Short-term survival after surgery for epiploic foramen entrapment compared with other strangulating diseases of the small intestine in horses.
Authors: Freeman D E, Schaeffer D J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Epiploic Foramen Entrapment Surgery — Better Prognosis Than Expected Contrary to recent pessimistic reports in the literature, horses undergoing surgery for epiploic foramen entrapment (EFE) demonstrate significantly better short-term survival than those with other strangulating small intestinal lesions. Freeman and Schaeffer analysed surgical outcomes for 157 horses presenting with small intestinal strangulation at the University of Illinois between 1994 and 2003, comparing discharge rates and pathological findings across three groups: EFE cases, lipoma strangulation, and miscellaneous strangulating conditions. The results were striking—95% of EFE cases were discharged alive compared with substantially lower survival rates in the other groups, despite a higher proportion of EFE cases involving ileal tissue, which paradoxically did not compromise outcomes. These findings suggest that whilst jejunocaecostomy (the surgical anastomosis often required in EFE cases) carries concern regarding long-term complications, immediate post-operative prognosis is favourable; however, surgeons should continue refining both the technique of jejunocaecostomy and assessment of bowel viability to further improve results and potentially avoid resection altogether where marginal tissue may recover.
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Practical Takeaways
- •Epiploic foramen entrapment carries a significantly better surgical prognosis (95% discharge rate) than other small intestinal strangulating conditions, which should inform owner counseling and treatment decisions
- •Ileal involvement is more frequent in epiploic foramen entrapment cases but does not necessarily worsen outcome, suggesting careful case-by-case assessment of viability rather than location-based prognosis
- •Surgeons should focus on improving jejunocaecostomy techniques and developing better methods for assessing bowel viability to optimize outcomes and avoid unnecessary resection
Key Findings
- •Horses with epiploic foramen entrapment had a 95% discharge rate compared to lower rates in other strangulating lesions (P < 0.05)
- •Ileal involvement was significantly more common in epiploic foramen entrapment cases than in lipoma or miscellaneous strangulation groups (P < 0.05)
- •Viability grade distributions differed significantly between epiploic foramen entrapment and lipoma groups (P < 0.05)
- •Better prognosis for epiploic foramen entrapment surgery was achieved despite greater proportion of ileal involvement requiring further investigation of outcome factors