Surgical enlargement of the epiploic foramen in horses.
Authors: Wanstrath Meghan A, Bauck Anje G, Smith Andrew D, Freeman David E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical Enlargement of the Epiploic Foramen in Horses Epiploic foramen entrapment (EFE) remains a challenging surgical emergency, particularly when manual reduction proves difficult or time-consuming during exploratory celiotomy. Wanstrath and colleagues evaluated a blunt digital dissection technique to safely enlarge the caudal aspect of the epiploic foramen by separating the caudate lobe of the liver from its attachments to the right dorsal colon, right kidney, gastropancreatic fold, and pancreas. Across 14 healthy horses (assessed post-mortem) and three clinical EFE cases, the procedure caused no clinically significant haemorrhage and resulted in successful reduction of entrapped viscera without intraoperative complications, though one clinical case demonstrated partial re-closure of the enlarged foramen within 30 days. For practitioners managing EFE cases with difficult manual reduction, this technique offers a viable alternative when anatomical familiarity and careful case selection are prioritised; however, the small clinical cohort and lack of long-term follow-up data on postoperative outcomes mean further evidence is needed before widespread adoption.
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Practical Takeaways
- •This technique offers a safe surgical alternative for managing difficult epiploic foramen entrapments when manual reduction fails or takes excessive time
- •Surgeons should obtain anatomical training on cadavers and carefully select cases with the greatest clinical need before adopting this procedure
- •Monitor for possible re-entrapment postoperatively, as the foramen may partially close in some cases
Key Findings
- •Digital enlargement of the epiploic foramen via ventral midline celiotomy did not cause clinically relevant hemorrhage in 14 healthy horses assessed at necropsy
- •In three clinical cases of epiploic foramen entrapment, the procedure successfully reduced entrapment with no intraoperative complications
- •One clinical case showed partial closure of the enlarged epiploic foramen at 30-day necropsy, indicating potential for re-entrapment