Radiographic features of congenital segmental dilation of the intestine in a german shepherd dog.

A 10-week-old spayed female German Shepherd Dog was presented for acute vomiting and diarrhea. There was no reported foreign body or toxin ingestion. Radiographs showed a severely (∼11 × 7 cm), focally distended right abdominal intestinal segment containing gas and soft tissue material. Other small intestinal segments were segmentally gas distended. Celiotomy identified a ∼9 cm focally dilated segment at the jejunoileal junction with no aborad luminal obstruction. Resection and anastomosis of the dilation was performed. Histopathology showed mild mucosal inflammation, but otherwise normal wall layering and autonomic ganglia. Radiographic and histopathologic findings were consistent with congenital segmental dilation of the intestine.

Equine duodenitis-proximal jejunitis: A review.

Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically characterized by an acute onset of ileus and nasogastric reflux leading to systemic signs of toxemia. This review discusses the definition of the disease, potential etiologic agents, clinical findings, epidemiological features, histopathologic and clinico-pathological findings, and medical management of this condition. Salmonella spp., mycotoxins, Clostridium perfringens, and Clostridium difficile have all been associated with the disease but there is limited supporting evidence for any agent other than C. difficile. Particular attention, however, was given to etiological investigations and the data available to support the proposed etiological agents. The potential role of C. difficile as the etiological agent of DPJ, possible pathogenesis, and recent efforts to support this hypothesis are highlighted, but it is recognized that there could be more than one agent that causes the disease.

L'entérite proximale chez le cheval: revision. L'entérite proximale est un processus inflammatoire de la portion proximale du petit intestin qui se présente sporadiquement chez le cheval. Cliniquement, elle est caractérisée par un début soudain d'iléus et de reflux nasogastrique menant à des signes systémiques d'endotoxémie. Cet article discute de la définition de la maladie, des agents étiologiques potentiels, des signes cliniques, des caractéristiques épidémiologiques, des trouvailles histopathologique et clinique et du traitement médical de cette condition. Salmonella spp., les mycotoxines, Clostridium perfringens et Clostridium difficile ont tous été associés avec la maladie, mais les preuves sont limitées pour tout autre agent que C. difficile. Une attention particulière a été mise sur l'étude étiologique et sur les données disponibles pour supporter les agents étiologiques proposés. Le rôle potentiel de C. difficile comme étant l'agent étiologique de l'entérite proximale, la possible pathogénèse et les efforts récents pour supporter cette hypothèse sont soulignés, mais il est reconnu qu'il pourrait y avoir plus d'un agent causatif de la maladie.(Traduit par Dr Marie-Soleil Dubois).

End-to-Side Versus Side-to-Side Jejunocecostomy in Horses: A Retrospective Analysis of 150 Cases.

OBJECTIVES: To determine factors associated with postoperative reflux, postoperative colic, repeat celiotomy, and survival in horses after end-to-side (E2S) or side-to-side (S2S) jejunocecostomy. STUDY DESIGN: Retrospective, multicenter study. SAMPLE POPULATION: Horses (n = 150). METHODS: Admissions, intra- and postoperative data were collected from medical records of horses that had E2S or S2S jejunocecostomy. Descriptive statistics were calculated and data were analyzed using parametric and nonparametric tests, linear and multivariate logistic regression with significance set at P < .05. Kaplan-Meier estimate of the survival function was performed. RESULTS: One hundred fifty horses (S2S = 90, E2S = 60) were included. S2S procedures were performed using staples (n = 57) or hand-sewn (33). Method of anastomosis was not significantly associated with development of postoperative reflux or colic, repeat celiotomy, whether the horse was alive at hospital discharge or 12 months after discharge. The number of years that the principal surgeon was boarded by the American College of Veterinary Surgeons significantly affected whether the horse was discharged from the hospital alive (P = .003). Age (P = .006) was significantly associated with 12-month survival. Increased age (P = .013) and administration of prokinetic medication (P = .0006) were significantly associated with development of postoperative reflux. Sixty-eight (76%) horses with S2S and 52 (87%) horses with E2S were discharged alive. CONCLUSION: Age, patient related variables, and surgeon experience may influence morbidity and mortality more than method of jejunocecostomy.

Imaging diagnosis--muscular hypertrophy of the small intestine and pseudodiverticula in a horse.

A 14-year-old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall.

Intestinal epidermoid cyst in a cat.

A 3-year-old cat was presented with anorexia and vomiting. Palpation revealed a caudal abdominal mass. Ultrasound and explorative abdominal surgery revealed a cystic mass in the jejunum. Histopathologic findings were consistent with an epidermoid cyst. The cyst was likely of congenital origin, since the cat had not undergone previous abdominal surgery, and gradually grew to reach a size that caused intestinal obstruction. Extrapolating from findings in people, intestinal epidermoid cysts are considered benign with a good long-term prognosis when completely excised.

Mouldy feed, mycotoxins and Shiga toxin - producing Escherichia coli colonization associated with Jejunal Hemorrhage Syndrome in beef cattle.

BACKGROUND: Both O157 and non-O157 Shiga toxin - producing Escherichia coli (STECs) cause serious human disease outbreaks through the consumption of contaminated foods. Cattle are considered the main reservoir but it is unclear how STECs affect mature animals. Neonatal calves are the susceptible age class for STEC infections causing severe enteritis. In an earlier study, we determined that mycotoxins and STECs were part of the disease complex for dairy cattle with Jejunal Hemorrhage Syndrome (JHS). For STECs to play a role in the development of JHS, we hypothesized that STEC colonization should also be evident in beef cattle with JHS. Aggressive medical and surgical therapies are effective for JHS, but rely on early recognition of clinical signs for optimal outcomes suggesting that novel approaches must be developed for managing this disease. The main objective of this study was to confirm that mouldy feeds, mycotoxins and STEC colonization were associated with the development of JHS in beef cattle. RESULTS: Beef cattle developed JHS after consuming feed containing several types of mycotoxigenic fungi including Fusarium poae, F. verticillioides, F. sporotrichioides, Penicillium roqueforti and Aspergillus fumigatus. Mixtures of STECs colonized the mucosa in the hemorrhaged tissues of the cattle and no other pathogen was identified. The STECs expressed Stx1 and Stx2, but more significantly, Stxs were also present in the blood collected from the lumen of the hemorrhaged jejunum. Feed extracts containing mycotoxins were toxic to enterocytes and 0.1% of a prebiotic, Celmanax Trademark, removed the cytotoxicity in vitro. The inclusion of a prebiotic in the care program for symptomatic beef calves was associated with 69% recovery. CONCLUSIONS: The current study confirmed that STECs and mycotoxins are part of the disease complex for JHS in beef cattle. Mycotoxigenic fungi are only relevant in that they produce the mycotoxins deposited in the feed. A prebiotic, Celmanax Trademark, acted as a mycotoxin binder in vitro and interfered with the progression of disease.

A case of lymphocytic-plasmacytic jejunitis diagnosed by double-balloon enteroscopy in a dog.

A 3 yr old male English setter dog was presented for evaluation of a 6-wk history of intermittent diarrhea. After standard gastroduodenoscopy and colonoscopy showed normal mucosa, double-balloon endoscopy (DBE) was used via both oral and anal approaches. Gross changes consistent with inflammation in the jejunum were seen, and biopsy specimens were obtained. Histologic analysis confirmed a diagnosis of lymphocytic-plasmacytic jejunitis. Clinical remission of the disease occurred after 3 mo of therapy with prednisone, metronidazole, and a novel protein diet. Use of DBE has not been previously reported in dogs with inflammatory bowel disease, and isolated lymphocytic-plasmacytic jejunitis has not been described. The described cases of intestinal inflammatory disease diagnosed by conventional endoscopy were related to pathologic changes in the duodenum, ileum or colon, but not the jejunum. The main advantage of the DBE technique allowed examination of portions of the small intestine (jejunum) that were not commonly accessible by standard endoscopic techniques, and permitted a minimally invasive collection of biopsy samples compared with surgical biopsy. This case highlights the need to consider using DBE in animals with gastrointestinal disorders, whose symptoms are not readily explained by routine tests, conventional endoscopy, and dietary or therapeutic trials.

Concurrent nephrosplenic entrapment and acquired inguinal herniation of the jejunum in a Standardbred stallion.

A stallion presenting for surgical correction of an acquired inguinal hernia was also diagnosed with a nephrosplenic entrapment (NSE) intraoperatively. Surgical intervention resulted in a successful outcome. To date, these conditions have not been reported to occur simultaneously.

Small intestinal strangulation caused by a mesodiverticular band and diverticulum on the mesenteric border of the small intestine in a horse.

A 4-year-old Quarter horse stallion was presented for acute abdominal pain. Exploratory celiotomy revealed a mesenteric diverticulum of the jejunum and mesodiverticular band that were associated with small intestinal strangulation. Resection and anastomosis were performed. A second celiotomy was performed due to adhesions. The horse recovered completely and returned to training.

Multiple small-intestine intussusceptions: a complication of purpura haemorrhagica in a horse.

A Belgian draft horse stallion presented with classical signs of purpura haemorrhagica: oedema of the distal limbs, ventral abdomen and head, ecchymotic haemorrhage of mucous membranes, epistaxis, fever, lethargy, reluctance to move, and anorexia. Serum chemistry revealed a highly elevated gamma-globulin fraction. Streptococcal lymphadenitis (strangles) had been present on a neighbouring farm in the past few months. After an initial positive response to therapy with benzylpenicillin, flunixin and dexamethasone, the horse's condition deteriorated suddenly on day 4 of hospitalization, with signs of severe endotoxaemia and small-intestine obstruction. The horse was euthanized because of its poor prognosis and because of economic considerations. On necropsy, large serosal haemorrhages in the small and large intestine and multiple jejunojejunal intussusceptions were found. Intussusception is a well-known complication in children with Henoch-Schonlein purpura, a human autoimmune disease resembling purpura haemorrhagica in horses. To the author's knowledge, this is the first report to describe intussusception as a complication of purpura haemorrhagica in a horse.

Resveratrol sustains intestinal barrier integrity, improves antioxidant capacity, and alleviates inflammation in the jejunum of ducks exposed to acute heat stress.

Resveratrol, a natural antioxidant, anti-inflammatory plant extract, was found to have a protective effect in poultry subjected to heat stress. In this study, we strove to characterize resveratrol on intestinal of duck exposed to acute heat stress and investigate the underlying mechanism. A total of 120 Shan-ma ducks (60 days old) were randomly divided into 2 groups. The control group was fed a basal diet, and the resveratrol group was fed a basal diet supplemented with 400 mg/kg resveratrol. Animals in 2 groups were kept at a temperature of 24°C ± 2°C for 15 d. Then, animals of both groups were placed in an artificial climate room at 39°C. Twelve ducks of each group were sacrificed for sampling at 0, 30, and 60 min, respectively. Results indicated that resveratrol increased the ratio of villus height to crypt depth, increased the number of goblet cells, and reduced the histopathological damage of jejunum caused by acute heat stress. Furthermore, the gene expression of heat shock proteins (HSP60, HSP70, and HSP90) and tight junction proteins (CLDN1 and OCLN) was significantly increased in the resveratrol group compared to that in the control groups. Simultaneously, resveratrol significantly activated the SIRT1-NRF1/NRF2 signaling pathways, improved ATP level of jejunum, and increased SOD and CAT antioxidant enzymes activities. In addition, we found that the NF-κB/NLRP3 inflammasome signaling pathways were repressed under acute heat stress. Meanwhile, supplement resveratrol further inhibited the NLRP3 inflammasome pathway, decreased protein level of NLRP3 and caspase1 p20, reduced the secretion of IL-1ß. Taken together, our results indicate that resveratrol against the oxidative damage and inflammation injury in duck jejunum induced by heat stress via active SIRT1 signaling pathways.

Ischemic postconditioning does not attenuate ischemia-reperfusion injury of rabbit small intestine.

OBJECTIVE: To determine whether ischemic postconditioning can attenuate intestinal ischemia-reperfusion (I-R) injury and has a beneficial effect on tissue blood flow during reperfusion. STUDY DESIGN: In vivo experimental study. ANIMALS: New Zealand White rabbits (n=6). METHODS: Rabbits were anesthetized with pentobarbital, to avoid the preconditioning effects of volatile anesthetics, and ventilated with room air. Rectal temperature, hemodynamics, and normocapnia were maintained. After celiotomy, 3 jejunal segments were isolated in each rabbit for the following groups: (1) control, (2) I-R, and (3) I-R with postconditioning. I-R was induced by a 45-minute occlusion of the segment jejunal artery followed by 2-hour reperfusion. The postconditioning segment had 4 cycles of 30-second reperfusion and 30-second reocclusion during the initial 4 minutes of reperfusion. Stable isotope-labeled microspheres were used to measure intestinal blood flow at baseline, end occlusion, and end reperfusion. At the end of reperfusion, intestine segments were harvested and the rabbits euthanatized. A semiquantitative histopathologic evaluation (0-5) was conducted by a single, blinded observer. Wet-to-dry weight ratios were calculated to assess intestinal edema. RESULTS: There was no significant difference in grade of necrosis, tissue wet-to-dry weight ratios, or blood flow at any time point between ischemic and postconditioning groups. CONCLUSIONS: Ischemic postconditioning was ineffective in this model of intestinal I-R. CLINICAL RELEVANCE: Further experimental studies will need to be performed before clinical application of postconditioning for intestinal ischemia.

Acquired jejunal pseudodiverticula in a yearling Arabian filly.

OBJECTIVE: To report a case of multiple acquired jejunal pseudodiverticula managed successfully by resection and jejunojejunostomy. STUDY DESIGN: Clinical report. ANIMALS: Arabian filly. METHODS: The filly was referred for signs of acute colic of several hours duration and had a 2-week history of inappetence and weight loss. Three meters of thickened, edematous, and dilated jejunum removed during exploratory celiotomy had an intussusception and numerous diverticula; jejunojejunostomy performed. The pathoanatomic diagnosis was proliferative enteropathy with pseudodiverticula formation and jejunal muscular hypertrophy and diverticulosis. The diverticula appeared to be acquired; however, the exact cause was not determined. RESULTS: There were no postoperative gastrointestinal complications and 1 year later, the filly was doing well. CONCLUSION: Multiple acquired jejunal pseudodiverticula not associated with classic muscular hypertrophy can occur in young horses. Long-term prognosis seemingly can be excellent after resection and jejunojejunostomy. CLINICAL RELEVANCE: Compared with other reports of small intestinal diverticula in horses, this case is unique because it was not congenital or associated with classic muscular hypertrophy.

Post-anaesthetic myelopathy in a 3-year-old Friesian gelding.

A 3-year-old Friesian stallion was referred to the Department of Equine Sciences at Utrecht University with signs of colic. Laparotomy was performed and the stallion was castrated bilaterally because of an incarcerated inguinal hernia. Intestinal resection was not performed. Eight days postoperatively, the horse showed signs of severe colic and was admitted for re-laparotomy. After resection of 1.5 m of strangulated jejunum and severe intraoperative hypotension, bradycardia, and electrolyte disorders, the horse showed problems during recovery with signs of hindquarter paralysis. There was no pain perception in the hind limbs and there were no patellar or anal reflexes. The muscles of the hindquarters and the long extensor muscles of the back were soft and not painful on palpation. No improvement was seen 60 minutes after intravenous injection of corticosteroids. Because of the tentative diagnosis of post-anaesthetic myelopathy and its poor prognosis, and the fact that the horse was restless and did not accept being lifted with a sling system, the horse was euthanized with the owner's consent. Post-anaesthetic myelopathy is a rare neuropathological condition in the horse. Because of its low incidence, knowledge about its aetiology and contributing factors is rather limited. This case report presents the clinical observations and the anaesthetic protocol and compares this case with previously reported cases in the literature.

Geographic Disparities in Clinical Characteristics of Duodenitis-Proximal Jejunitis in Horses in the United States.

Duodenitis-proximal jejunitis (DPJ) is an idiopathic and potentially fatal disease of horses characterized by abdominal pain, proximal intestinal inflammation, and subsequent gastric and small intestinal fluid accumulation. Although this disease is known to be costly and life threatening in the equine industry, the severity of clinical signs can vary widely, and an exact etiology has yet to be elucidated. This study looked to identify differences in clinical parameters of horses with DPJ between geographic regions in an effort to corroborate anecdotal reports and support theories of differing etiologies. Case records were compared from veterinary academic referral hospitals in three different geographic locations in the United States to determine if significant differences in clinical, clinicopathologic, and prognostic characteristics exist among horses with DPJ. Clinical measurements on presentation that were significantly different between regions included heart rate, peritoneal total protein, albumin, anion gap, aspartate aminotransferase, gamma-glutamyl transferase, sodium, chloride, potassium, and creatinine. Duration of hospitalization and maximum body temperature while hospitalized were also different between regions. There were no significant differences in peritoneal cell count, total white blood cell count, neutrophil count, band neutrophils, calcium, total plasma protein, temperature on presentation, duration of reflux, total reflux volume, or age between hospitals. The mortality rates between hospitals were not significantly different. Increased severity of clinical signs and biochemical abnormalities were identified in the Southeastern United States hospital compared with the Northeastern and Western hospitals. A prospective, multicenter case-control study could identify risk factors contributing toward regional differences in this disease in the future.

Effect of firocoxib or flunixin meglumine on recovery of ischemic-injured equine jejunum.

OBJECTIVE: To determine whether treatment of horses with firocoxib affects recovery of ischemic-injured jejunum, while providing effective analgesia. ANIMALS: 18 horses. PROCEDURES: Horses (n = 6 horses/group) received saline (0.9% NaCl) solution (1 mL/50 kg, IV), flunixin meglumine (1.1 mg/kg, IV, q 12 h), or firocoxib (0.09 mg/kg, IV, q 24 h) before 2 hours of jejunal ischemia. Horses were monitored via pain scores and received butorphanol for analgesia. After 18 hours, ischemic-injured and control mucosa were placed in Ussing chambers for measurement of transepithelial resistance and permeability to lipopolysaccharide. Histomorphometry was used to determine denuded villus surface area. Western blots for cyclooxygenase (COX)-1 and COX-2 were performed. Plasma thromboxane B(2) and prostaglandin E(2) metabolite (PGEM) concentrations were determined. RESULTS: Pain scores did not significantly increase after surgery in horses receiving flunixin meglumine or firocoxib. Transepithelial resistance of ischemic-injured jejunum from horses treated with flunixin meglumine was significantly lower than in saline- or firocoxib-treated horses. Lipopolysaccharide permeability across ischemic-injured mucosa was significantly increased in horses treated with flunixin meglumine. Treatment did not affect epithelial restitution. Cyclooxygenase-1 was constitutively expressed and COX-2 was upregulated after 2 hours of ischemia. Thromboxane B(2) concentration decreased with flunixin meglumine treatment but increased with firocoxib or saline treatment. Flunixin meglumine and firocoxib prevented an increase in PGEM concentration after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Flunixin meglumine retarded mucosal recovery in ischemic-injured jejunum, whereas firocoxib did not. Flunixin meglumine and firocoxib were effective visceral analgesics. Firocoxib may be advantageous in horses recovering from ischemic intestinal injury.

Surgical findings and outcome for dairy cattle with jejunal hemorrhage syndrome: 31 cases (2000-2007).

OBJECTIVE: To describe signalment; surgical findings; short-, medium-, and long-term outcome; and recurrence rate for cattle undergoing celiotomy because of jejunal hemorrhage syndrome (JHS) and to analyze risk factors associated with outcome and recurrence. DESIGN: Retrospective case series. ANIMALS: 31 dairy cattle with JHS. PROCEDURES: Medical records were analyzed. Follow-up information was obtained from owners of cattle surviving until discharge. RESULTS: 18 of 31 (58%) cattle undergoing celiotomy survived to initial discharge. Fifteen (48%) and 13 (42%) were alive 6 and 12 months after discharge, respectively. All 5 deaths within 12 months after discharge were attributed to JHS recurrence. Survival time was 12 to 85 months for the 13 long-term survivors. Six of 7 that died > 12 months after celiotomy did so for reasons unrelated to JHS. Recurrence rate among short-term survivors was 7 of 18; 1 of these survived long-term. A significant proportion of affected cattle were Brown Swiss, compared with proportions for other breeds. Manual massage of the bowel to break down clots was associated with a significantly higher short-term survival rate than was enterectomy or enterotomy. Medium- and long-term survival rate was higher in cattle referred 24 to 48 hours after onset of signs. Length of obstructing blood clots was not associated with outcome. Other factors were not significantly associated with recurrence. CONCLUSIONS AND CLINICAL RELEVANCE: Survival rates were higher than those in other reports. Prompt celiotomy and resolution by use of manual massage were associated with higher survival rates. In this population, JHS recurred in 7 of 18 short-term survivors.

Repeated occurrence of jejuno-jejunal intussusception in a calf.

This paper reports the clinical findings, diagnostic imaging, surgical management, and necropsy of an unusual case of jejuno-jejunal intussusception in a calf that was diagnosed with the use of ultrasonography, and treated surgically by resection and end-to-end anastomosis. The calf fatally relapsed 8 d after laparotomy. Necropsy and histology revealed enteritis and myenteric ganglionitis.

Comparison of two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs.

BACKGROUND: Hand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology. RESULTS: Mean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites. CONCLUSIONS: Barbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.

Complications and survival associated with surgical compared with medical management of horses with duodenitis-proximal jejunitis.

REASONS FOR PERFORMING STUDY: Based on clinical observation, it is hypothesised that horses with duodenitis-proximal jejunitis (DPJ) that are treated surgically have a shorter duration, smaller volume, and slower rate of nasogastric reflux (NGR) compared to horses treated medically, are more likely to develop diarrhoea than medically managed cases, and have a higher incisional infection rate than a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ. OBJECTIVES: To compare: 1) duration, volume and rate of NGR and the percentage of horses with diarrhoea between medically and surgically treated DPJ cases; and 2) incisional infection rate in horses with DPJ undergoing abdominal exploration to a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ. METHODS: Medical records of cases with DPJ diagnosed 1995-2006 were reviewed. Information obtained included subject details, presenting clinical findings, treatment category (medical/surgical), complications (diarrhoea, incisional infection), and outcome (survival/nonsurvival). Data were analysed using a Chi-squared test and a mixed model analysis of variance. Level of significance was P<0.05. RESULTS: Compared to medical cases, surgical cases had significantly decreased survival, a longer duration and larger total volume of NGR, and were more likely to develop diarrhoea. The incisional infection rate for horses with DPJ undergoing abdominal exploration was 16% compared to 7% for the sample population of horses. CONCLUSIONS: Surgical treatment of horses with DPJ did not lead to resolution of NGR faster than medical treatment. Surgical cases were more likely to develop diarrhoea and did not have a significantly higher incisional infection rate than the sample population.