EQUINE | Proceedings
EQUINE | Proceedings
Proceedings
To Cut Or Not To Cut : Decision Making In Colic Management
Michael Schramme DrMedVet , CertEO , PhD , HDR , DipECVS , DipACVS , AssocECVDI Campus Vétérinaire de Lyon , VetAgro Sup Université de Lyon , France
When making the decision whether a horse with abdominal discomfort needs surgery to assure survival , the clinician needs to have a good understanding of the broad classification of the mechanisms of intestinal pain and the different intestinal abnormalities that can cause them . The first objective of the clinical assessment of the patient is not to make an accurate diagnosis but to establish whether emergency surgery may be required to relieve a life threatening intestinal problem . It is therefore essential to determine whether pain is caused by a non obstructive intestinal abnormality , a simple intestinal obstruction or a strangulating obstructive lesion . The latter typically leads to obstruction and hypoperfusion of the bowel and is therefore more closely associated with endotoxaemia , circulatory impairment and shock . The appropriate recognition of coexisting signs of intestinal obstruction and cardiovasculuar compromise is the key to the decision making process . It must be remembered that irreversible shock ( cardiovascular failure ) may occur as early as 4 hours following onset of intestinal strangulation .
Taken from the Colic WETLAB Proceedings South African Equine Veterinary Association Congress February 2017
The need for surgical intervention can be determined from basic clinical parameters and a few diagnostic tests . Laboratory test and diagnostic imaging can be useful in some cases where the clinical signs are confusing . No single decisive criterion exists . Therefore the veterinarian builds as complete a clinical picture as possible given the available instrumentation , weighs off all the parameters and makes a preliminary decision . When the results of the initial examination are inconclusive or conflicting , an hourly monitoring programme is initiated in order not to allow developing trends of clinical deterioration to go unnoticed for some time and thereby not to miss the best window of opportunity for surgical intervention . Studies of survival information clearly show that surgery is best performed in the early stages of intestinal injury . A hospital environment , where surgery can be performed immediately if necessary , is better suited to this careful monitoring process and early referral is therefore advisable .
During the early stages of intestinal injury , evidence of cardiovascular compromise ( elevated heart rate , dehydration ) is often absent and the abdominal fluid is frequently normal . The only early signs indicative of the need for surgery may be unrelenting or frequently recurring abdominal pain , absence of intestinal movement and tentative rectal findings of displacement or distension . A decision to cut based on these signs only will however lead to instances where laparotomy is performed unnecessarily . This results in avoidable cost , increased lay-up time , and potential for incisional and other surgery-related problems . On the other hand , waiting for signs of shock , intestinal degeneration or serosanguinous peritoneal fluid to become obvious , may decrease chances of survival .
Each clinician develops a customized pattern of decision making that best suits his or her temperament and skills . In this process each surgeon balances the reduction in survival chances associated with a delay in surgical intervention against the inherent morbidity associated with
• Volume 19 no 3 • September 2017 • 23