Strangulating obstruction caused by intestinal herniation through the proximal aspect of the cecocolic fold in 9 horses

Objective-To report the clinical and surgical findings and outcome for hors es with strangulating obstruction caused by herniation through the proximal aspect of the cecocolic fold. Study Design-Retrospective study. Animals-Nine horses. Methods-Medical records were reviewed for clinical signs, surgical findings and technique, and outcome. Cadaver ponies and necropsy specimens were als o used to study the regional anatomy of the cecocolic fold. Results-The ileum and distal jejunum were strangulated in 8 horses, whereas in 1 horse the small intestine and the left ascending colons were incarcer ated in a rent in the cecocolic fold. Two horses were euthanatized at surge ry, 6 horses had a small intestinal resection (mean length, 3 m; range, 1.5 -6.4 m) and an end-to-side jejunocecostomy, and the entrapment was reduced without resection in the horse that had small intestine and ascending colon incarceration; cecocolic fold defects were not closed. One horse was eutha natized 36 hours after surgery because of endotoxemia. Six horses were disc harged; 4 were available for long-term follow-up, of which 2 were euthanati zed, and 2 were euthanatized 12 and 18 months after surgery because of coli c signs. Variations in thickness of the cecocolic fold were observed in spe cimens obtained from necropsy of other horses and ponies. Conclusions-Reasons for this defect are unknown, although observed anatomic differences in cecocolic fold thickness may contribute to the development of defects. Clinical Relevance-Reduction of the entrapped bowel is easiest when tractio n is placed on the bowel at a 90 degrees to the base of the cecum. Intestin al incarceration through rents within the proximal part of the cecocolic fo ld should be considered as a differential diagnosis for strangulating obstr uction in horses. (C) Copyright 2001 by The American College of Veterinary Surgeons.