Horse Colic Surgery

August 23, 2019

Hi I’m Dr. Garnet Hall and I’m Dr. Max
Hall and welcome to West Coast Vets. Today we’ll be discussing a very complex
case of colic surgery, which is abdominal surgery in horses So I’ve just seen a horse on farm, a three-year-old thoroughbred gelding who’s showing signs of colic.
Now for those of you who don’t know colic is abdominal pain, it’s not that
specific, but it just means they’ve got a very bad tummy ache.
So when I got to the farm the horse was not comfortable, it was pawing the
ground, it was going down trying to roll and obviously the owners were very
concerned. So what we went ahead and did on farm was to force some
medications to try and make it feel better and we also did a drench – that’s
when we put a tube down their nose into their stomach to try and give them some
fluids, oil and maybe either relieve some pressure. So I did that a few hours ago,
the owners now called me and said that the horse is beginning to show signs of pain
again. Now this is extremely concerning because horses that have this recurrent
pain, after treating them, sometimes they’ve actually got a surgical problem
in there – that could be a twist or a blockage. The horse is about to
arrive we’re going to do a rectal exam ultrasound and blood work and see what
we’ve got going. Right, so we’ve examined that horse. It’s very very serious this. I’ve done a rectal exam and its got something
called a large colon displacement. I can barely get my arm in there (like about to there) and the whole large colon is distended. The horse is still showing
signs of colic and ultrasound is extremely concerning. We’ve got to take it in here, get it anaesthetised and then we’ll lift it up on the hoist and get it on the surgery table. Come on through. Ok, what’s going to happen is, the horse is going to be anaesthetised in the knock down box here. We have to bring it through on the gantry and it’s going to be placed on this table here. So we are just getting everything ready for surgery now. Our anaesthetist is going to come and set up their machine and get everything ready. Alright, so we’ve got an extremely gas distended, impacted large colon here that we’re attempting to exteriorise in the horse. It’s extremely heavy. We have a very bad displacement as well. This would weigh about 40 or 50 kilos. That’s if I can get it out. And how big is that compared to a normal caecum Max? This caecum was extremely distended, and now we are just trying to remove the remainder of the large colon. We are just going to have to try to suck off some of this air before we go any further. suctions a vital tool during colic surgery as there’s not a lot of space to move around within the horses’ abdomen so the more gas you can remove the easier it is to get the intestine out so that you can check the various parts of it. What are you up to there Josette? I’m just refilling the Iso. What’s Iso? Iso is the gas that keeps them under anaesthetic during surgery. Pretty important then. Kahla what are you doing there? Opening a bag of fluids sterile-ly. Well done! And Jess, what’s your role? I filter the hose up each side of the colon. Which then I pass to Kahla. Did you undertake any special training to learn that skill? Yes, hose mastership. So we’ve got it out, and you can see this is in no way a normal looking bowel here. We have a lot of haemorrhage all through the ventral colon here. All this petechial haemorrhage all through
here. So, that’s the easy bit done. I’m doing a colon enterotomy at the pelvic flexure here to empty the contents. Look at all the sand coming out, all sand. We’re just continuing to fill various
parts of the horses intestine with water, and sloshing it around and getting all of the sand out. Most people who’ve had anything to do with doctors and hospitals have seen 1 litre fluid bags before or even the 500ml fluid bags that are common in most human medical procedures. But when we do things on horses, we deal with big things and big volumes. This is a 5
litre fluid bag and that is the standard size for all horse procedures. There’s no mucking around with these. Remember how big and heavy the large colon was before? This is what is remaining. So we’re just shutting the surgical incision we’ve just made
into the large colon. Now it’s very important that we seal this correctly. We’ve finished the final layer of sutures in the intestine there. So these sutures are designed to hold the intestine edges together where it’s been incised to allow us to get the sand out. This final
layer actually inverts the incision back over itself to give it as much
protection as possible. You wanna tell us about the layers of the skin and muscle there that you’re suturing through. Sure, we are closing the linea alba here which is the strength layer of the abdomen here. It’s actually, if you’re being technical, it’s the aponeurosis of the external rectus sheaths. That I’m suturing, which is the strength layer. Then, I’m gonna do two additional layers here. One will be the subcutaneous layer,
which is this type of skin through here. And then we’ll actually do the skin
itself, so it’ll be a 3 layer closure which is very strong. How long does a typical colic surgery take? It’s hard to say a typical colic surgery, it depends on how complex they are. One where you don’t have to resect bits of bowel And maybe just do a correction of the displacement Like what we’ve done here, look we should take anywhere from, you know sometimes it only takes you 45 minutes, sometimes it’ll take you 90 minutes or so. After discussions with Josette and Garnett We’ve worked it out that we’re nearly up to 80 minutes surgery time which seems – that’s fine for
colic surgery of this nature. I’ll just get these last couple of layers of skin done and then hopefully, we’ll have a smooth recovery The recovery process for horses is a very important time. After they have their surgery there because They can damage themselves while standing up. There’s a lot of animals that do have surgery that do end up, you know, fracturing their legs in the recovery process and that, once again, ends in disaster. The more you get to know us, the more times you’ll probably hear that about
horses and recovery and things like that, however, we have the safest possible
recovery boxes here. So hopefully, this one will recover well. It’s not sick and Josette’s done a very good anaesthetic, and the surgery time hasn’t been that long. So with all those things, it’s in our favour that this horse should recover well. We’re in the recovery room, it’s very well padded. So they can have a safe recovery And it’s got a non-slip floor as well, so they can get good grip. Jess and Amelia are just taping it’s feet so it’ll have a much better recovery as well. We can watch them on cameras and assist their recovery as well. We can see it. so this is where he’s going to wake-up. So this is our patient, we’re now
the day after surgery and he’s looking really good, certainly much more
comfortable. He’s producing faeces, they’ve still get a little bit of sand in them
but everything is moving through well. The main key is that he’s looking and
feeling much better. Thanks for watching our video today. We hope you had just as much fun watching it as we did making it. And if you want to stay in touch with our adventures then just click on the
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