Preoperative factors associated with resection and anastomosis in horses presenting with strangulating lesions of the small intestine.
Authors: Pye Jannah, Espinosa-Mur Pablo, Roca Rodrigo, Kilcoyne Isabelle, Nieto Jorge, Dechant Julie
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Preoperative Predictors of Small Intestinal Resection in Horses When faced with a strangulating small intestinal lesion, equine surgeons must decide whether tissue viability permits preservation or whether resection and anastomosis is necessary. This retrospective analysis of 243 horses examined preoperative clinical and diagnostic variables to identify which factors predicted the need for resection across 172 cases. Three key indicators emerged as strong predictors: horses presenting with gastric reflux on admission were 5.6 times more likely to require resection, those with amotile small intestine on ultrasonography were 9.7 times more likely to need resection, and each unit increase in the difference between peritoneal fluid and blood lactate was associated with a 1.55-fold increased probability of resection. Whilst these findings provide valuable prognostic information for preoperative counselling and surgical planning, it is sobering that horses requiring resection and anastomosis demonstrated lower survival to discharge than those with preserved bowel, underscoring the serious nature of extensive intestinal damage. Incorporating these objective markers—particularly ultrasonographic assessment of motility and lactate gradient calculation—into your diagnostic protocol can better inform decision-making at the operating table and realistic owner discussions regarding prognosis.
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Practical Takeaways
- •Use preoperative gastric reflux, ultrasound findings of intestinal motility, and lactate differential as predictive indicators to anticipate which cases will likely need resection — this aids surgical planning and owner communication about prognosis
- •Horses requiring intestinal resection have substantially worse discharge survival rates; ensure owners understand this increased risk when strangulation severity indicators are present
- •Combine clinical signs with objective diagnostics (ultrasound, lactate measurement) rather than relying on presentation alone — this improves prognostic accuracy before entering the surgical suite
Key Findings
- •Horses with gastric reflux at admission were 5.56 times more likely to require resection and anastomosis
- •Amotile small intestine on ultrasound was the strongest predictor, with 9.69 times higher odds of requiring resection
- •Increased lactate difference (peritoneal fluid vs blood) was significantly associated with resection requirement (OR 1.55)
- •Survival to discharge was significantly lower in horses undergoing resection and anastomosis compared to those managed conservatively