gábor bodó ph.d, dipl. ecvs - kisallatsebeszet.hu · equine intestinal tract: surgical anatomy...
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Equine Intestinal Tract: Surgical anatomy Reperfusion injury
Gábor Bodó Ph.D, Dipl. ECVS
SZIU, FVS, Equine Clinic
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Surgical anatomy Do you recognise this organ?
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•Stomac
•Duodenum
•Jejunum
•Ileum
•Caecum
•Right Ventral Colon
•Flexura sternalis
•Left ventral colon
•Flexura pelvina
•Left dorsal colon
•Flexura diaphragmatica
•Right dorsal colon
•colon transversum
•colon descendens
•Rectum
Gastrointestinal tract
Abdomen
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Topographic Anatomy - Glasshorse
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Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
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Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
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Surgical approaches to the abdomen
Illustration: Gabor Bodo SZIU Lig. teres hepatis
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Paramedian Laparotomy
Picture: G.Bodo
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Surgical approaches to the abdomen
Auer & Stick: Equine Surgery 4th Ed
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Laparoszkópos feltárás
Képek: ISME Pferdeklinik Bern
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Képek: ISME Pferdeklinik Bern
Laparoszkópos feltárás
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Illustration: Auer Stick: Equine Surgery
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• Cecum is the first sturcture
• Corpus caeci in the midline
• Cecocolic lig.: between lat. cecum tenia and right ventral colon lat. tenia
Illustration: Caroline Tessier
Right v. colon
Lig. Cecocolicum or cecocolic lig.
Cecum
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Cecum: – 4 tenias
– Bloodsupply: lat and med tenia
– Lat.: leads to cecocolic lig.
– Dorsal tenia with lig. ileocaecale
Illustration: Caroline Tessier: Cornell
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Illustration: Caroline Tessier: Cornell
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Illustration: Caroline Tessier: Cornell
Lig. Cecocolicum
Plica Ileocecalis
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Illustration: Caroline Tessier: Cornell
Plica Ileocecalis
Dorsal cecum tenia
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Illustration: Budras: Anatomy of the horse
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• Colon ascendens left side (LVC, LDC) • exploration of the pelvic flexure
Illustration: Caroline Tessier: Cornell
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Illustration: Gabor Bodo SZIU
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Illustration: Caroline Tessier: Cornell
A.V. ilealis
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Illustration: Gabor Bodo SZIU
Lipoma
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Illustration: Gabor Bodo SZIU
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Illustration: Gabor Bodo SZIU
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Illustration: Caroline Tessier: Cornell
Lig. duodenocolicum Colon transversum
duodenum
mesocolon
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Illustration: Gabor Bodo SZIU
Right flank
Caecum cupula
Duodenum
Rectum
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Illustration: Gabor Bodo SZIU
Duodenum
Foramen Epiploicum Winslowi
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Illustration: Gabor Bodo SZIU
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Illustration: Gabor Bodo SZIU
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Illustration: Gabor Bodo SZIU
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• Descending duodenum, duod. Transversum, asc. duod.
• Liver: sigmoid flexure
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Illustration: Caroline Tessier: Cornell
Pylorus
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Illustration: Caroline Tessier: Cornell
Omentum
Spleen
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Illustration: Caroline Tessier: Cornell
Lig renolienale or: nephrosplenic ligament
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?
Illustration: Gabor Bodo SZIU
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Illustration: Caroline Tessier: Cornell
Descending colon with mesocolon
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Illustration: Gabor Bodo SZIU
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Illustration: Gabor Bodo SZIU
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Illustration: Caroline Tessier: Cornell
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Lesions of the intestinal wall • Distension
– Intraluminal perssure for 2-4 hours
• 18 H2O cm: seromusc. edema
• 25 H2O cm: Hypoperfusion, edema
inflammatory cellinvasion
Adhesions within 10 days postop,
• fibrin, serous exudate
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• Ishaemia of the mucosa
– Smal intestine: „tips of villi”: spec. blood supply
– Large intestine: no villi withstands 25% more
Lesions of the intestinal wall
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Tips of villi: blood supply
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Normal Mucosa
Pictures: KE Sullins
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Endotoxin
Pictures: KE Sullins
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Grüenhagen’s Space
Bild: KE Sullins
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• Reperfusion injury - Darmwand
– Neutrophil infiltration
• Muskularis and Serosa
• Fibrin - Adhesions
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Seromuscular Infiltration of neutrophils
Picture: KE Sullins
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Case: 12 y PRE stallion
Pendulating lipoma strangulating middle jejunum (50 cm)
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Knot
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Prestenotic small intestine: suffusions and adhesive serosal surface
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Anastomosis 1m of prestenotic and 50 cm of poststenotic intestinal
resection (all together: 2m)
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3 days later: Anastomosis OK
Distal
proximal
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Ca. 60 cm prox. from the anastomosis: Adhesions with fibrin between small intest. loops lead
to new strangulation and reflux
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Distal Jejunum - Proximal Jejunum
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?
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Take home message
• What should I know about the thopographic anatomy of the gastrointerstinal tract in the horse?
• „Reperfusion injury” – what is it?
– What are the consequences?
Questions? 1. Which cecal tenia leads to the ileum?
2. What are the consequences of 2-4 hours of small intestinal distension (above 18 H2O cm pressure)?
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Skikjöring, St. Moritz - Switzerland
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