Interesting In-Patients

            The past few weeks, we have been treating a couple unpredictable cases. The first was a colic that was diagnosed as an impaction on the farm but was also running a high fever. He was brought into the isolation unit at the clinic, worked up, and placed on fluids with antibiotics. His bloodwork was indicative of infection and inflammation, but the specific tests for serious contagious conditions were negative. So, when his fever broke he was moved out of isolation and switched to oral fluids. After a few days, the impaction resolved, his appetite returned, and he began to act brighter. Suddenly, he stopped eating and became even more depressed than he had been previously. Upon rectal examination, we found that his cecum had been displaced across midline. Although his heart rate was low and he was not acting uncomfortable, we encouraged his owner to make arrangements to ship him to Ohio State for further monitoring and surgery if needed. By the time they arrived at Ohio State, he was acting painful and was taken to surgery. The surgeon there found the majority of the small intestine and part of the colon pulled through the nephrosplenic space, so much so that the cecum was pulled across the abdomen. Surprisingly, all of the gut was still viable and after several painstaking hours, was returned to its rightful place. Still not out of the woods, the horse re-displaced his intestines and went to surgery for the second time. Now he is recovering well, but a third surgery is not an option, so hopefully he has no more surprises.

            The second case was a 3 month old filly that came down with diarrhea and a fever. We initially treated her with fluids, biosponge, antibiotics, and a little bit of banamine. Later the following afternoon, she was found recumbent and declining swiftly. With her fast action, Dr. Hill was able to stabilize the filly and get her on her feet, but she remained depressed and refused to eat for the next few days. Despite supportive care the filly did not improve, so we ultrasounded her thorax and abdomen. We found pleural pneumonia and pulmonary abscesses as well as what can only be described as a lake of abdominal fluid and fibrin. With a tentative diagnosis of raging peritonitis with secondary pneumonia, we continued supportive care. The next day, she took a huge turn for the worse and the owners elected to euthanize. Upon field necropsy, we discovered horrible gastric ulcers that had perforated into the abdomen. This led to utter confusion since 1) ulceration in foals is uncommon, especially when this foal has not been previously stressed or medicated and 2) assuming she perforated several days previous when she crashed the first time, how did she live that long and never act colicky? So, Dr. Paradine and Dr. Hill asked their contacts at MSU and OSU for possible explanations.  Dr. Schott has seen babies with sensitivity to NSAIDs that can get ulcers from just one or two doses. He also said foals can more easily wall off perforations, tolerating them better and for longer than adults.