Inferior shoulder dislocation after shortening osteotomy of the humerus. A case report.

We present a case of a post-surgical complete dislocation after excessive proximal humeral shortening osteotomy performed in a patient operated on for atrophic non-union of a proximal humeral fracture. This complication has not been previously reported. The dislocation occurred due to extensive laxity of the soft tissue envelope, predominantly the deltoid muscle, as well as rotator cuff tear. The reconstructive procedure consisted of vertical duplication of the capsule, reinforcement of the repair with coracoacromial ligament, tenodesis of the long head of the biceps tendon to the conjoined tendon and distal transfer of the deltoid muscle. The repair was reinforced with transarticular Steinmann pins. 15 months after surgery, there is an inferior subdislocation present, with full reduction in active abduction. Patient is pain-free at rest, and pain grade 4 in VAS scale in activity with loading.

Urinary bladder rupture in a two-year-old horse: sequel to a surgically repaired neonatal injury.

After routine cryptorchid castration, a 2-year-old Thoroughbred colt was admitted 72 hours later because of depression, abdominal distention, and pollakiuria, with production of small quantities of urine. A diagnosis of a ruptured bladder was made on the basis of a large volume of abdominal fluid and a disparity between the urea nitrogen and creatinine concentrations in the serum (70 mg/dl and 8.4 mg/dl, respectively) and in the abdominal fluid (154 mg/dl and 43 mg/dl, respectively). The colt had undergone surgical correction of a ruptured urinary bladder at 4 days of age, and a 5-cm tear through one of the previous scars was identified and repaired during exploratory celiotomy. The previous injury to the bladder was extensive and may have left an inherent weakness in the bladder wall. Evidence of adhesion formation or urethral obstruction was not found. The combination of a full bladder and the trauma associated with induction of anesthesia may have contributed to the recurrence of bladder rupture.

Cecal volvulus in a dairy cow: partial resection of the proximal portion of the ascending colon.

Cecal volvulus in a dairy cow with vascular compromise of the proximal portion of the ascending colon was corrected surgically with preservation of the ileocecocolic junction. Partial cecectomy was combined with resection of the proximal portion of the ascending colon and anastomosis of the remaining cecum to the distal portion of the ascending colon. The procedure was done with the use of mechanical suturing devices while the cow was standing. Previously, general anesthesia and relocation of the ileocecocolic junction had been suggested.

Exsanguination due to gastric ulceration in a foal.

An Arabian foal with a congenital heart disease died due to hemorrhage secondary to a large gastric ulcer. Previously, death of foals with gastric ulcers has been due to diffuse peritonitis resulting from gastric ulcer perforation. The foal in this case report died due to hemorrhage secondary to a large gastric ulcer.

Esophageal disorders in 61 horses. Results of nonsurgical and surgical management.

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.

Ileocolostomy. A technique for surgical management of equine cecal impaction.

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.