Standing jejunal enterotomy for resolution of an ileal impaction

A 22-year-old American Quarter Horse gelding was referred to the JT Vaughan Large Animal Teaching Hospital at Auburn University, College of Veterinary Medicine for moderate signs of abdominal pain responsive to sedation. A presumptive preoperative diagnosis of ileal impaction was made based on physical examination, ultrasonography of the abdomen and clinical pathological data. Despite appropriate medical therapy and improvement in the diagnostic and clinical parameters, the gelding continued to be uncomfortable. A standing right flank laparotomy facilitated access to the ileum which contained approximately 80 cm of consolidated ingesta from the ileocaecal orifice extending orally. The distal jejunum was exteriorised and an enterotomy performed, permitting lavage of the ingesta and resolution of the impaction. The gelding was discharged 6 days after surgery. Two weeks after surgery, the gelding re-presented for surgical treatment of an incisional abscess. At 4-month follow-up, the gelding was reportedly doing well. The described surgical technique may be a viable option for resolution of ileal impactions in horses non-responsive to medical management when exploratory celiotomy under general anaesthesia is not possible due to financial constraints, the health of the horse or other reason.