Tercio

The wire can be seen above a thin layer of sand

Repeat radiographs one week later

Dr. Errico & Dr. Inoue locate the inflamed bowel

Radiograph of the removed section of small intestine to confirm the wire's location

Tercio is a 19 year old Peruvian Paso owned by Kathy Keenan of Loomis. He presented to LBEMC for inappetance and weight loss. He was initially examined in the field by Dr. Anne Hitchcock and had a fever, increased heart rate and respiratory rate with labored breathing.

He came into the clinic for further diagnostics. His blood work revealed changes consistent with an ongoing inflammatory response. Abdominal radiographs were taken and to our surprise a small radioopaque foreign body (suspected wire) was seen in his ventral abdomen. A belly tap was performed where we take a sample of the fluid surrounding his intestines. Normal abdominal fluid is straw colored and clear. Tercio’s abdominal fluid was essentially pus which indicated that an advanced peritonitis was the cause of his fever, weight loss and inappetance. This peritonitis was most likely a result of the wire perforating his intestine as it moved along his intestinal tract.

Tercio was started on injectable antibiotics and anti-inflammatories. He was offered anything he would eat which consisted of everything from fresh grass to equine senior. A long term catheter was placed in his jugular vein since he would be on antibiotics and anti-inflammatories for severalweeks. His abdomen was clipped and a thorough abdominal ultrasound was performed. On ultrasound we could see thickened sections of the wall of his small intestine as well as his large colon. Radiographs were taken again after he had been in the hospital for 5 days. The wire appeared to be in the same location.

Wire removal surgery can be very risky due to the fact that the intestinal tract is approximately 100 feet long and, because of attachments inside the abdomen, not all of the intestine can be exteriorized outside the abdomen for safe access to the foreign object. Also, it is not ideal to perform abdominal surgery on a horse that has infectious peritonitis because this could compromise the integrity of the closure of the abdomen and increases the risk of an incisional infection. The concern was that if we took him to surgery and were not able to find the wire we would not have gained any ground in improving his condition. However, the wire needed to be removed in order for Tercio to heal.

OnceTercio was stabilized, he was taken to surgery for an exploratory celiotomy. In all of the radiographs, ultrasounds and even with the use of a metal detector, we felt fairly certain that the wire was staying put just to the left of midline on his ventral abdomen. He was anesthetized and laid on his back on the surgery table. A mass of small intestine was found that was adhered to itself, the apex of his cecum and his left body wall. These three structures should not be attached to one another. The adhered cecum and small intestine were freed from the body wall. The cecum was freed from the small intestine. The wire could not be palpated but the discreet section of inflamed and hemorrhagic bowel seemed to be the only place where the wire could be located. To remove this portion of small intestine, a resection was performed which removed approximately six feet of small intestine in his proximal jejunum. Radiographs of the piece of bowel removed confirmed the inclusion of the wire. Tercio had an excellent recovery from anesthesia and did well in the hospital postoperatively.

Tercio is currently being rehabilitated in order to give the abdominal incision time to heal properly. All horses with ventral midline incisions require approximately 90-120 days of rehabilitation before they are back to full work or full turnout. Tercio is no longer being ridden due to his Degenerative Suspensory Ligament Desmitis which affects many Paso’s. But he is eager to be turned out in the field where he is the leader of two sheep.

Horses are usually very selective eaters, but we do see wires and nails occasionally causing problems for horses. This can be a life threatening condition and Tercio was lucky to have a dedicated owner that supported him through this.