Luta was just 10 months old the first time she colicked, and her owner Jody Rutherford spotted the trouble right away. Normally, the Andalusian filly was active and curious, Rutherford says: “She was a wonderful little baby. I couldn’t leave brushes around when she was little. She’d pick them up and run off with them.” But on the morning of March 8, 2010, Luta was showing all the typical colic signs. “She was turning her head to look at her sides, shivering and sort of hunched over,” Rutherford recalls. “It was obvious that she was in pain.”
Luta was one of three horses on Rutherford’s property just west of Saskatoon in the Canadian province of Saskatchewan. “It was just Luta, her mother and my husband’s horse,” Rutherford says.
She called the field services of the University of Saskatchewan, and Kate Robinson, DVM, arrived within a half-hour. After a full examination turned up no clues as to why the filly was colicking, Robinson gave her a dose of pain medication. “I remember her telling me that Luta looked like she was in a lot of pain, and if that didn’t change pretty quickly we’d have to refer her to the clinic,” says Rutherford.
Four hours later, with no significant change in Luta’s condition, Rutherford hooked up her trailer and headed toward the university.
When Luta walked off the trailer, “she looked even worse than when she’d gotten on,” says Rutherford. Stacy Anderson, DVM, MVSc, Dipl. ACVS-LA, and a team of technicians and veterinary students immediately began a new physical examination---but they, too, turned up no immediate answers.
“When you have a horse that age come into the clinic with colic, there are a few things you suspect,” says Anderson. “There are some types of colic you’re more likely to see in a younger animal, like ascarid0 impactions or some sort of intestinal accident like strangulation.” During a rectal exam, however, Anderson couldn’t feel an obvious abnormality. Ultrasound didn’t help much more. “On the ultrasound we could see a few loops of small intestine that seemed a bit distended, but nothing really remarkable,” she said.
Under the knife
The next decision was whether to send the filly for exploratory surgery. The diagnostic workup at the clinic had included an abdominocentesis, a procedure that pulls a sample of fluid from the abdominal cavity for analysis. “That fluid was very high in protein and lactate,” says Anderson. “These usually indicate a serious colic and that the horse may be a good surgical candidate.”
But the more compelling reason for sending Luta into surgery was her extreme, unrelenting pain. “One of our main determiners for sending a horse to colic surgery is a lack of control of pain,” says Anderson. “When we can’t make a horse comfortable with the usual drugs, it means we are dealing with something serious that is going to require surgery to correct.”
Rutherford gave her approval for the procedure, and Luta was prepped. The surgical team, led by Luca Panizzi, DVM, MVSc, Dipl. ACVS-LA, didn’t know exactly what they would be looking for, so they went in ready to perform a standard protocol for exploratory colic surgeries that would entail examining every inch of her intestines.
“What we do is start at the cecum, pretty much because it’s right there in front of you when you open a horse up,” says Anderson. “Starting from there you trace the small intestines forward to the stomach, looking and feeling every inch for anything unusual. After that you work backward through the large intestines.”Rutherford headed home as the surgery began. “I didn’t watch,” she says. “I had other animals at home who needed to be tended to, so I left and waited for the phone call.
”When the call finally came, Panizzi had an unusual question for Rutherford: “He asked me, ‘Has this horse been around porcupines lately?’”
The surgical team had found two adhesions formed by the omentum, the fatty, lacy structure that lines the abdominal cavity and organs, sticking to the small intestine.“
The omentum surrounds the intestines like a net,” says Anderson, “and is very important to abdominal healing.” Adhesions between the omentum and intestines occur when some trauma or damage causes a very localized and overzealous inflammatory reaction and the overproduction of fibrin, the tough, sticky protein that helps create blood clots over wounds.
“Fibrin is typically laid down as part of the healing process, but after it’s laid down, it’s then broken down in areas where it’s not needed,” says Anderson. “Sometimes, however, that breakdown doesn’t happen efficiently, and structures end up getting stuck together that shouldn’t be.”
Adhesions that form on the intestines may interfere with the function of the gut, slowing or stopping the movement of ingesta. The two omental adhesions were clearly the source of Luta’s colic, but why they had formed in a healthy young filly was still a mystery---until Panizzi spotted a small hole in the center of one of the areas. Nearby within the intestine, he found the culprit: a three-inch, yellowish and brown-striped, very sharp porcupine quill.“
The quill had made a hole through the small intestine, which the body tried to close up, forming the adhesion,” says Anderson. The surgical team found a nearly identical hole at the second adhesion location, but no additional quill. “It’s possible there was a second quill,” he says, “or it’s possible that the one quill punctured both areas.”
Apart from the quill holes, the rest of Luta’s intestine was healthy, so once they had Rutherford’s approval, the surgical team decided to perform two side-by-side resections and anastomoses, a procedure in which the damaged length of intestine is removed and the two healthy ends sewed back together. ‘We removed six inches from each area with an adhesion,” says Anderson, “so only about a foot total, which isn’t much.”
The rest of the surgery went smoothly, and Luta recovered uneventfully. But how she managed to swallow a porcupine quill will likely never be known. “We had shot two porcupines a few months previously in the yard,” Rutherford says. “But they hadn’t gotten near the horses, and we picked their bodies up and put them directly in the trash.” Nor had Luta ever been found with a noseful of quills, as one might expect if the curious filly had inspected a passing porcupine a bit too closely. “Our best guess is that a porcupine got killed by a mower and maybe just a few quills were baled with some hay,” says Rutherford.
A serious setback
Luta stayed at the university clinic to recover, remaining on intravenous fluids, antibiotics and painkillers for several days. Rutherford visited her daily. “The first time I saw her, she looked terrible, with tubes hanging all over her,” she says. But the filly perked up with each passing day and was soon her normal, friendly self. “Every time I went to see her, she’d nicker at me.”
On the 10th day after surgery Rutherford arrived to bring Luta home. But that plan changed quickly: “I remember it was about 5 p.m., and I was so excited that she was coming home,” says Rutherford. “Then as I stood there, she started to lie down again and looked like she was in pain. The students watching her called the surgeon immediately, and I knew in my heart it wasn’t good.”
Luta was colicking again, but this time the timing of the episode provided an important clue about what was wrong: “When we do surgery on a horse we are initiating an inflammatory process that can lead to adhesions,” says Anderson. “Adhesions are a particular risk after anastomoses and in young horses. They form about three days after surgery, and if they are going to interfere with the gut in any significant way, you usually see signs of colic around day 10.” Luta’s new colic was right on that schedule.
After confirming by ultrasound that adhesions were causing the problem, Panizzi explained that fixing them would require a second surgery. “He told me they might be able to do it laparoscopically, without having to put her under anesthesia, but he would have to check because she might be too small,” says Rutherford. “He explained that they needed some room between her hips and ribs to insert the instruments, and she didn’t have much. Even as he told me this, I got the feeling he was preparing me for the fact that regular surgery might be my only option.”
Rutherford’s hunch was correct, and Panizzi returned with the news that Luta would need general anesthesia and another traditional colic surgery. “She’s my baby and she was in pain,” says Rutherford. “I wasn’t going to say no. On the drive home, though, I burst into tears and worried about how we would afford it all, but my wonderful husband told me that we’d figure something out. He understands what she means to me.”
For the second surgery, the team opted to make a new incision parallel to the first. “This is an area of debate,” says Anderson. “When you have to go back in, do you use the same incision line? Whenever you do a repeat surgery within two to four weeks and use the same incision, you disrupt an important stage of the healing process, and there is an increased risk of a hernia developing as it heals up again. Ten days is sort of a gray zone.”
Their next decision was whether to resect the intestines again---removing another portion of the gut---or to simply cut through and separate the “stuck” tissues. “Simply cutting through the adhesions can open up the intestines, and then you’ve created a very serious problem,” says Anderson. But after examining Luta’s new adhesions, the team decided they could safely cut most of them away without resecting more intestine.
“There was one adhesion that was pretty intimately involved with the intestine,” says Anderson. “We did worry that cutting that would one cause problems, but we were able to use a very neat surgical stapling device that reduces the risk of breaching the intestine; it fires two rows of staples then cuts in between.” After they finished, Luta’s second incision was closed, and she headed to recovery once again.
“I got the call later that night that everything had gone well,” says Rutherford. “But now I knew that we still had a ways to go.”
Because Luta now had two side-by-side incisions, the veterinarians put her in a hernia belt that would wrap securely around her belly to help support the pressure placed by the weight of the intestines on her abdominal wall as the incisions healed. She would need to wear the belt constantly, having it removed only for bandage changes, until the incisions were completely healed in about two months. Luta remained at the clinic for another 20 days, colic-free, before she was sent home.
“We had to clean her incision twice a day and change the bandages,” says Rutherford. “So they showed us how to put the hernia belt on. It’s very similar to a saddle.” Luta remained on stall rest for another month, then was gradually started on hand-walking and returned to full turnout.
Despite the hernia belt, Luta did develop a small bulge on her second incision line near her udder. “We were trailering her back for regular rechecks and they noticed it at the clinic,” says Rutherford. “You wouldn’t know it was there if you didn’t go looking for it, and they say it isn’t likely to affect her at all.”
Otherwise, Luta recovered with a clean bill of health.
Luta has had three mild colics since her last surgery, and each incident has passed with simple medical treatment. Still, Rutherford doesn’t take chances: “We don’t mess around, we load her up immediately and head to the university. We aren’t sure if these colics are related to what she went through, but she stays overnight so they can keep an eye on her.”
Now 5 years old, Luta is scheduled to start training this summer, and Rutherford hopes to be able to ride her next year. “I’d like to do some dressage with her,” she says. “But we will see what happens. I’m just happy she’s here.”
This article first appeared in EQUUS issue #442.