Reporte de caso clínico: síndrome abdominal agudo por impactación en colon menor, retroflexión de la flexura pélvica y adherencias a causa de un enterolito en yegua gestante de 12 años.

Abstract

A 12 year old female Colombian Criollo Horse (CCC) from La Estrella, Antioquia, was referred to Equine Hospital Internal MV for colic. In the anamnesis the referring veterinarian reports colic of 24 hours of evolution with poor response to analgesia, severe abdominal distension with presumptive diagnosis of impaction in the small colon. In addition to this, the patient is 10 months pregnant. The initial clinical examination shows a slightly depressed patient, tachycardia, hypomotility in all four quadrants with tympanic sound, severe bilateral abdominal distension and signs compatible with moderate visceral pain, fetocardia of 100 bpm. On rectal palpation there is absence of stool in the rectal ampulla and distended viscera with abundant presence of gas. In addition to this, she presented hyperlactatemia (5.9 mmol/L), hyperglycemia (221 mg/dL), azotemia (2.02 mg/dL). Abdominocentesis was performed and showed a peritoneal lactate of 11.6 mmol/L, RGB of 4000 cells/uL and total solids of 3 g/dL. Due to the findings, exploratory laparotomy was proposed, but the owner did not authorize it, so she was given medical management for approximately 20 hours. Fluid therapy with Ringer Lactate Solution at double maintenance (90 ml/kg/day), Flunixin Meglumine 0.5 mg/kg IV BID, Dipyrone 22 mg/kg IV BID, walks and enemas with tempered water and carboxymethylcellulose (CMC), During the course of the night, an increase in abdominal distention is evidenced and a trocarization in the right flank is performed, timing 18 minutes of gas output, the next day there is no response to medical management, so it is reiterated to the owner that the mare needs surgical intervention and he agrees. In the surgical intervention, exploratory laparotomy was performed where retroflexion of the pelvic flexure was evidenced, foreign body in the minor colon and with presence of adhesions in the aboral anti mesenteric border to the foreign body. Decompression of the cecum and minor colon is performed, the pelvic flexure is positioned and enterotomy is performed to evacuate all intestinal contents. Subsequently, enterotomy was performed in the minor colon to evacuate the foreign body that was identified as an enterolith of significant size when it was removed. Finally, the adhesions were debrided and the small intestine was evaluated without abnormalities.