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| − | Also known as: '''''Colic — Impaction — Simple Obstruction — Small Intestinal Simple Obstruction — Small Intestinal Obstruction — Small Intestinal Impaction | + | |
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| | + | {| cellpadding="10" cellspacing="0" border="1" |
| | + | | Also known as: |
| | + | |'''Colic<br> |
| | + | '''Impaction<br> |
| | + | '''Simple Obstruction<br> |
| | + | '''Small Intestinal Simple Obstruction<br> |
| | + | '''Small Intestinal Obstruction<br> |
| | + | '''Small Intestinal Impaction''' |
| | + | |} |
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| − | ==Introduction== | + | |
| − | The most common condition causing simple obstruction of the small intestinal lumen.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> | + | |
| | + | ==Description== |
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| | + | The most common condition causing simple obstruction of the small intestinal lumen(Merck) |
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| | ==Signalment== | | ==Signalment== |
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| | Adult horses | | Adult horses |
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| | ==Prevalence== | | ==Prevalence== |
| − | Ileal impaction occurs most frequently in the southeastern USA, Germany and The Netherlands.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> In the southeastern USA, there appears to be an increased prevalence in the autumn which may relate to changing weather and feedng regimes at that time of year.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref>
| + | Most common in the southeastern USA, Germany, and The Netherlands.(Merck) Anoplocephala perfoliata has a prevalence as high as 60% in some geographical areas and has been associated with increased risk for serious conditions in the horse including bowel irritation, ileal impaction, and spasmodic colic. (Kania) |
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| | ==Aetiology== | | ==Aetiology== |
| − | In the southeastern United States, feeding of poor quality coastal Bermuda hay and lack of administration of the anthelmintic pyrantel pamoate have been implicated as risk factors.<ref>Little, D, Blikslager, A.T (2002) Factors associated with development of ileal impaction in horses with surgical colic:78 cases (1986-2000). ''Equine Vet J'' 34(5):464-8.</ref> It is proposed that when this forage has a high fibre content, there is an increased proportion of thin fibres which are prematurely swallowed.<ref>Blikslager, A.T (2010) ''Obstructive Disorders of the Gastrointestinal Tract'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Chapter 15, ''Saunders''.</ref> Sudden feed changes may also contribute.<ref>Parks, A.H.A, Allen, D (1998) ''The purported role of coastal Bermuda hay in the etiology of ileal impactions: results of a questionnaire (abstract), 6th Equine Colic Research Symposium'', University of Georgia, p37. In: Blikslager, A.T (2010) ''Obstructive Disrodersof the Gastrointestinal Tract'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Chapter 15, ''Saunders''.</ref> In the UK, infection with the tapeworm [[Anoplocephala|''Anoplocephala perfoliata'']] is an important risk factor. Proudman and colleagues (1998) found that more than 80% of ileal impactions were associated with serological or faecal evidence of tapeworm infection.<ref>Proudman, C.J, French, N.P, Trees, A.J (1998) Tapeworm infection is a significant risk factor for spasmodic colic and ileal impaction colic in the horse. ''Equine Vet J'', 30:194-199.</ref> ''Anoplocephala perfoliata'' infects up to 60% of horses in some geographical areas and has also been implicated as a risk factor for bowel irritation and spasmodic colic.<ref name="Kania">Kania, S.A, Reinemeyer, C.R (2005) ''Anoplocephala perfoliata'' coproantigen detection: a preliminary study. ''Vet Parasitol'', 127(2):115-9.</ref>Impaction may also develop secondary to spastic contractions of the ileal musculature against ingesta.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> | + | |
| | + | In the southeastern United States, feeding of sub-optimal Coastal Bermuda hay and lack of administration of the anthelmintic pyrantel pamoate have been implicated as a risk factors.(Little) It is thought this forage contains a high amount of thin fibres which are prematurely swallowed. Sudden feed changes may also be a risk (38). In the UK, infection with the tapeworm [[Anoplocephala|''Anoplocephala perfoliata'']] is an important risk factor. Data suggests that more than 80% of ileal impactions were associated with serological or faecal evidence of tapeworm infection(39). Impaction may also develop secondary to spastic contractions of the ileal musculature against ingesta.(Merck) |
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| | ==Clinical Signs== | | ==Clinical Signs== |
| − | Typical [[Colic Diagnosis - Clinical Signs|signs]] associated with small intestinal obstruction: | + | |
| | + | Typical signs associated with [[Colic Diagnosis - Clinical Signs|small intestinal obstruction]]: |
| | *Moderate to severe colic | | *Moderate to severe colic |
| − | *Reduced [[Colic Diagnosis - Abdominal Auscultation|borborygmi]] | + | *Reduced boriborygmi |
| | *Tachycardia | | *Tachycardia |
| − | *[[Colic Diagnosis - Naso-gastric Intubation|Nasogastric reflux]] may take a considerable time to develop because the ileum is the distal-most part of the small intestine. | + | *Nasogastric reflux may take a considerable time to develop because the ileum is the distal-most part of the small intestine. Reflux is found in 50% of horses requiring surgical conrrection for ileal impaction(35,41) |
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| | ==Diagnosis== | | ==Diagnosis== |
| − | Early [[Colic Diagnosis - Rectal Examination|rectal examination]] may reveal the impaction low in the right caudal abdominal quadrant. Subsequent distention of the jejunum will be palpable ''per rectum'' but may preclude palpation of the impaction, thus the definitive diagnosis is often made at surgery. Many horses with ileal impaction are delayed in their referral because initially their colic is mild and their condition deceptively stable. [[Colic - Peritoneal Fluid Analysis|Abdominocentesis]] may show an elevated protein concentration if the impaction has persisted for more than about 18 hours.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> The most likely differential diagnosis is '''proximal jejunitis''', which can be challenging to rule out.
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| | + | Usually made at surgery. Although early rectal examination may permit identification of the impaction low in the right caudal abdominal quadrant, subsequent distention of the jejunum may make this identification difficult or impossible. The most common differential diagnosis is proximal jejunitis, and distinguishing the 2 conditions can often be difficult. Because the horse’s condition initially may remain stable and the degree of abdominal pain may be mild, many horses with this condition are not referred for intensive care or surgery for >18 hr. The protein concentration of the peritoneal fluid may increase if the impaction has persisted for this long. Rectal palpation may identify loops of distended small intestine as the condition progresses. |
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| | ==Treatment== | | ==Treatment== |
| − | [[Colic, Medical Treatment|'''Medical treatment''']] may be feasible if the pain is manageable, if repeated abdominocentesis demonstrates no evidence of intestinal degeneration, if there is no nasogastric reflux and if multiple tightly distended loops of small intestine are not present on rectal examination. In this situation, balanced electrolyte solutions (administered IV) and analgesia may suffice. Substances via nasogastric tube are contraindicated, even if reflux is absent, because the small intestinal distension and reduced motility proximally will prevent these reaching the impaction. The response to medical intervention will be evidenced by a reduction in colic signs and an improvement in cardiovascular status.<ref name="Hanson 2">Hanson, R.R, Schumacher, J, Humburg, J, Dunkerley, S.C (1996) Medical treatment of horses with ileal impactions: 10 cases (1990-1994). ''J Am Vet Med Assoc'', 208(6):898-900.</ref> Although medical treatment may resolve the impaction early on, surgery is typically required.
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| − | '''Surgical treatment''' comprises celiotomy followed by reduction of the impaction via extraluminal massage aided by admixing of the intestinal fluid oral to the impaction or injection of fluids intraluminally. The ingesta can then be moved into the caecum. Infusions into the impaction may include saline, '''carboxymethylcellulose''' or '''dioctyl sodium sulfosuccinate (DSS)'''. An '''enterotomy''' in the distal jejunum may be instigated to evacuate impacted contents and minimise intestinal manipulation. Recurrent ileal impaction may demand a '''jejunocecostomy'''.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref> | + | [[Colic, Medical Treatment|Medical treatment]] with fluids and liquid paraffin may resolve the impaction early on(36) but '''surgery''' is typically required. At surgery, fluids such as saline or carboxymethylcellulose can be directly infused into the mass so that the impaction can be manually broken down and massaged into the caecum. '''Dioctyl sodium sulfosuccinate (DSS)''' may be included in the infusion to help disrupt the mass. An enterotomy in the distal jejunum should be considered to evacuate impacted contents and reduce intestinal manipulation. |
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| | ==Complications== | | ==Complications== |
| − | Small intestinal distension and manipulation of the ileum at surgery may lead to '''post-operative ileus'''<ref>Blikslager, A.T, Bowman, K.F, Levine, J.F, ''et al.'' (1994) Evaluation of factors associated with postoperative ileus in horses: 31 cases (1990-1992). ''J Am Vet Med Assoc'', 205:1748-1752.</ref> but the risk is reduced if the duration between disease onset and surgical intervention is decreased.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref> Depending on the degree of damage to the serosal surface of the small intestine at surgery, complications may develop several weeks after surgery due to intra-abdominal '''adhesions'''.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> Most of the problems related to adhesions are thought to occur within 2 months.<ref name="Baxter">Baxter, G.M, Broome, T.E, Moore, J.N (1989) Abdominal adhesions after small intestinal surgery in the horse. ''Vet Surg'', 18(6):409-14.</ref>
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| | + | Extensive small intestinal distension and intraoperative manipulation of the ileum may lead to postoperative ileus(42) but the risk is reduced if the duration between disease onset and surgical intervention is decreased.(35)Depending on the degree of damage to the serosal surface of the small intestine at the time of surgery, complications may develop several weeks after surgery due to intra-abdominal adhesions.(Merck) |
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| | ==Prognosis== | | ==Prognosis== |
| − | The prognosis for survival is generally good.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref><ref name="Hanson 2">Hanson, R.R, Schumacher, J, Humburg, J, Dunkerkley, S.C (1996) Medical treatment of horses with ileal impactions: 10 cases (1990-1994). ''J Am Vet Med Assoc'', 208(6):898-900.</ref> The shorter the duration of colic before surgical intervention, the better the prognosis.<ref>Embertson, R.M, Colahan, P.T, Brown, M.P, Peyton, L.C, Schneider, R.K, Granstedt, M.E (1985) Ileal impaction in the horse. ''J Am Vet Med Assoc'', 186(6):570-2.</ref> The requirement for enterotomy, enterectomy, jejunocecostomy during surgery<ref>Parks, A.H, Doran, A.E, White, N.A, Allen, D, Baxter, G.M (1989) Ileal impaction in the horse: 75 cases. ''Cornell Vet'', 79(1):83-91.</ref> and the development of postoperative adhesions have all been associated with a poorer prognosis for survival.<ref name="Baxter">Baxter, G.M, Broome, T.E, Moore, J.N (1989) Abdominal adhesions after small intestinal surgery in the horse. ''Vet Surg'', 18(6):409-14.</ref> | + | |
| | + | The prognosis for survival is good(35,36). |
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| | ==Prevention== | | ==Prevention== |
| − | *Adequate and appropriate feeding of good quality forage
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| − | *Avoidance of sudden dietary changes
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| − | *An adequate tapeworm control programme
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| − | *Avoid practices that encourage the development of [[Anthelmintic Resistance|anthelmintic resistance]]
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| − | Feacal worm egg counts do not reliably detect horses infected with ''A.perfoliata''. An '''ELISA''' to test for the host antibody response to tapeworms has been developed with a reported sensitivity of 70% and a specificity of 95%.<ref>Proudman, C.J, Trees, A.J (1996) Use of excretory/secretory antigens for the serodiagnosis of ''Anoplocephala perfoliata'' cestodosis. ''Vet Parasitol'', 61:239-247.</ref> Although this test is useful for detecting horses with a high intensity of infection, it measures past and current infection so must be interpreted in light of the anthelmintic history. More recently, a '''coproantigen capture ELISA''' has demonstrated some promise in a small sample of horses.<ref name="Kania">Kania, S.A, Reinemeyer, C.R (2005) ''Anoplocephala perfoliata'' coproantigen detection: a preliminary study. ''Vet Parasitol'', 127(2):115-9.</ref> Such tests may be used as part of a '''targeted strategic dosing''' programme for anthelmintic administration.
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| − | {{Learning
| + | Faecal tapeworm ELISA test: senstivity 70%, specificity 95%(40). |
| − | |literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28ileum%29+OR+title%3A%28ileal%29%29+AND+%28title%3A%28impaction%29+OR+title%3A%28obstruction%29%29+AND+od%3A%28horses%29 Ileal Impaction in horses publications]
| + | Identification of infected animals based upon detection of eggs in feces is labor intensive and unreliable. This study involved the development of a test for A.perfoliata coproantigen using an antigen capture enzyme linked immunosorbent assay (ELISA) and correctly distinguished between infected and uninfected animals in a trial with a small sample size.(Kania) |
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| | ==References== | | ==References== |
| | <references/> | | <references/> |
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| − | {{review}}
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| − | {{OpenPages}}
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| | [[Category:Intestine_-_Mechanical_Obstruction]] | | [[Category:Intestine_-_Mechanical_Obstruction]] |
| | [[Category:Surgical_Colic_in_the_Horse]] | | [[Category:Surgical_Colic_in_the_Horse]] |
| − | [[Category:Expert_Review]] | + | [[Category:To_Do_-_Nina]] |
| − | [[Category:Impaction - Horse]]
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| − | [[Category:Colic - Small Intestinal Causes]]
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| − | [[Category:Small Intestinal Diseases - Horse]]
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| Also known as:
|
Colic
Impaction
Simple Obstruction
Small Intestinal Simple Obstruction
Small Intestinal Obstruction
Small Intestinal Impaction
|
Description
The most common condition causing simple obstruction of the small intestinal lumen(Merck)
Signalment
Adult horses
Prevalence
Most common in the southeastern USA, Germany, and The Netherlands.(Merck) Anoplocephala perfoliata has a prevalence as high as 60% in some geographical areas and has been associated with increased risk for serious conditions in the horse including bowel irritation, ileal impaction, and spasmodic colic. (Kania)
Aetiology
In the southeastern United States, feeding of sub-optimal Coastal Bermuda hay and lack of administration of the anthelmintic pyrantel pamoate have been implicated as a risk factors.(Little) It is thought this forage contains a high amount of thin fibres which are prematurely swallowed. Sudden feed changes may also be a risk (38). In the UK, infection with the tapeworm Anoplocephala perfoliata is an important risk factor. Data suggests that more than 80% of ileal impactions were associated with serological or faecal evidence of tapeworm infection(39). Impaction may also develop secondary to spastic contractions of the ileal musculature against ingesta.(Merck)
Clinical Signs
Typical signs associated with small intestinal obstruction:
- Moderate to severe colic
- Reduced boriborygmi
- Tachycardia
- Nasogastric reflux may take a considerable time to develop because the ileum is the distal-most part of the small intestine. Reflux is found in 50% of horses requiring surgical conrrection for ileal impaction(35,41)
Diagnosis
Usually made at surgery. Although early rectal examination may permit identification of the impaction low in the right caudal abdominal quadrant, subsequent distention of the jejunum may make this identification difficult or impossible. The most common differential diagnosis is proximal jejunitis, and distinguishing the 2 conditions can often be difficult. Because the horse’s condition initially may remain stable and the degree of abdominal pain may be mild, many horses with this condition are not referred for intensive care or surgery for >18 hr. The protein concentration of the peritoneal fluid may increase if the impaction has persisted for this long. Rectal palpation may identify loops of distended small intestine as the condition progresses.
Treatment
Medical treatment with fluids and liquid paraffin may resolve the impaction early on(36) but surgery is typically required. At surgery, fluids such as saline or carboxymethylcellulose can be directly infused into the mass so that the impaction can be manually broken down and massaged into the caecum. Dioctyl sodium sulfosuccinate (DSS) may be included in the infusion to help disrupt the mass. An enterotomy in the distal jejunum should be considered to evacuate impacted contents and reduce intestinal manipulation.
Complications
Extensive small intestinal distension and intraoperative manipulation of the ileum may lead to postoperative ileus(42) but the risk is reduced if the duration between disease onset and surgical intervention is decreased.(35)Depending on the degree of damage to the serosal surface of the small intestine at the time of surgery, complications may develop several weeks after surgery due to intra-abdominal adhesions.(Merck)
Prognosis
The prognosis for survival is good(35,36).
Prevention
Faecal tapeworm ELISA test: senstivity 70%, specificity 95%(40).
Identification of infected animals based upon detection of eggs in feces is labor intensive and unreliable. This study involved the development of a test for A.perfoliata coproantigen using an antigen capture enzyme linked immunosorbent assay (ELISA) and correctly distinguished between infected and uninfected animals in a trial with a small sample size.(Kania)
References
