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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

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Surgical approaches to the abdomen

Auer & Stick: Equine Surgery 4th Ed


Illustration: Gabor Bodo SZIU Lig. teres hepatis

Paramedian Laparotomy

Picture: G.Bodo


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


Lig. Cecocolicum

Plica Ileocecalis


Plica Ileocecalis

Dorsal cecum tenia

Illustration: Budras: Anatomy of the horse

• Colon ascendens left side (LVC, LDC) • exploration of the pelvic flexure


Illustration: Gabor Bodo SZIU


A.V. ilealis


Lipoma


Lig. duodenocolicum Colon transversum

duodenum

mesocolon


Right flank

Caecum cupula

Duodenum

Rectum


Duodenum

Foramen Epiploicum Winslowi

• Descending duodenum, duod. Transversum, asc. duod.

• Liver: sigmoid flexure


Pylorus


Omentum

Spleen


Lig renolienale or: nephrosplenic ligament

?



Descending colon with mesocolon

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)

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!

gábor bodó ph.d, dipl. ecvs - kisallatsebeszet.hu · equine intestinal tract: surgical anatomy...

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