Week 11 at BEH

Since Brown Equine Hospital offers 24/7/365 emergency services, I have seen my fair share of emergency cases, but one patient that came in this week brought new meaning to the term "urgent".  Castrations, while usually considered a "routine" surgical procedure, can still experience serious post operative complications.  The serous membrane that lines the inside of the abdomen (the peritoneum) is continuous along the inside of the scrotum, which means that it is possible for parts of the gastrointestinal tract (especially the small intestines) to pass out of the abdomen through the inguinal ring and into the scrotum.  If there is an opening in the scrotum, such as with castrations, the intestines can essentially fall out of the horse (NOT GOOD!).

This unfortunately was what happened to this patient.  He was castrated "in the field" (Meaning not in a surgical suite.  This is a common way to do castrations) by another vet and upon getting to his feet, the incision opened and began to eviscerate! The referring vet acted quickly, temporarily replaced the small intestines, and the owners raced the horse to BEH.  Upon arrival the patient was in shock and we took him to surgery immediately.  We had our work cut out for us.  In addition to blood loss and low blood pressure, the part of the intestines that had passed through the inguinal ring were dead and the horse was still bleeding from vessels in the abdomen.  Dr. Brown worked quickly and meticulously to find and close the bleeding vessels, cut out the dead portion of intestine, and then suture together the healthy ends.  This was truly a team effort to save our patient: Dr. Moschgat assisted Dr. Brown by passing him surgical tools, gripping suture, and holding the intestines in the appropriate position, I retrieved additional supplies that were needed throughout the surgery and poured sterile saline over the intestines to keep them from drying out, and the tech worked tirelessly to stabilize the patient while under anesthesia.  After repairing the damage to the intestines, the next step was to address the inguinal ring where the intestines had passed out of the abdomen into the scrotum.  The inguinal ring had ripped open, which caused quite a bit of damage and made the repair even more difficult.

Dead intestine (dark) next to healthy intestine (lighter pink)

The dead portion of the intestine that was removed

Suturing the healthy ends of the intestine back together 

The repaired small intestine

After 5 hours under anesthesia, Dr. Brown had done everything he could and we moved our patient to the recovery stall.  And then we anxiously waited...  Because he had been in surgery for so long (in addition to blood loss, being in shock, and having surgery earlier in the day) it took 3 hours for the horse to recover and get to his feet.

That was 3 days ago.  We have kept a close eye on his heart rate, gastrointestinal motility, and pain level as a way to assess his status after the life saving surgery.  So far, he has been doing great (knock on wood)! He is by no means out of the woods, but with each day we are more optimistic about his recovery.

This patient has been a grim reminder that no surgical procedure is without risk, no matter how "routine" it may be.  Hopefully, with the help of the amazing doctors and technicians at BEH caring for him, this patient will make a full recovery.

As I head into my last week of BEH, I am honored to have been able to work with such a great team, and in awe of how much I have learned.  The time has flown by and I have had such a wonderful experience.  I am truly grateful for Brown Equine Hospital for providing me with this opportunity and know that I am that much more prepared for entering clinics in a few months.

What will my last week bring? Who knows, but check back next week for my final post from BEH in Somerset, PA!