Reevaluation of the effect of phenylephrine on resolution of nephrosplenic entrapment by the rolling procedure in 87 horses.
Authors: Baker William True, Frederick Jeremy, Giguere Steve, Lynch Timothy M, Lehmkuhl Heather D, Slone Donnie E
Journal: Veterinary surgery : VS
Summary
# Nephrosplenic Entrapment: Does Phenylephrine Improve Non-surgical Outcomes? Nephrosplenic entrapment (NSE) of the large colon represents a significant cause of colic in horses, and whilst surgical correction is reliable, non-surgical management via the rolling procedure offers a less invasive alternative. Baker and colleagues reviewed 87 horses treated with rolling and 155 treated surgically across two referral centres between 2001 and 2008, specifically examining whether phenylephrine—a splenic vasoconstrictor theoretically capable of reducing splenic volume and facilitating colonic repositioning—improved rolling success rates. Rolling alone resolved NSE in 58% of cases with 98% surviving to discharge, whilst surgical management achieved a 94% short-term survival rate; notably, phenylephrine premedication showed no statistically significant benefit (P = 0.91) in improving rolling success compared to rolling without it. These findings suggest that whilst rolling remains a viable first-line option with reasonable success and survival rates, the routine addition of phenylephrine does not enhance non-surgical outcomes, potentially simplifying clinical decision-making and reducing pharmaceutical costs for practitioners selecting medical management of suspected NSE. The substantial failure rate of rolling (42%) underscores the importance of clear case selection criteria and realistic client expectations, particularly when considering that many surgical candidates may have already failed previous rolling attempts.
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Practical Takeaways
- •Rolling is a viable first-line treatment for nephrosplenic entrapment with a success rate just above 50% and excellent survival to discharge, making it worth attempting before surgery
- •Phenylephrine does not improve rolling outcomes, so its use cannot be justified as an adjunct to optimize the procedure's success
- •Surgical intervention remains appropriate for horses that fail rolling attempts, with good short-term survival expectations
Key Findings
- •Rolling procedure was successful in resolving nephrosplenic entrapment in 58% of cases (50/87 horses)
- •98% of horses treated with rolling survived to discharge (85/87)
- •Surgical treatment achieved 94% short-term survival rate in 155 horses
- •Phenylephrine premedication showed no significant benefit to rolling success (P = 0.91)