Prevention of ischaemia-induced small intestinal adhesions in foals.
Authors: Sullins K E, White N A, Lundin C S, Dabareiner R, Gaulin G
Journal: Equine veterinary journal
Summary
# Prevention of Ischaemia-induced Small Intestinal Adhesions in Foals Postoperative adhesions remain a significant complication following colic surgery in foals, with ischaemia-reperfusion injury recognised as a key pathophysiological mechanism driving their formation. Sullins and colleagues investigated whether targeted anti-inflammatory and anticoagulant therapies could reduce adhesion development by creating a controlled model of complete intestinal ischaemia followed by reperfusion in 16 foals, then administering one of four treatment protocols (flunixin meglumine with penicillin G and gentamicin; heparin alone; dimethylsulphoxide; or sodium carboxymethylcellulose) for 72 hours post-operatively. The anti-inflammatory approaches proved most effective: foals receiving flunixin meglumine with antibiotics or DMSO developed zero bowel-to-bowel adhesions, compared with 5/6 untreated controls, 3/4 receiving heparin, and 2/4 receiving sodium carboxymethylcellulose. Whilst these results are encouraging, the authors emphasise that controlled laboratory conditions cannot fully replicate the complexity of clinical colic cases, meaning that anti-inflammatory protocols should be viewed as adjunctive measures to improve outcomes rather than definitive adhesion prevention. The findings support incorporating aggressive anti-inflammatory therapy into perioperative management protocols for foals at high risk of ischaemic intestinal injury, though meticulous surgical technique and postoperative care remain fundamental to minimising adhesion-related morbidity.
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Practical Takeaways
- •Consider aggressive anti-inflammatory therapy (flunixin meglumine) combined with antimicrobials in foals undergoing colic surgery with significant intestinal ischaemia to minimize post-operative adhesion risk
- •DMSO may offer an alternative anti-inflammatory approach for adhesion prevention when other protocols are contraindicated
- •While these therapies show promise in controlled settings, clinical outcomes remain variable—manage owner expectations that adhesion prevention cannot be guaranteed even with optimal treatment
Key Findings
- •FPG (flunixin meglumine, penicillin G, gentamicin) treatment prevented bowel-to-bowel adhesions in all treated foals (0/4 adhesions)
- •DMSO treatment also prevented adhesions completely (0/4 adhesions), demonstrating anti-inflammatory efficacy
- •Untreated control foals developed adhesions in 5/6 cases, while heparin (3/4) and sodium carboxymethylcellulose (2/4) showed intermediate effectiveness
- •Anti-inflammatory therapy targeting ischaemia-reperfusion pathology significantly reduced adhesion formation compared to standard post-operative care