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==Description==

==Description==

==Clinical signs==

==Clinical signs==

The presentation of this condition is similar to that of other strangulating lesions such as small intestinal volvulus. Horses with epiploic foramen entrapment frequently exhibit acute onset and severe abdominal pain that is usually non-responsive to analgesia. This is often characterised by clinical signs including rolling, pawing at the ground, flank watching and kicking at the abdomen. Other clinical signs may include tachycardia, tachypnoea and reduced borborygmi. If endotoxaemia has occurred other clinical features may include a prolonged capillary refill time and congested mucous membranes. A rare feature of the condition is sudden death due to rupture of the portal vein and subsequent haemorrhage.

The presentation of this condition is similar to that of other strangulating lesions such as [[Small Intestine Volvulus - Horse|small intestinal volvulus]]. Horses with epiploic foramen entrapment frequently exhibit acute onset and severe abdominal pain that is usually non-responsive to analgesia. This is often characterised by[[Colic Diagnosis - Clinical Signs| clinical signs]] including rolling, pawing at the ground, flank watching and kicking at the abdomen. Other clinical signs may include tachycardia, tachypnoea and reduced borborygmi. If endotoxaemia has occurred other clinical features may include a prolonged capillary refill time and congested mucous membranes. A rare feature of the condition is sudden death due to rupture of the portal vein and subsequent haemorrhage.

==Diagnosis==

==Diagnosis==

Definitive diagnosis of epiploic foramen entrapment may not be straightforward and is usually made at surgery. Rectal palpation is often unrewarding due to the anterior position of the lesion but a marked pain response to traction of the caudal caecal band may aid in distinguishing epiploic entrapment from other conditions. Distended coils of small intestine may also be identified.

Definitive diagnosis of epiploic foramen entrapment may not be straightforward and is usually made at surgery. Rectal palpation is often unrewarding due to the anterior position of the lesion but a marked pain response to traction of the caudal caecal band may aid in distinguishing epiploic entrapment from other conditions. Distended coils of small intestine may also be identified.

Nasogastric reflux of large volumes of alkaline gastric fluid is frequently present but may not lead to pain relief. Transabdominal ultrasonography may reveal distended, hypomotile small intestine and small intestine identified in the right dorsal quadrant of the abdomen is highly suggestive of the disease. Abdominocentesis is often useful to determine the degree of strangulation and peritoneal fluid may be serosanguineous with an increased lactate, total protein and leukocyte count. If the herniation occurs from right to left however, the tranudation enters the omental bursa and may not be collected by abdominocentesis.

 

Nasogastric reflux of large volumes of alkaline gastric fluid is frequently present but may not lead to pain relief. [[Colic Diagnosis - Abdominal Ultrasound|Transabdominal ultrasonography]] may reveal distended, hypomotile small intestine and small intestine identified in the right dorsal quadrant of the abdomen is highly suggestive of the disease. [[Colic Diagnosis - Abdominocentesis|Abdominocentesis]] is often useful to determine the degree of strangulation and peritoneal fluid may be serosanguinous with an increased lactate, total protein and leukocyte count. If the herniation occurs from right to left however, the transudation enters the omental bursa and may not be collected by abdominocentesis.

See also <big>'''[[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]]</big>

See also <big>'''[[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]]</big>

==Treatment==

==Treatment==

Initial treatment consists of gastric decompression, fluid therapy and analgesia. If epiploic foramen entrapment is suspected, surgical intervention is required. Surgical treatment of the condition is not straightforward due to the inaccessibility of the foramen and the delicate surrounding structures. A ventral midline exploratory coeliotomy is performed and palpation of small intestine (other than the duodenum) in the right dorsal quadrant of the abdomen will confirm diagnosis. The encarcerated portion of intestine is reduced by gentle traction; decompression may be required prior to reduction if the segment is oedematous or filled with ingesta. Manual dilation of the foramen in order to aid reduction has been reported but this may lead to rupture of the portal vein and great care must be taken when doing so. The viability of the affected intestine is assessed and a resection and anastamosis may be performed if necessary.  

Initial treatment consists of '''gastric decompression, fluid therapy and analgesia'''. If epiploic foramen entrapment is suspected, surgical intervention is required. Surgical treatment of the condition is not straightforward due to the inaccessibility of the foramen and the delicate surrounding structures. A ventral midline exploratory coeliotomy is performed and palpation of small intestine (other than the duodenum) in the right dorsal quadrant of the abdomen will confirm diagnosis. The encarcerated portion of intestine is reduced by gentle traction; decompression may be required prior to reduction if the segment is oedematous or filled with ingesta. Manual dilation of the foramen in order to aid reduction has been reported but this may lead to rupture of the portal vein and great care must be taken when doing so. The viability of the affected intestine is assessed and a resection and anastamosis may be performed if necessary.  

==Prognosis==

==Prognosis==

The prognosis following surgical treatment is considered to be poor, especially if the length of bowel affected is long. The prognosis may be altered by the extent of strangulation observed at surgery and the presence of endotoxaemia. Recurrence of epiploic foramen entrapment several months or years later has been reported in a small number of cases.

The prognosis following surgical treatment is considered to be poor, especially if the length of bowel affected is long. The prognosis may be altered by the extent of strangulation observed at surgery and the presence of endotoxaemia. Recurrence of epiploic foramen entrapment several months or years later has been reported in a small number of cases.

==References==

==References==

*Radostits, O. M., Arundel, J. H., Gay, C. C. (2000) '''Veterinary Medicine: a textbook of the diseases of cattle, sheep, pigs, goats and horses''' ''Elsevier Health Sciences''

*Radostits, O. M., Arundel, J. H., Gay, C. C. (2000) '''Veterinary Medicine: a textbook of the diseases of cattle, sheep, pigs, goats and horses''' ''Elsevier Health Sciences''

[[Category:Colic - Small Intestinal Causes]]

[[Category:Colic - Small Intestinal Causes]]

[[Category:Surgical Colic in the Horse]]

[[Category:Surgical Colic in the Horse]]

[[Category:To_Do_-_SophieIgnarski]]

[[Category:Expert_Review]]

[[Category:To_Do_-_Review]]

[[Category:Small Intestinal Disorders - Horse]]

[[Category:Small Intestinal Disorders - Horse]]