Evaluation of the effect of onlay mesenteric flaps on end-to-end jejunojejunostomy healing in horses.

OBJECTIVE: To evaluate the effect of onlay mesenteric flaps (MFs) with end-to-end jejunojejunostomy on stomal diameter, length of jejunum with reduced stomal diameter, abdominal adhesion formation, and healing. STUDY DESIGN: Experimental study. ANIMALS: Healthy adult horses (n = 6). METHODS: Two hand sewn end-to-end jejunal anastomoses using a 1 layer simple continuous serosubmucosal suture pattern were performed in each horse ∼ 2 and 5 m oral to the ileocecal fold. Using a random design for selection anastomosis location (oral or aboral), 1 anastomosis was covered with 2 adjacent onlay MFs secured with interrupted sutures and cyanoacrylate glue. Two weeks later, adhesion formation, stomal diameter, length of reduced jejunal stomal diameter, and healing were evaluated. RESULTS: Use of onlay MFs decreased stomal diameter (P = .05), increased length of reduced peristomal jejunal diameter (P = .05), surgical time (P = .003), and serosal fibrosis (P = .05). No difference was evident for adhesion formation, and degree of inflammation between techniques. CONCLUSION: End-to-end jejunojejunostomy covered with 2 onlay MFs is not recommended because this technique results in luminal reduction.

Effect of intraperitoneal PERIDAN™ concentrate adhesion reduction device on clinical findings, infection, and tissue healing in an adult horse jejunojejunostomy model.

OBJECTIVE: To evaluate the effect of PERIDAN™ Concentrate on clinical findings, infection, and tissue healing in adult horses undergoing celiotomy and jejunojejunostomy. STUDY DESIGN: Block randomized blinded experimental in vivo study. ANIMALS: Adult horses (n = 12). METHODS: Horses had jejunojejunostomy at 2 sites and were administered 5 L of diluted PERIDAN™ Concentrate (6 horses) or Lactated Ringer's Injection (LRS) control intraperitoneally (6 horses) before body wall closure. Postoperative monitoring comprised physical examinations, serial hematology, coagulation and chemistry panels, and ultrasonographic examination. Horses were euthanatized 10 days postoperatively. Anastomoses and linea alba incisions were tested for mechanical strength; and tissue healing, inflammation, and infection were assessed by histological evaluation. Data were analyzed using a mixed model ANOVA. Level of significance was P < .05. RESULTS: No physical examination differences were observed between groups. Statistically significant differences were observed in leukocyte and neutrophil counts, prothrombin time, antithrombin III activity, intestinal bursting pressures, and histologic healing grade in the mid region of the linea alba. These differences were minimal, and of no observable clinical significance. Other blood variable and histologic differences between groups were not significant. CONCLUSIONS: PERIDAN™ Concentrate was safely administered intraperitoneally to healthy horses undergoing celiotomy and anastomosis.

Evaluation of equine cecal motility by ausculation, ultrasonography and electrointestinography after jejunocecostomy.

OBJECTIVE: Horses often suffer reduced intestinal motility after jejunocecostomy. Therefore, accurate evaluation of intestinal motility is important for the prevention, diagnosis and treatment of this condition. The purpose of this study was to evaluate intestinal motility in horses after jejunocecostomy using three different methods, i.e. auscultation, ultrasonography and electrointestinography. ANIMALS: Six healthy thoroughbreds were used in this study. They were subjected to jejunocecostomy. PROCEDURE: Bowel sounds in the right paralumbar fossa were assigned a score of 0-3 for intestinal motility evaluation by auscultation, and the number of cecal contractions during a 3-min period were counted by ultrasonography. Electrointestinography (EIG) was used to measure percutaneous potential of the cecum. RESULTS: We identified three specific postoperative periods: the period of reduced intestinal motility (postoperative day 1 to day 2), in which intestinal motility declined, the unstable period (day 3 to day 7), in which intestinal motility partially recovered, and the full recovery period (day 8 to day 31), in which intestinal motility returned to preoperative state. Careful management was found to be especially important during the period of reduced intestinal motility and the unstable period. We found that, in healthy horses that underwent jejunocecostomy, it takes approximately one month for the cecum to return to normal motility patterns observed before surgery. CONCLUSION: We have shown in this study that evaluation of intestinal motility after jejunocecostomy in horses by EIG is more objective and provides more details than evaluation by auscultation or ultrasonography.

Comparison of different tube materials and use of Chinese finger trap or four friction suture technique for securing gastrostomy, jejunostomy, and thoracostomy tubes in dogs.

OBJECTIVE: To compare Chinese finger trap (CFT) and 4 friction suture (FFS) techniques to secure gastrostomy (GT), jejunostomy (JT), and thoracostomy (TT) tubes of different materials. STUDY DESIGN: Prospective experimental study. ANIMALS: Canine cadavers (n=20). METHODS: Randomly, GT (n=20), JT (20), and TT (20) were inserted using 2 different suture techniques (10 for each tube type) and either silicone or another material (10 for each type). Axial distraction was applied to each tube until failure. Force and displacement to failure and failure mode were recorded and compared between techniques and materials for GT, JT, and TT. RESULTS: CFT failed most commonly by suture breakage whereas FFS failed mainly by tube slippage (P=.003). For GT, failure occurred more commonly by tube slippage (n=15; P<.001) whereas tube breakage was more common for JT (n=10; P<.001) and suture breakage for TT (n=14; P=.022). Silicone had higher force to failure than latex with GT, lower force to failure than red rubber with JT, and lower displacement to failure than polyvinylchloride with TT. CONCLUSIONS: Different failure modes occurred for CFT (suture breakage) and FFS (tube slippage) and among different tube types (tube slippage with GT, tube breakage with JT, and suture breakage with TT). Based on study results, CFT is preferred to FFS for anchoring silicone GT and TT. Silicone GT, red rubber JT, and polyvinylchloride TT were more secure than latex GT, silicone JT, and silicone TT, respectively. CLINICAL RELEVANCE: CFT should be preferred over FFS based on force and displacement to failure, but tube type and tissue reaction could influence anchoring strength.

Evaluation of various gastrojejunostomy tube constructs for enteral support of small animal patients.

OBJECTIVE To evaluate the feasibility of manufacturing gastrojejunostomy tubes from jejunostomy and gastrostomy tubes that would allow for gastric and enteral feeding of and aspiration of gastric contents from small animal patients. DESIGN In vitro study. SAMPLE 9 gastrojejunostomy constructs. PROCEDURES Commercially available gastrostomy and jejunostomy tubes were combined to create 9 constructs. Three investigators tested each construct with 4 solutions (tap water, a commercial enteral diet, and 2 canned food-water mixtures) and 3 syringe sizes for ease of injection through the gastrostomy and jejunostomy tubes and aspiration through the gastrostomy tube. Flow rates were calculated and analyzed to evaluate effects of tube diameter and syringe size for each solution. RESULTS The 20F/8F, 24F/8F, 28F/8F, and 28F/10F (gastrostomy tube/jejunostomy tube) constructs allowed for injection and aspiration of all solutions. The 5F jejunostomy tubes allowed only water to be injected, whereas the 8F jejunostomy tubes did not allow injection of the canned food-water mixtures. The 20F/10F construct did not allow injection or aspiration through the gastrostomy tube, whereas the 18F/8F construct allowed injection but not aspiration through the gastrostomy tube. Faster flow rates through the gastrostomy tube were associated with larger gastrostomy tube diameter, smaller jejunostomy tube diameter, and smaller syringe size. Faster flow rates through the jejunostomy tube were associated with smaller jejunostomy tube diameter. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that homemade gastrojejunostomy constructs would allow for administration of a variety of enteral diets. Limitations to the administration and aspiration of various enteral diets as well as patient needs should be considered before a gastrojejunostomy tube combination is chosen.

Evaluation of jejunostomy tube feeding after abdominal surgery in dogs.

OBJECTIVE: To describe the use of postoperative intrajejunal feeding and to evaluate the association of preoperative plasma albumin concentrations with intrajejunal feeding-related complications and clinical outcome. DESIGN: Prospective, observational study. SETTING: University veterinary teaching hospital. ANIMALS: Sixty-four dogs. INTERVENTIONS: Jejunostomy tube placement during abdominal surgery. MEASUREMENTS AND MAIN RESULTS: Most dogs (81%) survived. The median intrajejunal feeding period was 2.1 days (range: 1-16 days; n = 64). Only 3 (5%) dogs received their estimated resting energy requirement by intrajejunal feeding. Of dogs that were fed intrajejunally (58 out of 64), most (55 out of 58) received intrajejunal feeding within 24 hours after surgery. Energy provision via the jejunal feeding tube did not differ between dogs with and without complications (P = 0.592), or between nonsurvivors and survivors (P = 0.298). Thirty-five dogs ate voluntarily concurrently with intrajejunal feeding. Of dogs that ate voluntarily concurrently with intrajejunal feeding for ≤50% of the postoperative period, most (74%) survived to discharge. Complications were seen in 22% of dogs, and none were life-threatening; gastrointestinal signs were most common. There was no difference in preoperative plasma albumin concentration between dogs with and without complications (P = 0.432) and between nonsurvivors and survivors (P = 0.727). Fecal score was not significantly different between the 2 liquid diets studied (FormulaV Enteral Care HLP and CliniCare Canine/Feline; P = 0.927). CONCLUSIONS: A jejunostomy tube placed during abdominal surgery was likely to be used at the study institution. Few complications were seen and none were life-threatening. Intrajejunal feeding was initiated early after surgery and did not interfere with the initiation of voluntary oral intake. Fecal scores were high and were useful for an objective assessment of fecal consistency in dogs with intrajejunal feeding.

Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog.

A 2-year-old female Siberian Husky was referred for evaluation of a rectocutaneous fistula of unknown etiology. On evaluation, a rectal tear and an associated perivulvar abscess and draining tract were identified. Several attempts were made to repair the rectocutaneous fistula and associated rectal tear. Primary repair and fascia lata graft repair failed. Successful management was achieved via a laparoscopic-assisted end-on jejunostomy for fecal diversion, and the wound healed readily by second intention. During the period of hospitalization, the dog lost a considerable amount of weight. Particular care should be taken regarding fluid therapy, administration of antimicrobials, and adequate nutrition in patients with rectocutaneous fistulas. Overall, the use of laparoscopic-assisted end-on jejunostomy for fecal diversion in the management of rectocutaneous fistulas in dogs appears to be feasible; end-on or loop jejunostomy may also be an option for the treatment of other diseases of the distal portion of the gastrointestinal tract.

In vitro evaluation of bursting pressure and intestinal luminal area of three jejunostomy tube placement techniques in dogs.

OBJECTIVE: To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro. SAMPLE: Jejunal specimens from 10 dogs. PROCEDURES: Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution-soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques. RESULTS: The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique. CONCLUSIONS AND CLINICAL RELEVANCE: In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.

Effect of intestinal resection on two juvenile horses with granulomatous enteritis.

Two horses were presented with lethargy, weight loss, anorexia, and swelling of the limbs and ventral body wall. One horse, a 12-month-old American Paso Fino colt, also had acute abdominal pain. The other horse, a seven-month-old Tennessee Walking Horse (TWH) filly passed diarrheic stools during the initial examination. Each horse had low serum protein, neutropenia, and a normal packed cell volume (3.2 g/dl, 1300 cells/ul, and 38%, respectively, for the colt, and 2.4 g/dl, 696 cells/ul, and 44%, respectively for the filly). After intravenously administering plasma, the colt's PCV dropped to 23%, and the filly's dropped to 30%. During exploratory surgery, 3.5 and 2.0 meters of thickened terminal small intestine were removed from the colt and filly respectively, and a jejunocecostomy performed. The results of histologic examination of resected intestine were consistent with a diagnosis of equine granulomatous enteritis (EGE). Both horses showed clinical improvement within two days after surgery. The colt developed a neutrophilia (20,500 cells/ul) within 24 hours of surgery. Serum protein concentrations remained stable and gradually elevated to normal or near normal values of 7.0 g/dl (colt) and 5.8 g/dl (filly) by two weeks. The colt was killed four months after surgery because of signs of abdominal pain. Postmortem examination revealed a small intestinal volvulus associated with an adhesion. The TWH filly remains clinically normal 13 months after surgery.

Serum C-reactive protein (CRP) in horses: the effect of aging, sex, delivery and inflammations on its concentration.

The serum concentration of C-reactive protein (CRP) in horses was measured by single radial immunodiffusion (SRID) using rabbit anti-equine CRP serum to evaluate the significance of CRP as an acute-phase reactive protein. In serum samples of clinically normal newborn thoroughbred foals before being given colostrum, serum CRP was not detectable (less than or equal to 1 microgram/ml). The serum CRP concentration was found to increase quickly and reach a peak level of approximately 14.1 micrograms/ml in 12-month-old horses. Then, it decreased gradually to reach a low value of 5.4 micrograms/ml in the 4-year-old. In horses over 5-year-old, serum CRP concentration was stable at values of 7 to 8 micrograms/ml. In mares during the peri-natal period, serum CRP concentration decreased at 2 months before delivery, showed moderate changes just before and after delivery, and then increased to relatively high level by 2 months after delivery. The concentration of serum CRP was found to be increased at 24 hours after experimentally inflammatory stimuli in adult horses, and reached peak values of 3 to 6 times as high as the base line values at 3 to 5 days. Serum CRP concentration returned to base line values by 2 to 3 weeks after treatments. It is clear from these data that CRP is one of the acute-phase reactive proteins in horses.

Evaluation of serum amyloid A protein as an acute-phase reactive protein in horses.

Serum amyloid A protein (SAA) was isolated from equine acute-phase serum by repeating Sephadex G-75 gel filtration 3 times. Quantitative measurement of equine SAA was performed by the single radial immunodiffusion technique with rabbit anti-equine SAA serum. In clinically normal horses, the SAA concentration remained relatively high from immediately after birth up to 1 week of age. After this the concentration showed periodic fluctiation in the range of approximately 13 to 30 micrograms/ml. The mean (+/- SD) concentration of SAA in foals (< or = 12 months old) and in adult horses (> or = 18 months old) was 19.37 +/- 9.41 and 21.53 +/- 9.81 micrograms/ml, respectively. In mares during the perinatal period, the SAA concentration remained stable and within the normal range for 4 months before parturition. After foaling, it increased quickly and reached a peak value of 136.78 +/- 56.74 micrograms/ml on day 3 postpartum, and then began to decrease at 2 weeks postpartum returning to within the normal range by 1 month postpartum. In horses with experimentally induced inflammation, the SAA concentration increased quickly, and reached the highest value, approximately 4 to 20 times higher than pre-treatment values, on day 2 after treatment. It then returned to the base line values within 10 days to 4 weeks, concurrent with the disappearance of local inflammatory signs. The SAA concentration was very high in most horses with clinical signs of inflammation. It was concluded from these data that equine SAA was a sensitive acute-phase reactive protein which increased in the early phase of various acute inflammations.

Sandwich enzyme-linked immunosorbent assay for quantitative measurement of serum amyloid A protein in horses.

To measure the concentration of serum amyloid A (sAA) protein in horses, a sensitive and highly reproducible sandwich (ELISA) was established, using affinity purified SAA antibody. Results of the ELISA were found to have a high correlation (r = 0.95) with those of the single radial immunodiffusion test. Equine SAA concentration was measured by use of this ELISA. In clinically normal horses, the concentration of SAA was high immediately after birth to 2 weeks of age. After that, SAA concentration had periodic fluctuations in the range of approximately 1.0 to 30 micrograms/ml. Mean (+/- SD)) concentrations of SAA in foals (< or = 12 months old) and adult horses (> or = 18 months old) were 21.23 +/- 12.20 and 14.93 +/- 9.07 micrograms/ml, respectively. In mares during the perinatal period, SAA concentration remained stable within the reference range before parturition. It increased quickly after delivery, and reached a peak value of 101.29 +/- 98.82 micrograms/ml on postpartum day 3, then began to decrease, at postpartum week 2, to the reference range by the end of postpartum month 1. In horses with experimentally induced inflammation, SAA concentration increased quickly and reached approximately four- to 40-fold increase over the pretreatment value on day 1 and remained high on days 2 to 6 after treatment. It then returned to the baseline value by 2 to 4 weeks in association with disappearance of local signs of inflammation. The SAA concentration was high in most horses with clinical signs of inflammation. It was concluded from these data that this ELISA is sensitive and reliable for measuring SAA in horses.

Isolation, characterization, and quantitative analysis of ceruloplasmin from horses.

Ceruloplasmin (Cp) was isolated from fresh equine plasma by precipitation, cellulose chromatography, and improved ion-exchange chromatography. Purified equine Cp is a glycoprotein having a molecular weight of approximately 115,000. In electrophoresis, equine Cp migrated to the alpha 1-globulin region, its isoelectric point was about 4.15 and consisted of about 890 amino acid residues. Serum Cp concentration was measured by use of the single radial immunodiffusion method. In clinically normal horses, the mean (+/- SD) serum Cp concentration of newborn foals was 2.87 +/- 0.40 mg/ml and that of 3-month-old foals was 5.02 +/- 0.92 mg/ml, which was similar to the adult value. It reached a peak of 6.06 +/- 0.74 mg/ml in 2-year-old horses. The Cp concentration in mares was not statistically different for the perinatal period, but it decreased immediately before and after delivery. Concentration of Cp increased at 6 days after IM administration of turpentine oil, castration, or jejunojejunostomy in adult horses, and increased to peak values twice as high as baseline values at 7 to 14 days, returning to baseline values at 28 days after treatment. We concluded that equine serum Cp is an acute-phase reactive protein increased in the intermediary or later phase of acute inflammation.

Surgical management of duodenal obstruction in an adult horse.

A 3-year-old Standardbred stallion was admitted for treatment of acute enterocolitis. The horse improved in response to empiric treatment, but subsequently developed ventral edema, scrotal abscessation, and severe laminitis. Improvement again was seen, but on day 29 of hospitalization, the horse developed rapid heart rate and signs of abdominal pain. Exploratory celiotomy revealed complete obstruction of the descending portion of the duodenum, 20 cm caudal to the duodenal sigmoidal flexure. Three-tier duodenojejunostomy and jejunojejunostomy were performed to bypass the duodenal obstruction.

Jejunal intussusception in adult horses: 11 cases (1981-1991).

Medical records of 11 adult horses with jejunal intussusception examined at 5 veterinary teaching hospitals between 1981 and 1991 were reviewed. Nine of 11 horses had signs of acute abdominal discomfort for < 24 hours, whereas 2 horses had a history of chronic signs. Five of 11 horses had an intraluminal or intramural mass associated with the jejunal intussusception. Two horses died or were euthanatized prior to surgery. Partial jejunal resection and jejunojejunal anastomosis were performed in 9 horses. One horse died during surgery and 2 were euthanatized prior to hospital discharge because of postoperative complications. Four of the 6 horses that were discharged from the hospital survived from 16 months to 6 years and returned to their previous level of performance. One horse died 3 months after surgery from unknown causes, and 1 horse was lost to long-term follow-up evaluation.

Surgical treatment of perforating duodenal ulcer in a dog by use of modified choledochoduodenostomy and gastrojejunostomy.

Modified choledochoduodenostomy and gastrojejunostomy were used successfully to treat extensive duodenal ulceration and perforation in a dog. Concomitant pyometra, simultaneously managed by ovariohysterectomy, may have predisposed the dog to stress ulceration. Choledochoduodenostomy was performed by transplantation of the entire common bile duct and associated major duodenal papilla to a more distal duodenal location. An indwelling choledochostomy tube was used to stent the anastomotic site, externally divert bile flow, and allow postoperative cholangiography. Early postoperative complications included presumed metronidazole-induced neurotoxicosis, choledochostomy tube obstruction, and pancreatitis, all of which resolved within 2 weeks. The dog was clinically normal and medication (ranitidine and sucralfate) was discontinued 35 months later.

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs.

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.

Complications associated with use of jejunostomy tubes in dogs and cats: 40 cases (1989-1994).

OBJECTIVE: To evaluate complications and outcomes of surgeries in which jejunostomy tubes were used in critically ill dogs and cats. DESIGN: Retrospective review of medical records. ANIMALS: 32 dogs and 8 cats. PROCEDURE: In each animal, a 5-F or 8-F red rubber urethral/feeding catheter was surgically placed in the proximal portion of the jejunum. RESULTS: The most common indication for jejunostomy tube placement in dogs was a gastrointestinal condition (20 dogs; 62.5%). Neoplasms were detected in 11 of the 20 dogs. Pancreatic disease was the most common indication for tube placement in cats (7 cats; 87.5%). Thirty-three animals (27 dogs, 6 cats; 82.5%) did not have complications. Five dogs and 2 cats had 10 tube-related complications, including focal cellulitis (3 dogs), tube dislodgement (2 dogs, 1 cat), and tube occlusion (1 dog, 1 cat). Twenty-four animals (20 dogs, 4 cats; 60%) were discharged from the hospital. Fifteen dogs and 4 cats were alive 2 weeks after discharge, and 5 dogs and 2 cats survived for at least 4 weeks after discharge. Deaths were related to disease and were not associated with jejunostomy tubes. CLINICAL IMPLICATIONS: The complication rate associated with jejunostomy tubes appears to be low. Complications usually are nonfatal.

Treatment of irreducible caecocolic intussusception in horses by jejuno(ileo)colostomy.

Six of eight horses with caecocolic intussusception were treated successfully by jejuno- or ileocolostomy. The other two horses were euthanased during surgery. Four of the six horses survived long term, but two died within two-and-a-half months, of problems related to the surgery. Compared with other techniques for treating caecocolic intussusception, jejuno- or ileocolostomy reduces surgical time and decreases the risk of abdominal contamination.

Efficacy of metoclopramide for treatment of ileus in horses following small intestinal surgery: 70 cases (1989-1992).

In this retrospective study, postoperative ileus was studied in horses having resection of the small intestine followed by a jejunojejunal (n = 35) or a jejunocaecal (n = 35) anastomosis. Twenty-six horses received no metoclopramide, 27 received metoclopramide as an intermittent intravenous infusion and 17 horses received metoclopramide as a continuous intravenous infusion (0.04 mg/kg/hour). Horses receiving a continuous infusion of metoclopramide had a reduced total volume (P < 0.001), shorter duration (P < 0.001), and a slower rate (P < 0.001) of postoperative gastric reflux, and a shorter postoperative hospital stay (P < 0.01) when compared to horses receiving no metoclopramide and horses receiving metoclopramide as an intermittent infusion. Horses having jejunocaecostomy performed had a larger volume (P < 0.05), longer duration (P < 0.05), and a greater rate (P < 0.05) of postoperative gastric reflux, and a longer postoperative hospital stay (P < 0.001) than horses undergoing jejunojejunostomy. Horses that had an abdominal drain placed during surgery had a longer length of intestine resected (P < 0.05) and a longer postoperative hospital stay (P < 0.05) than horses without an abdominal drain. Horses that died or were euthanased during the postoperative period had a greater total volume (P < 0.05), longer duration (P < 0.05), and greater rate of postoperative gastric reflux (P < 0.01), a longer length of small intestine resected (P < 0.01), and a shorter postoperative hospital stay (P < 0.05) than horses that survived until discharge from the hospital. In a multivariate regression analysis the continuous infusion of metoclopramide was the only variable that contributed significantly to predicting the total volume (P < 0.001; r2 = 0.24), duration (P < 0.001; r2 = 0.24) and rate (P < 0.001; r2 = 0.25) of postoperative gastric reflux. We concluded that metoclopramide given as a continuous intravenous infusion decreased the incidence and severity of ileus following small intestinal resection and anastomosis in horses.