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.