title: Life-threatening hemorrhage from enterotomies and anastomoses in 7 horses.
abstract: OBJECTIVE
  To report our experience with horses that presumptively had severe intraluminal hemorrhage from enterotomy or anastomosis.
  
  
  METHODS
  Clinical study.
  
  
  METHODS
  Six adult horses and 1 adult donkey.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Hemorrhage from incisional edges, particularly in the large intestine, should be considered a rare but possibly fatal complication of enterotomy or anastomosis in horses.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Illinois, College of Veterinary Medicine, 1008 W. Hazelwood Drive, Urbana, IL, USA.
authors.forename: Aimie J
authors.initials: AJ
authors.lastname: Doyle
authors.forename: David E
authors.initials: DE
authors.lastname: Freeman
authors.forename: Hans
authors.initials: H
authors.lastname: Rapp
authors.forename: Jose A Verocay
authors.initials: JA
authors.lastname: Murrell
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Wilkins
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000401:mortality / Q000662:veterinary; D000740:Anemia / Q000209:etiology / Q000401:mortality / Q000662:veterinary; D000818:Animals; D018397:Equidae / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000662:veterinary*; D006734:Horse Diseases / Q000209:etiology* / Q000401:mortality; D006736:Horses / Q000601:surgery*; D007422:Intestines / Q000601:surgery*; D008297:Male; D008551:Melena / Q000209:etiology / Q000401:mortality / Q000662:veterinary; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000662:veterinary*; D012189:Retrospective Studies; D016896:Treatment Outcome