REFEREED Surgical Management of Cecal Impaction/ Dysfunction by Ileocolostomy in a Horse Antonio Cezar de Oliveira Dearo, DVSc, Carmen Esther Santos Grumadas, DVSc, Peter Reichmann, DVSc, Gustavo Rodrigues Queiroz, DVM, Marilu Constantino Max, DVM, and Mariana Cosenza, DVM ABSTRACT A four-year-old Appaloosa brood mare was referred for evaluation of a colic episode of 24 hours’ duration. Physical examination revealed a distended cecum filled predominantly with fluid. A tentative diagnosis of cecal dysfunction was determined, and surgical intervention was performed by means of typhlotomy and ileocolos- tomy techniques through a complete bypass of the cecum. Postanaesthetic myopathy and incisional infec- tion developed as postoperative complications. The mare was discharged 13 days after surgery. Follow-up information obtained from the owner and referring vet- erinarian 4 months after discharge revealed full recovery of the mare. Keywords: Cecum; Impaction; Dysfunction; Ileocolos- tomy; Colic INTRODUCTION Cecal impaction/dysfunction has been clinically presented as a primary condition or as a complication in horses hospi- talized for unrelated musculoskeletal or gastrointestinal diseases. 1 In a hospital setting, horses undergoing general anesthesia and receiving phenylbutazone administration seem to be at greater risk. 1 The major and deadly complication of cecal impaction/ dysfunction is perforation or rupture. 2,3 Therefore, expedited recognition and management of the condition is crucial to prevent cecal perforation. Medical and surgical treatments have been proposed to manage cecal impaction. However, not only the treatment modality (ie, medical or surgical) but also the surgical tech- nique employed to manage an impacted cecum is still a matter of debate. 4,5 Moreover, preoperative distinction be- tween cases of cecal impaction and cecal dysfunction may sometimes be challenging 5,6 ; therefore, a definitive diag- nosis may not be established until surgery is performed. This article describes a case of cecal dysfunction success- fully managed by a handsewn ileocolostomy and its associ- ated postoperative complications. CASE REPORT A 4-year-old, 470-kg Appaloosa brood mare with a 24- hour colic history was referred to the State University of Londrina—Veterinary Teaching Hospital (Londrina, Par- ana ´, Brazil) for treatment. The mare had been treated intra- venously with nonsteroidal antiinflammatory drugs such as flunixin meglumine (Banamine; Schering Plough, Rio de Janeiro, Rio de Janeiro, Brazil), phenylbutazone (Equipa- lazone; Marcolab, Duque de Caxias, Rio de Janeiro, Brazil) and dipyrone (Vetalgin; Intervet, Sa ˜o Paulo, Sa ˜o Paulo, Brazil) at different intervals and 8 liters of lactated Ringer’s solution by the referring veterinarian. History of previous illness, surgery, or other stressful episodes was denied by the caregiver. On arrival, the mare showed signs of mild to moderate and intermittent abdominal pain. Physical ex- amination revealed a heart rate of 48 beats/minute, respi- ratory rate of 20 breaths/minute, and rectal temperature of 38.38C. Mucous membranes were slightly congested, cap- illary refill time was 3 seconds, and peripheral pulse was normal. Auscultation of the abdomen, which was not dis- tended, revealed decreased gut sounds in all quadrants. No net reflux was recovered on nasogastric intubation. Rectal examination revealed marked distention of the ce- cum, with taut ventral and medial bands, filled predomi- nantly with fluid and gas. Solid material with a doughy consistency was palpated at the base. Preliminary blood work showed no abnormalities. Based on the history and clinical findings, a tentative diagnosis of cecal impaction/ dysfunction was determined. An intravenous (IV) catheter was placed, and infusion of lactated Ringer’s solution was started. Eight liters of water was administered via nasogastric tube. Overnight, the mare exhibited two distinct pain episodes, which were controlled with flunixin meglumine (Banamine; Schering Plough, Rio de Janeiro, Rio de Janeiro, Brazil) and xylazine (Sedazine 10%; Fort Dodge Sau ´de Animal Ltda, Campinas, Sa ˜o Paulo, Brazil). A second rectal examination performed CASE STUDY From the Departamento de Clı´nicas Veterina´rias, Universidade Estadual de Londrina, Londrina, Pr, Brazil. Reprint requests: Antonio Cezar de Oliveira Dearo, DVSc, Departamento de Clı´nicas Veterina´rias, Centro de Cieˆncias Agra´rias, Universidade Estadual de Londrina, C.P. 6001, 86051-990 Londrina—Pr, Brazil. 0737-0806/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jevs.2007.11.003 34 Journal of Equine Veterinary Science  Vol 28, No 1 (2008)