However, these drugs can be dangerous: if the segment of intestine involved has been damaged or weakened, they can lead to a rupture. Pain relief may be provided by the use Dipyrone or a similar drug.ĭrugs that stimulate the intestinal tract, such as terpasol, and Peristal, are sometimes used to treat impaction. Severe impactions, which may have developed over several days, could require the administration of fluids via a drip into the vein in order to rehydrate the animal. These must be given by the veterinarian by stomach tube. Treatment: Impactions are treated by lubricants (e.g., mineral oil), water, and agents that add bulk and/or make the stool more soft (dioctynate, DSS, docusate, Sileum). A large pelvic flexure filled with stodgy feces will be felt on rectal examination, but peritoneal fluid will be normal and little or no fluid will be obtained from the stomach when the stomach tube is passed. Heart and respiratory rates may be elevated, consistent with pain, but will return to normal during pain-free periods. Fecal output will be markedly reduced, and feces are drier than normal. Some horses show only mild pain, but go off their food, whereas others are violently colicky. However, some horses may pass large amounts of mucus and/or watery diarrhea, without normal manure, when they are impacted. Signs: Diagnosis is fairly easy with most horses: the stall does not have the normal amount of manure in it. It can also occur in autumn and winter as horses are brought in of grass to stables but is also fairly common in animals which are quite fit and in a lot of work but which then receive an injury requiring them to be completely box rested. Ingested grain or grass may produce by-products that suppress the normal movements of the intestinal wall, while foreign material, such as wood chewed from fences (wood shavings or sawdust ingested with hay), can become lodged in the intestine and block the passage of gut contents. Insufficient water intake, insufficient fiber intake, a “sluggish” intestinal movement, and other conditions of the digestive tract may cause impaction.Ĭauses: Pelvic flexure impaction can result from sudden changes in feed, excessive consumption of grain or lush pasture, dehydration, by ingestion of foreign material, by ingesting too coarse hay or too much straw when not accustomed having the latter as bedding. Impaction can be described as a severe constipation ~ the horse is unable to pass manure. Pelvic flexure impactions and spasmodic colic are extremely common causes of colic in the horse. Not surprisingly, this is the site where food accumulates if a horse becomes constipated. It is the place where the large colon doubles on itself, producing a similar shape to a toilet U tube. Computed tomography of the abdomen showed an abnormality at the hepatic flexure (fig 1 ⇓).The pelvic flexure is the narrowest part of the large colon. Oesophagogastroduodenoscopy showed no cause for the anaemia. Lisinopril and bendroflumethiazide were stopped and the postural hypotension and hyponatraemia resolved. No masses were palpable on abdominal examination.īlood tests showed iron deficiency anaemia and hyponatraemia (haemoglobin 75 g/L (normal range 115-165), mean corpuscular volume 78 fL (80-97), iron 2 µmol/L (12-26), total iron binding capacity 42 µmol/L (45-70 1 µmol/L=5.59 µg/dL), transferrin saturation (ratio of iron to total iron binding capacity) 4.76% (15-50), sodium 130 mmol/L (135-145 1 mmol/L=1 mEq/L)). Her blood pressure was 117/54 mm Hg when lying and 52/31 mm Hg when standing. On examination she appeared cachectic with evidence of conjunctival pallor. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer. Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. She recalled standing from her chair, feeling lightheaded, and then collapsing. Correspondence to: J Naqvi Ī 92 year old woman presented to the emergency department after collapsing at home.1University Hospital of South Manchester, Manchester M23 9LT, UK.Sarah Duff, consultant colorectal surgeon.Velauthan Rudralingham, consultant gastrointestinal radiologist ,.Gill Watts, consultant gastroenterologist ,.Jawad Naqvi, academic foundation doctor,.
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