Use of a pneumatic device for intraluminal enterolith fragmentation in horses

• Published in: Equine veterinary education Vol. 35; no. 9; pp. e579 - e588
• Main Authors: Machado Amaral Rosa, Bruna, Dornbusch, Peterson Triches, Duque Moreno, Juan Carlos, Schade, Jackson
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc 01-09-2023
• Subjects: Calculi; enterolithiasis; enterotomy; Fragmentation; horse; Horses; Intestine; Lithotripsy; obstruction; pneumatic ballistic lithotripsy; Segments; small colon; Surgical instruments
• ISSN: 0957-7734; 2042-3292
• DOI: 10.1111/eve.13814

Summary
Horses with enterolithiasis may develop clinical signs of colic due to partial or complete obstruction of the right dorsal, transverse or small colon. Laparotomy followed by enterotomy at the site of obstruction or mobilisation of enteroliths to intestinal segments deemed more appropriate for incision is indicated in these cases. However, surgical removal of enteroliths lodged in nonexteriorisable intestinal segments and/or not amenable to mobilisation may be labour intensive and dangerous. Pneumatic impact (or ballistic) lithotripsy is a potential tool for surgical resolution of simple and complex cases of enterolithiasis in horses. This study describes the use of a pneumatic lithotripsy device for intraluminal enterolith fragmentation in five cases of enterolithiasis. Seven calculi were successfully fragmented. In four cases, fragmentation was achieved at the site of obstruction and fragments exteriorised through an enterotomy incision created for device introduction or advanced towards the rectum and removed. In two cases, enteroliths were manipulated back to the pelvic flexure, fragmented and removed. Findings of this study suggest that intraluminal enterolith fragmentation can be used to avoid long enterotomy incisions and facilitate removal of calculi lodged in bowel segments that cannot be exteriorised. However, it is important to be aware of the risks of enterolith fragmentation in nonexternalisable bowel segments that cannot be visualised for intestinal viability assessment.