Gábor Bodó Ph.D, Dipl. ECVS - kisallatsebeszet.hu · Equine Intestinal Tract: Surgical anatomy...

Equine Intestinal Tract: Surgical anatomy Reperfusion injury

Gábor Bodó Ph.D, Dipl. ECVS

SZIU, FVS, Equine Clinic

Surgical anatomy Do you recognise this organ?

•Stomac

•Duodenum

•Jejunum

•Ileum

•Caecum

•Right Ventral Colon

•Flexura sternalis

•Left ventral colon

•Flexura pelvina

•Left dorsal colon

•Flexura diaphragmatica

•Right dorsal colon

•colon transversum

•colon descendens

•Rectum

Gastrointestinal tract

Abdomen

Topographic Anatomy - Glasshorse

Surgical approaches to the abdomen

Auer & Stick: Equine Surgery 4th Ed

Surgical approaches to the abdomen

Auer & Stick: Equine Surgery 4th Ed

Surgical approaches to the abdomen

Illustration: Gabor Bodo SZIU Lig. teres hepatis

Paramedian Laparotomy

Picture: G.Bodo

Surgical approaches to the abdomen

Auer & Stick: Equine Surgery 4th Ed

Laparoszkópos feltárás

Képek: ISME Pferdeklinik Bern

Képek: ISME Pferdeklinik Bern

Laparoszkópos feltárás

Illustration: Auer Stick: Equine Surgery

• Cecum is the first sturcture

• Corpus caeci in the midline

• Cecocolic lig.: between lat. cecum tenia and right ventral colon lat. tenia

Illustration: Caroline Tessier

Right v. colon

Lig. Cecocolicum or cecocolic lig.

Cecum

Cecum: – 4 tenias

– Bloodsupply: lat and med tenia

– Lat.: leads to cecocolic lig.

– Dorsal tenia with lig. ileocaecale

Illustration: Caroline Tessier: Cornell

Illustration: Caroline Tessier: Cornell

Illustration: Caroline Tessier: Cornell

Lig. Cecocolicum

Plica Ileocecalis

Illustration: Caroline Tessier: Cornell

Plica Ileocecalis

Dorsal cecum tenia

Illustration: Budras: Anatomy of the horse

• Colon ascendens left side (LVC, LDC) • exploration of the pelvic flexure

Illustration: Caroline Tessier: Cornell

Illustration: Gabor Bodo SZIU

Illustration: Caroline Tessier: Cornell

A.V. ilealis

Illustration: Gabor Bodo SZIU

Lipoma

Illustration: Gabor Bodo SZIU

Illustration: Gabor Bodo SZIU

Illustration: Caroline Tessier: Cornell

Lig. duodenocolicum Colon transversum

duodenum

mesocolon

Illustration: Gabor Bodo SZIU

Right flank

Caecum cupula

Duodenum

Rectum

Illustration: Gabor Bodo SZIU

Duodenum

Foramen Epiploicum Winslowi

Illustration: Gabor Bodo SZIU

Illustration: Gabor Bodo SZIU

Illustration: Gabor Bodo SZIU

• Descending duodenum, duod. Transversum, asc. duod.

• Liver: sigmoid flexure

Illustration: Caroline Tessier: Cornell

Pylorus

Illustration: Caroline Tessier: Cornell

Omentum

Spleen

Illustration: Caroline Tessier: Cornell

Lig renolienale or: nephrosplenic ligament

?

Illustration: Gabor Bodo SZIU

Illustration: Caroline Tessier: Cornell

Descending colon with mesocolon

Illustration: Gabor Bodo SZIU

Illustration: Gabor Bodo SZIU

Illustration: Caroline Tessier: Cornell

Lesions of the intestinal wall • Distension

– Intraluminal perssure for 2-4 hours

• 18 H2O cm: seromusc. edema

• 25 H2O cm: Hypoperfusion, edema

inflammatory cellinvasion

Adhesions within 10 days postop,

• fibrin, serous exudate

• Ishaemia of the mucosa

– Smal intestine: „tips of villi”: spec. blood supply

– Large intestine: no villi withstands 25% more

Lesions of the intestinal wall

Tips of villi: blood supply

Normal Mucosa

Pictures: KE Sullins

Endotoxin

Pictures: KE Sullins

Grüenhagen’s Space

Bild: KE Sullins

• Reperfusion injury - Darmwand

– Neutrophil infiltration

• Muskularis and Serosa

• Fibrin - Adhesions

Seromuscular Infiltration of neutrophils

Picture: KE Sullins

Case: 12 y PRE stallion

Pendulating lipoma strangulating middle jejunum (50 cm)

Knot

Prestenotic small intestine: suffusions and adhesive serosal surface

Anastomosis 1m of prestenotic and 50 cm of poststenotic intestinal

resection (all together: 2m)

3 days later: Anastomosis OK

Distal

proximal

Ca. 60 cm prox. from the anastomosis: Adhesions with fibrin between small intest. loops lead

to new strangulation and reflux

Distal Jejunum - Proximal Jejunum

?

Take home message

• What should I know about the thopographic anatomy of the gastrointerstinal tract in the horse?

• „Reperfusion injury” – what is it?

– What are the consequences?

Questions? 1. Which cecal tenia leads to the ileum?

2. What are the consequences of 2-4 hours of small intestinal distension (above 18 H2O cm pressure)?

Skikjöring, St. Moritz - Switzerland

Thank You for Your Attention!