Week 3 @ Cleveland Equine Clinic

This week has been a busy one and full of surgeries and colics. 
I have been helping care for the colicing horses that are currently in the clinic, both with impaction colics. Treatments for each of the horses have been quite similar.  Treatments include, hydrating them by using an NG tube to deliver fluids to their stomachs, and feeding mashes and small amounts of hay.  One horse also has received IV fluids based on the severity of his impaction and the necessity to provide him with more fluids than NG tubing could.  Often electrolytes or epsom salts are added to the fluids that are being pumped into their stomachs.  This helps not only with hydration but also aids to draw in water from interstitial fluid into the gut.  The goal is to provide enough fluids to hopefully soften the impaction to help the horse in passing it through.  Positive signs of the impaction resolving are passing manure, drinking water, and regaining GI sounds as well as comfort.

One amazing surgery I had the chance to observe was a repair of a rectovaginal tear.  The tear occurred due to the mare aborting and having a traumatic foaling. For these repairs you must wait until the tissue swelling and inflammation goes down.  Due to the location of the repair, you also must ensure that the horse has relatively soft stool before and after the surgery. This is important so that after the reconstruction is complete there will be minimal straining to defecate. For this the mare was kept on pasture from the time of the tear until surgery, as to soften her manure. The surgery is by no means sterile or even aseptic, but prepping consists of trying to clear away as much manure and dirt as possible from the site.  First incisions are made along the angle of where the rectum once was.  This is done to create a "raw" edge that can be sutured to the opposing side's edge. For those of you who are familiar, this is the same idea behind the tissue scoring done for a caslicks procedure.   In this case when these edges heal together, there will be a rectum and vestibule.  2 Vicryl was used in a modified mattress suture pattern. The vulva was repaired with 1 prolene in a simple interrupted pattern.

 Before--as you can tell there is no separation between rectum and vestibule.

 This is blurry- but this is how she looked before any incisions were made.  There is a slight shelf of tissue that exists, the goal is to extend that shelf and separation to create two openings. The rectal mucosa is also used as a landmark of where the rectum vs. vestibule is located.

 In this image the surgeon is creating a fresh edge of tissue to form the perineal body.

 The surgeon is suturing the fresh edges of rectal mucosa together to form the rectum.

 Nearing the end of the procedure, tissues start to be in a normal anatomical placement.  A rectum and anal sphincter can be seen, however it should be noted that the anal sphincter cannot be repaired (but the horse lives outside or in a stall--so there is no true need for continence.)

After surgery- she may not be as symmetrical as she once was, but there is now a true separation between rectum and vestibule.  Thoroughbred breeding requires live cover and does not allow for AI, therefore a caslicks was not done at this time--however could have been done if there were no breeding restrictions.  Once in foal again, she will most likely receive a caslicks to prevent any contamination of fecal material into her vagina. 

I am so happy to be at Cleveland Equine this summer, and I am learning so much from all of the doctors and staff.  I am thankful for this opportunity to take part in such a wonderful practice and experience!!!
-Roya Oliai