Equine Intestinal Tract: Surgical anatomy Reperfusion injury
Gábor Bodó Ph.D, Dipl. ECVS
SZIU, FVS, Equine Clinic
Surgical anatomy Do you recognise this organ?
•Stomac
•Duodenum
•Jejunum
•Ileum
•Caecum
•Right Ventral Colon
•Flexura sternalis
•Left ventral colon
•Flexura pelvina
•Left dorsal colon
•Flexura diaphragmatica
•Right dorsal colon
•colon transversum
•colon descendens
•Rectum
Gastrointestinal tract
Abdomen
Topographic Anatomy - Glasshorse
Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
Surgical approaches to the abdomen
Illustration: Gabor Bodo SZIU Lig. teres hepatis
Paramedian Laparotomy
Picture: G.Bodo
Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
Laparoszkópos feltárás
Képek: ISME Pferdeklinik Bern
Képek: ISME Pferdeklinik Bern
Laparoszkópos feltárás
Illustration: Auer Stick: Equine Surgery
• Cecum is the first sturcture
• Corpus caeci in the midline
• Cecocolic lig.: between lat. cecum tenia and right ventral colon lat. tenia
Illustration: Caroline Tessier
Right v. colon
Lig. Cecocolicum or cecocolic lig.
Cecum
Cecum: – 4 tenias
– Bloodsupply: lat and med tenia
– Lat.: leads to cecocolic lig.
– Dorsal tenia with lig. ileocaecale
Illustration: Caroline Tessier: Cornell
Illustration: Caroline Tessier: Cornell
Illustration: Caroline Tessier: Cornell
Lig. Cecocolicum
Plica Ileocecalis
Illustration: Caroline Tessier: Cornell
Plica Ileocecalis
Dorsal cecum tenia
Illustration: Budras: Anatomy of the horse
• Colon ascendens left side (LVC, LDC) • exploration of the pelvic flexure
Illustration: Caroline Tessier: Cornell
Illustration: Gabor Bodo SZIU
Illustration: Caroline Tessier: Cornell
A.V. ilealis
Illustration: Gabor Bodo SZIU
Lipoma
Illustration: Gabor Bodo SZIU
Illustration: Gabor Bodo SZIU
Illustration: Caroline Tessier: Cornell
Lig. duodenocolicum Colon transversum
duodenum
mesocolon
Illustration: Gabor Bodo SZIU
Right flank
Caecum cupula
Duodenum
Rectum
Illustration: Gabor Bodo SZIU
Duodenum
Foramen Epiploicum Winslowi
Illustration: Gabor Bodo SZIU
Illustration: Gabor Bodo SZIU
Illustration: Gabor Bodo SZIU
• Descending duodenum, duod. Transversum, asc. duod.
• Liver: sigmoid flexure
Illustration: Caroline Tessier: Cornell
Pylorus
Illustration: Caroline Tessier: Cornell
Omentum
Spleen
Illustration: Caroline Tessier: Cornell
Lig renolienale or: nephrosplenic ligament
?
Illustration: Gabor Bodo SZIU
Illustration: Caroline Tessier: Cornell
Descending colon with mesocolon
Illustration: Gabor Bodo SZIU
Illustration: Gabor Bodo SZIU
Illustration: Caroline Tessier: Cornell
Lesions of the intestinal wall • Distension
– Intraluminal perssure for 2-4 hours
• 18 H2O cm: seromusc. edema
• 25 H2O cm: Hypoperfusion, edema
inflammatory cellinvasion
Adhesions within 10 days postop,
• fibrin, serous exudate
• Ishaemia of the mucosa
– Smal intestine: „tips of villi”: spec. blood supply
– Large intestine: no villi withstands 25% more
Lesions of the intestinal wall
Tips of villi: blood supply
Normal Mucosa
Pictures: KE Sullins
Endotoxin
Pictures: KE Sullins
Grüenhagen’s Space
Bild: KE Sullins
• Reperfusion injury - Darmwand
– Neutrophil infiltration
• Muskularis and Serosa
• Fibrin - Adhesions
Seromuscular Infiltration of neutrophils
Picture: KE Sullins
Case: 12 y PRE stallion
Pendulating lipoma strangulating middle jejunum (50 cm)
Knot
Prestenotic small intestine: suffusions and adhesive serosal surface
Anastomosis 1m of prestenotic and 50 cm of poststenotic intestinal
resection (all together: 2m)
3 days later: Anastomosis OK
Distal
proximal
Ca. 60 cm prox. from the anastomosis: Adhesions with fibrin between small intest. loops lead
to new strangulation and reflux
Distal Jejunum - Proximal Jejunum
?
Take home message
• What should I know about the thopographic anatomy of the gastrointerstinal tract in the horse?
• „Reperfusion injury” – what is it?
– What are the consequences?
Questions? 1. Which cecal tenia leads to the ileum?
2. What are the consequences of 2-4 hours of small intestinal distension (above 18 H2O cm pressure)?
Skikjöring, St. Moritz - Switzerland
Thank You for Your Attention!