Identification, management and outcome of postoperative hemoperitoneum in 23 horses after emergency exploratory celiotomy for gastrointestinal disease.
Authors: Gray Sarah N, Dechant Julie E, LeJeune Sarah S, Nieto Jorge E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Postoperative Hemoperitoneum Following Emergency Colic Surgery Bleeding into the abdominal cavity following emergency colic surgery represents an uncommon but clinically significant complication that warrants heightened awareness during early postoperative monitoring. This retrospective analysis of 23 cases drawn from 4,520 emergency celiotomies (0.5% incidence) identified that postoperative hemoperitoneum developed a mean of 1.0 days after surgery and was significantly associated with horses requiring intestinal resection, with Thoroughbreds disproportionately represented in the affected population. Clinical recognition relied on typical peritonitis signs—tachycardia, declining packed cell volume, incisional drainage, and ultrasonographic evidence of swirling echogenic fluid—whilst management centred on aggressive supportive care including intravenous fluids (all cases), colloids (20/23), blood transfusion (13/23), and antifibrinolytic agents (11/23). Survival to discharge occurred in 65% of cases and correlated with lower admission lactate values and shorter hospitalisation periods, though prognosis remains guarded due to risks of secondary septic peritonitis and adhesion formation. For practitioners, maintaining a high index of suspicion for bleeding complications in the immediate postoperative period—particularly in resection cases—and prompt institution of multimodal supportive therapy appear critical to optimising outcomes.
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Practical Takeaways
- •Monitor postoperative colic surgery patients closely for declining hematocrit and tachycardia in the first 1-2 days after surgery, as these may indicate hemoperitoneum requiring aggressive fluid and blood product support
- •Intestinal resection cases carry higher risk for postoperative bleeding; be prepared with colloid support and transfusion capabilities for these patients
- •Early recognition through ultrasound and clinical signs combined with supportive care (fluids, colloids, blood products, antifibrinolytic agents) offers the best chance of survival in this serious complication
Key Findings
- •Postoperative hemoperitoneum occurred in 23 of 4520 horses (0.5% incidence) undergoing emergency exploratory celiotomy for gastrointestinal disease
- •Hemoperitoneum was significantly associated with intestinal resection procedures
- •Clinical signs including tachycardia, decreasing hematocrit, incisional drainage, and ultrasonographic findings of swirling echogenic fluid appeared a mean of 1.0 ± 0.7 days after surgery
- •65% of horses (15/23) survived to discharge; survival was associated with lower admission lactate levels and shorter hospitalization duration