Equine Post-Op Complications

Introduction

  • Discussed postoperative complications in colic, relevant for field practitioners.

  • Importance of recognizing risk factors and treatment for complications.

  • Mention of Valentine’s Day and a personal anecdote.

Key Postoperative Complications

Incisional Infection

  • Most common postoperative complication in colic patients.

  • Mastery of recognition and treatment is essential.

Coagulopathy

  • Develops based on diagnostic testing in the near postoperative period.

Case Study: Benjie

  • 14-year-old Hanoverian Gelding with colic lasting 12 hours.

  • Treated in the field with persistent colic necessitating surgery.

  • Pre-surgery evaluations revealed gastric compaction.

  • Surgical findings:

    • Volvulus with moderate colonic edema.

    • Small intestine was displaced and trapped with gas and ingesta.

    • Severe gastric distension with firm feed despite lavage.

Likely Postoperative Complications for Benjie

  • Concerns over postoperative reflux due to:

    • Stomach dysfunction.

    • Manipulation of small intestine during surgery.

  • Other potential complications: incisional infection, adhesions, thrombophlebitis.

Management for Benjie Post-Surgery

  • Initiated IV fluids, lidocaine CRI, antibiotics (K Penjent), anti-inflammatories (flunixin meglumine).

  • Lavaged stomach every two hours post-surgery.

  • Proactive administration of metronidazole for possible anaerobic overgrowth.

  • Introduced metoclopramide to stimulate gastric motility.

Ultrasound Imaging

  • Ultrasound indicated large fluid collection in the stomach precluding effective gastric emptying.

  • Initial management strategies did not resolve gastric stasis but eventually led to recovery.

Common Complications for Small vs. Large Intestinal Disease

Small Intestinal Complications

  • Postoperative reflux and ileus: distinctions made between both conditions.

    • Postoperative reflux: Excess fluid production from the stomach.

    • Ileus: Gastrointestinal dysfunction leading to decreased motility and build-up.

  • Anastomotic complications following resections can lead to adhesions.

  • Recurrence of colic due to complications.

Causes of Ileus

  • Inflammation, neurogenic causes (e.g., pain, systemic illness like shock).

  • Significance of addressing inflammation to improve motility postoperatively.

Postoperative Reflux

  • Occurrence in up to 53% of small intestinal cases.

  • Risk factors include:

    • Presence of a small intestinal lesion and high preoperative pack cell volume.

    • Duration of anesthesia and surgical trauma.

Prevention of Postoperative Reflux

  • Supportive care: IV fluids and anti-inflammatories.

  • Minimize surgical trauma with adequate lubrication during handling.

  • Surgical decompression of distended bowel during surgery.

Treatment of Postoperative Reflux

  • Prokinetics such as lidocaine and metoclopramide are used to mitigate ileus and improve motility.

  • Monitoring and treating electrolyte imbalances.

Other Postoperative Complications

Anastomotic issues

  • Obstruction or leakage may develop post-surgery, leading to serious systemic complications.

Adhesions

  • Estimated prevalence of 9-27%. Higher risk in foals and diseases involving the small and large intestine.

  • Preventative measures include gentle handling, DMSO administration, and using anti-inflammatories.

Recurrence of Colic

  • Recurrence often mirrors pre-existing tendencies for colic.

  • Investigation into underlying causes is crucial for treatment.

Management of Postoperative Pain

  • Options include:

    • Butorphanol CRI for pain relief.

    • Lidocaine CRI for analgesic benefits and enhancing motility.

    • NSAIDs (banamine or equioxx) to manage inflammation.

Large Intestinal Complications

Common Postoperative Issues

  1. Endotoxemia/SIRS

  2. Coagulopathy

  3. Diarrhea/Colitis

  4. Laminitis

SIRS and Coagulopathy

  • SIRS prevalence and symptoms described.

  • Coagulopathy management with supportive care, monitoring parameters like fibrinogen and platelets.

Laminitis Prevention and Management

  • Importance of early intervention via continuous cryotherapy.

  • Pain management and supportive shoeing as integral parts of care.

Body Wall Complications

Dehiscence and Incisional Infection

  • Prevalence quite high. Steps for management of postoperative incisional infections outlined:

    • Physical examination, possible culture and sensitivity testing, drainage of purulent material.

    • Careful wound management to promote healing and prevent complications.

Hernia Formation

  • Prevalent when infections occur or due to mechanical strain post-surgery.

  • Timing of surgical repair critical for successful outcomes.