Editor's note: This article is the second in a series on Paynter, the Haskell Invitational winner that developed equine colitis and served as an illustration of this life-threatening condition in horses. The first article appeared in the November 2012 issue of DVM Newsmagazine ("Equine colitis: Causes, consequences and management challenges for veterinarians").
At New Bolton Center, Paynter was treated by Louise Southwood Parente, DVM, MS, PhD, DACVS, DACVECC, and a team of veterinarians and staff.
Upon his arrival at the center on Oct. 2, an ultrasonographic examination revealed two areas of abscessation or ulceration in the cecal apex with thickening of the cecal wall for about 35 cm from the cecal apex into the cecal body. The omentum appeared to be adhered to the abscessed areas.
During surgery, Southwood Parente explored the 3-year-old colt's abdomen to ensure there were no other complications. "Besides the cecal apex, everything else seemed within normal limits, and he did not have evidence of significant peritonitis," she says. "We were able to go back 35 to 40 cm from the cecal apex and staple across, using the ILA-100 stapler, and oversew the resection site."
At the conclusion of the surgery, Southwood Parente says she was happy with the surgical site. Paynter's abdomen was lavaged, and Peridan, an anti-adhesion device that contains fucoidan, a branched, sulfated, complex polysaccharide, was added.
Paynter was transferred to New Bolton Center on Oct. 2 after developing colitis in August and losing a considerable amount of weight. As reported in the November issue of DVM Newsmagazine, the winning racehorse had a history of pneumonia and laminitis. Additionally, he was hypoproteinemic and had intermittently spiked mild fevers.
Although there were reservations about taking Paynter to surgery because of his recent disease history and extreme weight loss, the ultrasonographic findings were concerning, and he continued to have low plasma protein concentrations and intermittent fevers. He was stable, and the lesion was in a surgically accessible area and somewhat localized, making resection feasible.
Recovery and continued care
After surgery, Paynter recovered well from general anesthesia, and his temperament and appetite remain good. "He never gave up," says Southwood Parente. "He always ate a lot, and he slept like a foal, which was helpful for his recovery."
Paynter had been treated with ampicillin and amikacin, as well as misoprostol (an anti-ulcer medication) prior to admission, and Southwood Parente continued those treatments perioperatively. "He seemed a bit quiet after surgery, and so the misoprostol was discontinued. He then looked remarkably better," she says.
Paynter's temperature was slightly elevated after surgery, and Southwood Parente says she could not determine why. He had been receiving antimicrobials for seven days after surgery, which was a significant time period. "We pulled his catheter, and lo and behold, his temperature came down, and he improved further," she says.
As of press time, Paynter was rehabilitating at Bruce Jackson's Equine Therapy Center in Elkton, Md. As of mid-October, his protein (albumin) concentration had increased, and his fibrinogen concentration had decreased dramatically after catheter removal. His temperature was continuously monitored, and veterinary staffers continued to keep a close eye on him to ensure the infection had been resolved and the horse didn't become uncomfortable.
Although he has a way to go until he's fully recovered, Paynter's positive outcome is not only his fighting temperament, but also the excellent teamwork of veterinary care he has received.
Ed Kane, PhD, is a researcher and consultant in animal nutrition. He is an author and editor on nutrition, physiology and veterinary medicine with a background in horses, pets and livestock. Kane is based in Seattle.