Complications and survival associated with surgical compared with medical management of horses with duodenitis-proximal jejunitis.
Authors: Underwood C, Southwood L L, McKeown L P, Knight D
Journal: Equine veterinary journal
Summary
# Editorial Summary: Surgical versus Medical Management of Duodenitis-Proximal Jejunitis Duodenitis-proximal jejunitis represents a challenging clinical presentation, and whether surgical intervention offers advantages over medical management remains contentious in equine practice. Underwood and colleagues compared outcomes in horses managed surgically versus medically, examining nasogastric reflux patterns, complication rates, and survival. Surgically managed cases exhibited markedly reduced reflux duration, volume, and rate compared to medical cases, suggesting more effective resolution of the proximal small intestinal obstruction; however, this benefit came at a cost, with surgical patients significantly more likely to develop post-operative diarrhoea and experiencing higher incisional infection rates than horses undergoing abdominal surgery for other gastrointestinal conditions. These findings underscore the importance of carefully selecting candidates for surgery based on individual presentation and response to initial medical management, as the improved reflux profile must be weighed against genuine post-operative morbidity risks when formulating treatment plans and discussing prognosis with owners.
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Practical Takeaways
- •Surgical management of DPJ reduces nasogastric reflux burden but increases risk of post-operative diarrhoea and incisional complications—weigh reflux control benefits against these risks
- •Post-operative infection surveillance should be intensified in DPJ surgery cases given elevated incisional infection rates compared to other abdominal procedures
- •Medical management may be preferable for horses where minimizing post-operative complications outweighs the benefits of reduced reflux volume and duration
Key Findings
- •Surgically treated horses with DPJ had shorter duration, smaller volume, and slower rate of nasogastric reflux compared to medically managed cases
- •Surgically managed horses were more likely to develop diarrhoea than medically managed cases
- •Surgically managed horses had higher incisional infection rate compared to horses undergoing abdominal exploration for other gastrointestinal diseases