Colic Surgery
Continuing from above post...
On the way back into the large animal hospital, I noticed a couple vets, a student, and a tech working up a colic case. I decided to watch. We studied the equine acute abdomen in large animal medicine class this term, and it was neat to try to apply what I learned to a real life scenario.
They did the following tests on the horse:
ultrasound (of abdomen)
abdominocentesis
rectal palpation
blood work
They found tight intestinal bands and dilated small intestine (normal small intestine should not have anything in it) and the abdominocentesis was unremarkable. The primary doctor thought the horse might have a blockage at the pelvic flexure, but he didn't want to state that with certainty. The horse was quite painful -- it trembled and tried to go down in the stocks as I was standing at its head.
They decided to take it to surgery, and I wanted to watch, so I did.
It was probably some time between 6 and 7 when they anesthetized the horse. They weren't done until ~10 pm.
The surgeon was a middle-aged fellow from Australia with a slight accent. He is new to the clinic (filling in for six months) and I had not met him before. I found him to be quite amenable to question-asking, which was glorious. He was also curious about my denomination. He wondered if I was the first Mennonite going through the program (which actually isn't the case) and remarked that I must be at the dangerous period of my life. Yaks! He was referring to the Amish rumspringa tradition, which I assurred him I do not agree with. (Being confused with Amish can be less than desirable... but I guess it shouldn't take long for people to figure out that I should not be lumped with the rumspringa youths.)
The surgery:
He made a 1-2 foot ventral midline incision (along the linea alba) and start fishing around among the intestines. He'd pull out a section, and put it back inside, pull out a section, and put it back inside. He didn't find any devitalized bowel (which wasn't a surprise as the abdominocentesis sample had been relatively normal) or a displacement of the colon.
He eventually found a lesion (in the mucosa of the pelvic flexure) unlike anything he'd ever seen (and this guy wasn't a young doc just out of vet school -- he's been around for a while). The lesion was somewhat lobulated, doughy/soft, and red. I got all excited - there's something about assessing an animal, getting an idea for what could be wrong with it, and then finding out for sure. (You don't have to agree with me.)
The main surgeon placed Doyan's clamps on one side of the lesion, severed the lesion from the rest of the intestine on that side, and did a Parker-Kerr oversew over the doyan. That suture pattern effectively closed that end of the intestine.
He did the same thing to the other side, handing the lesion-containing section to me once it was completely separated from the horse.
Having completed the Parker-Kerr on that side, he had two closed-off bowel ends and I was wondering if he knew what he was doing. Clearly, the intestines would serve little use to the horse if he left it like that. Well, as it turned out he did a side-to-side anastomosis. Because the bowel ends he wanted to stitch together weren't equally sized, an end-to-end anastomosis would not have been ideal.
He closed the linea alba (the size comparison to that of a cat, which I operated on last Tuesday, was amazing) and allowed the clinical fellow to complete the closure. I was sort of disappointed how little the senior student got to do... maybe I will have to be particularly forthright next year to make sure I get the experience I stand in need of.
Tonight I'm going to visit with an Australian Strubhar relation. I wonder how much of an accent I'll don while I'm with her... I am very prone to accent assimilation.
On the way back into the large animal hospital, I noticed a couple vets, a student, and a tech working up a colic case. I decided to watch. We studied the equine acute abdomen in large animal medicine class this term, and it was neat to try to apply what I learned to a real life scenario.
They did the following tests on the horse:
ultrasound (of abdomen)
abdominocentesis
rectal palpation
blood work
They found tight intestinal bands and dilated small intestine (normal small intestine should not have anything in it) and the abdominocentesis was unremarkable. The primary doctor thought the horse might have a blockage at the pelvic flexure, but he didn't want to state that with certainty. The horse was quite painful -- it trembled and tried to go down in the stocks as I was standing at its head.
They decided to take it to surgery, and I wanted to watch, so I did.
It was probably some time between 6 and 7 when they anesthetized the horse. They weren't done until ~10 pm.
The surgeon was a middle-aged fellow from Australia with a slight accent. He is new to the clinic (filling in for six months) and I had not met him before. I found him to be quite amenable to question-asking, which was glorious. He was also curious about my denomination. He wondered if I was the first Mennonite going through the program (which actually isn't the case) and remarked that I must be at the dangerous period of my life. Yaks! He was referring to the Amish rumspringa tradition, which I assurred him I do not agree with. (Being confused with Amish can be less than desirable... but I guess it shouldn't take long for people to figure out that I should not be lumped with the rumspringa youths.)
The surgery:
He made a 1-2 foot ventral midline incision (along the linea alba) and start fishing around among the intestines. He'd pull out a section, and put it back inside, pull out a section, and put it back inside. He didn't find any devitalized bowel (which wasn't a surprise as the abdominocentesis sample had been relatively normal) or a displacement of the colon.
He eventually found a lesion (in the mucosa of the pelvic flexure) unlike anything he'd ever seen (and this guy wasn't a young doc just out of vet school -- he's been around for a while). The lesion was somewhat lobulated, doughy/soft, and red. I got all excited - there's something about assessing an animal, getting an idea for what could be wrong with it, and then finding out for sure. (You don't have to agree with me.)
The main surgeon placed Doyan's clamps on one side of the lesion, severed the lesion from the rest of the intestine on that side, and did a Parker-Kerr oversew over the doyan. That suture pattern effectively closed that end of the intestine.
He did the same thing to the other side, handing the lesion-containing section to me once it was completely separated from the horse.
Having completed the Parker-Kerr on that side, he had two closed-off bowel ends and I was wondering if he knew what he was doing. Clearly, the intestines would serve little use to the horse if he left it like that. Well, as it turned out he did a side-to-side anastomosis. Because the bowel ends he wanted to stitch together weren't equally sized, an end-to-end anastomosis would not have been ideal.
He closed the linea alba (the size comparison to that of a cat, which I operated on last Tuesday, was amazing) and allowed the clinical fellow to complete the closure. I was sort of disappointed how little the senior student got to do... maybe I will have to be particularly forthright next year to make sure I get the experience I stand in need of.
Tonight I'm going to visit with an Australian Strubhar relation. I wonder how much of an accent I'll don while I'm with her... I am very prone to accent assimilation.
posted by Claire at 16:45
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