Diagnostic and Clinical Course of Small Colon Recurrent Impaction Associated with Severe Myenteric Ganglionopathy in A Mare.
Authors: Ortolani Flaminia, Nannarone Sara, Sforna Monica, Gialletti Rodolfo, Giglia Giuseppe, Mandara Maria Teresa
Journal: Journal of equine veterinary science
Summary
# Editorial Summary A 10-year-old Dutch Warmblood mare presented with recurrent small colon impactions over four months, each episode responding partially to conservative management with fasting, oral rehydration and magnesium sulphate, prompting investigation into underlying pathological causes beyond mechanical obstruction. The diagnostic workup included standing laparoscopy (which revealed no obvious abnormalities) and ultimately exploratory laparotomy with full-thickness biopsies of the caecum and large and small colon, with post-mortem examination providing definitive histological confirmation. Microscopic analysis revealed severe chronic lymphocytic enterocolitis and typhlitis coupled with marked depletion of myenteric ganglion bodies—a profound neuronal pathology that compromised the coordinated muscular contractions essential for normal faecal transit. The mare's rapid deterioration following surgery, characterised by tachycardia, fever and profuse gastric reflux, reflects the severity of the underlying neuromuscular dysfunction and the limitations of surgical intervention alone in cases of primary enteric neuropathy. This case highlights an important diagnostic consideration: whilst small colon impaction is routinely managed medically, practitioners should remain alert to the possibility of myenteric ganglionopathy as an underlying cause of recurrent impactions, as such cases carry a grave prognosis and may warrant earlier discussion of humane endpoints rather than repeated interventions.
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Practical Takeaways
- •Myenteric ganglionopathies should be considered in cases of recurrent small colon impaction, particularly when conservative management provides only temporary relief and impaction recurs within weeks to months.
- •Exploratory laparotomy with full-thickness intestinal biopsies of the caecum and colon may be necessary for definitive diagnosis when recurrent impaction is unexplained, as standing laparoscopy may not visualize critical pathology.
- •Prognosis is guarded even with diagnosis; severe myenteric depletion associated with chronic pseudo-obstruction can deteriorate rapidly post-operatively, and owners should be counseled on potential poor long-term outcomes.
Key Findings
- •A 10-year-old KWPN mare presented with recurrent small colon impaction over four months, partially responsive to conservative management (food deprivation, water and magnesium sulphate administration).
- •Exploratory laparotomy with surgical biopsies revealed lymphomonocytic enteritis and mild myenteric ganglionitis, while post-mortem examination showed severe chronic lymphocytic enterocolitis and marked depletion of myenteric ganglion bodies.
- •Recurrent small colon impaction was determined to be secondary to severe myenteric ganglionopathy associated with chronic intestinal pseudo-obstruction.
- •Despite initial post-operative improvement, rapid clinical deterioration with tachycardia, fever, and abundant gastric reflux occurred within days, necessitating euthanasia.