Use of pelvic flexure biopsy scores to predict short-term survival after large colon volvulus.
Authors: Levi Ohad, Affolter Verena K, Benak Jaromir, Kass Philip H, Le Jeune Sarah S
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Pelvic Flexure Biopsy Scores and Large Colon Volvulus Survival Determining tissue viability intraoperatively during large colon volvulus (LCV) repair is critical for deciding whether resection is necessary, yet objective methods remain elusive; this study evaluated whether histopathological assessment of pelvic flexure biopsies could reliably predict short-term survival in 28 horses undergoing surgical correction of LCV of ≥360°. Two independent board-certified pathologists scored biopsy samples using different histological scoring systems without knowledge of clinical outcome, and the authors used logistic regression to correlate tissue viability scores with hospital discharge rates and identify other prognostic clinical variables. Although 86% of horses survived to discharge, both histological scoring systems failed to accurately predict outcome in approximately 20–22% of cases, suggesting that tissue appearance alone cannot reliably guide surgical decision-making in this population. Instead, clinical parameters measured at admission and 24 hours post-operatively—specifically heart rate and packed cell volume—emerged as significantly better prognostic indicators of short-term survival. These findings suggest that whilst intraoperative biopsy assessment remains potentially useful, surgeons should not rely solely on histopathology to determine the necessity for large colon resection, and that serial monitoring of vital signs and haematological parameters may offer more reliable guidance for prognostication and post-operative management.
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Practical Takeaways
- •Do not rely solely on pelvic flexure biopsy histopathology scores to make prognostic decisions in large colon volvulus cases—clinical parameters like heart rate and PCV are more predictive
- •Monitor post-operative heart rate and packed cell volume at 24 hours post-surgery as more reliable indicators of short-term survival in colic surgery patients
- •The high survival rate (86%) in this surgical series suggests aggressive surgical intervention for large colon volvulus can be justified even in challenging cases
Key Findings
- •86% of horses (24/28) with large colon volvulus survived to hospital discharge
- •Pelvic flexure biopsy histopathology scores failed to predict short-term survival in 20-22.4% of cases using standard cutoffs
- •Heart rate at admission and 24 hours post-surgery, and packed cell volume at 24 hours were significantly associated with survival outcome
- •Histopathologic tissue viability assessment did not reliably correlate with clinical outcomes in this cohort