title: Complications and survival associated with surgical compared with medical management of horses with duodenitis-proximal jejunitis.
abstract: BACKGROUND
  Based on clinical observation, it is hypothesised that horses with duodenitis-proximal jejunitis (DPJ) that are treated surgically have a shorter duration, smaller volume, and slower rate of nasogastric reflux (NGR) compared to horses treated medically, are more likely to develop diarrhoea than medically managed cases, and have a higher incisional infection rate than a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ.
  
  
  OBJECTIVE
  To compare: 1) duration, volume and rate of NGR and the percentage of horses with diarrhoea between medically and surgically treated DPJ cases; and 2) incisional infection rate in horses with DPJ undergoing abdominal exploration to a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ.
  
  
  METHODS
  Medical records of cases with DPJ diagnosed 1995-2006 were reviewed. Information obtained included subject details, presenting clinical findings, treatment category (medical/surgical), complications (diarrhoea, incisional infection), and outcome (survival/nonsurvival). Data were analysed using a Chi-squared test and a mixed model analysis of variance. Level of significance was P<0.05.
  
  
  RESULTS
  Compared to medical cases, surgical cases had significantly decreased survival, a longer duration and larger total volume of NGR, and were more likely to develop diarrhoea. The incisional infection rate for horses with DPJ undergoing abdominal exploration was 16% compared to 7% for the sample population of horses.
  
  
  CONCLUSIONS
  Surgical treatment of horses with DPJ did not lead to resolution of NGR faster than medical treatment. Surgical cases were more likely to develop diarrhoea and did not have a significantly higher incisional infection rate than the sample population.
authors.affiliation: University of Pennsylvania, Department of Clinical Studies, 382 W. Street Road, Kennett Square, PA 19348, USA.
authors.forename: C
authors.initials: C
authors.lastname: Underwood
authors.forename: L L
authors.initials: LL
authors.lastname: Southwood
authors.forename: L P
authors.initials: LP
authors.lastname: McKeown
authors.forename: D
authors.initials: D
authors.lastname: Knight
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D016009:Chi-Square Distribution; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality / Q000662:veterinary; D004382:Duodenitis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000662:veterinary*; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000401:mortality / Q000662:veterinary; D006734:Horse Diseases / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D006736:Horses; D007579:Jejunal Diseases / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000662:veterinary*; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000662:veterinary*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000401:mortality / Q000662:veterinary; D016019:Survival Analysis; D016896:Treatment Outcome