. Colic is the most common cause of equine deaths in the United States. Severity of pain is an important parameter for decision making regarding a horse that is colicking; it can also assist in evaluating pain-relieving measures, patient status and surgical or euthanasia decisions.

The EAAP gives typical colic behaviors a one-digit score to grade the severity of pain, with 1 being the most mild (flank watching or lip curling) to 5 being the most severe (rolling). Participants at the two clinics where the EAAP was trialed reported that the EAAP was quick and easy to use, even with no training on the scale.

The creators determined that the EAAPS is feasible to use in an equine clinical setting to determine the severity of colic cases.

Read the full article here.