Doyle Aimie J, Freeman David E, Rapp Hans, Murrell Jose A Verocay, Wilkins Pamela A
University of Illinois, College of Veterinary Medicine, 1008 W. Hazelwood Drive, Urbana, IL, USA.
Vet Surg. 2003 Nov-Dec;32(6):553-8. doi: 10.1111/j.1532-950x.2003.00553.x.
To report our experience with horses that presumptively had severe intraluminal hemorrhage from enterotomy or anastomosis.
Clinical study.
Six adult horses and 1 adult donkey.
A retrospective study was conducted at the University of Illinois (April 1994 to December 2001) to determine the clinical course and outcome of horses with melena and/or anemia and evidence of life-threatening hemorrhage from intestinal incisions. Medical records of all horses that had colic surgery were reviewed to determine the proportion of horses with this complication. In addition, horses that fit the same criteria identified in 3 other veterinary clinics were included.
Three horses (1.3%) of those that had enterotomy or anastomosis at the University of Illinois and 4 horses from other clinics had complications presumptively related to severe hemorrhage from these intestinal procedures. Melena became evident within 72 hours of surgery and lasted 12 to 96 hours. Six horses had an acute and severe drop in packed cell volume (PCV), increased heart rates, and other signs of acute hemorrhage, and 1 horse had signs of colic postoperatively. Horses were administered intravenous formalin (3 horses) and whole blood transfusions (4 horses). Repeat celiotomy was performed on 2 horses. In 1 of these horses, a bleeding artery was ligated in the edge of the original enterotomy, and, in the other, a 25-cm-diameter intraluminal blood clot was found occluding the pelvic flexure. A horse that had jejunocolostomy for cecal impaction was not treated for hemorrhagic shock but was euthanatized and necropsied. Necropsy revealed blood-filled bowel from the jejunocolostomy to the anus. One of the remaining 6 horses died of enterocolitis and 5 survived to discharge.
Hemorrhage from incisional edges, particularly in the large intestine, should be considered a rare but possibly fatal complication of enterotomy or anastomosis in horses.
To prevent fatal hemorrhage from incisional edges during enterotomy or anastomosis, large vessels should be ligated at the original surgery, and hemostatic effects of different closure techniques should be considered. No intraoperative or postoperative findings were useful to predict this complication, and response to supportive medical therapy was favorable.
报告我们对疑似因肠切开术或吻合术导致严重腔内出血马匹的诊治经验。
临床研究。
6匹成年马和1头成年驴。
在伊利诺伊大学开展一项回顾性研究（1994年4月至2001年12月），以确定出现黑粪症和/或贫血且有肠道切口危及生命出血迹象的马匹的临床病程及转归。查阅所有接受结肠手术马匹的病历，以确定发生该并发症的马匹比例。此外，纳入了在其他3家兽医诊所符合相同标准的马匹。
在伊利诺伊大学接受肠切开术或吻合术的马匹中有3匹（1.3%），其他诊所的4匹马出现了可能与这些肠道手术严重出血相关的并发症。黑粪症在术后72小时内明显出现，并持续12至96小时。6匹马的红细胞压积（PCV）急剧严重下降、心率加快及出现其他急性出血迹象，1匹马术后出现腹痛迹象。对马匹静脉注射福尔马林（3匹）并进行全血输血（4匹）。对2匹马再次进行剖腹术。其中1匹马，在原肠切开术边缘结扎了一条出血动脉，另一匹马，发现一个直径25厘米的腔内血凝块阻塞了骨盆曲。一匹因盲肠阻塞行空肠结肠吻合术的马未接受失血性休克治疗，而是实施安乐死并进行尸检。尸检发现从空肠结肠吻合术部位到肛门的肠管充满血液。其余6匹马中有1匹死于小肠结肠炎，5匹存活出院。
切口边缘出血，尤其是在大肠，应被视为马匹肠切开术或吻合术一种罕见但可能致命的并发症。
为防止肠切开术或吻合术期间切口边缘致命性出血，应在初次手术时结扎大血管，并考虑不同闭合技术的止血效果。术中或术后均无有助于预测该并发症的发现，且对支持性药物治疗的反应良好。
