ISSN 2398-2977      

Colon: displacement - left dorsal

pequis

Synonym(s): Nephrosplenic entrapment, renosplenic entrapment, NSE, LDD


Introduction

  • Displacement of the ascending colon between the dorsal abdominal wall, the left kidney, the nephrosplenic ligament and the dorsal border of the spleen.
  • Cause: unknown.
  • Signs: signs of colic (pawing, lying down, rolling, etc), reduced fecal output, tympany, bloat, abdominal distention, few systemic signs. Occasionally peracute.
  • Diagnosis: rectal examination, ultrasonography.
  • Treatment: surgery, rolling (needs experience), medical treatment, including use of phenylephrine.
  • Prognosis: good if there is no marked vascular compromise of the colon wall.

Pathogenesis

Etiology

  • Uncertain.
  • May be a combination of tympany of the left colon and rapid splenic contraction.
  • Gastric dilatation may cause spleen to move away from abdominal wall creating room for colon to move into.

Predisposing factors

General

  • Gelding.
  • Large breed (large framed Warmblood types), Thoroughbred horses Thoroughbred, young adults (2-3 years old).

Pathophysiology

  • Displacement of ascending colon into nephrosplenic space → obstruction → accumulation of ingesta and gas.
  • Tympany of left colon and splenic contraction → colon moves dorsally, usually from a cranial direction → spleen refills and its base hooks under colon → colon trapped under left kidney → colon may herniate into nephrosplenic space as far as the middle of the right dorsal and ventral colon Colon: displacement 01 - left dorsal (diagram)Colon: displacement 02 - left dorsal (diagram).
  • Entrapment may be complete (edge of spleen laterodorsal to colon) or partial (edge of spleen ventral to colon).
  • Spleen usually engorged; nephrosplenic ligament stretched.
  • Colon over nephrosplenic ligament may be rotated 180° along its long axis → ventral colon lies above dorsal colon.
  • Diaphragmatic and sternal flexures lie between the stomach and the left lobe of the liver.
  • Impaction of the colon may be present in the pelvic flexure caudal to the entrapment or the ventral or dorsal large colon cranial to nephrosplenic entrapment (wedged against the stomach).

Timecourse

  • Usually protracted course, occasionally peracute (shock within 3-6 h).

Epidemiology

  • Usually seen in mature geldings of large breeds.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Gillen A, Kottwitz J & Munsterman A (2020) Meta-analysis of the effect of treatment strategies for nephrosplenic entrapment of the large colon. J Equine Vet Sci 92, 103169 PubMed.
  • Gillen A M, Munsterman A S & Reid Hanson R (2019) Evaluation of phenylephrine and exercise with or without trocarization for treatment of suspected nephrosplenic entrapment in horses. JAVMA 254 (12), 1448-1453.
  • Nelson B B, Ruple-Czerniak A A, Hendrickson D A & Hackett E S (2016) Laparoscopic closure of the nephrosplenic space in horses with nephrosplenic colonic entrapment: factors associated with survival and colic recurrence. Vet Surg 45 (S1), O60-O69 PubMed.
  • Burke M J & Parente E J (2016) Prosthetic mesh for obliteration of the nephrosplenic space in horses: 26 clinical cases. Vet Surg 45 (2), 201-7 PubMed.
  • Albanese V & Caldwell F J (2014) Left dorsal displacement of the large colon in the horse. Equine Vet Educ 26 (2), 107-111 VetMedResource.
  • Fultz L E, Peloso J G, Giguère S & Adams A R (2013) Comparison of phenylephrine administration and exercise versus phenylephrine administration and a rolling procedure for the correction of nephrosplenic entrapment of the large colon in horses: 88 cases (2004-2010). JAVMA 242 (8), 1146-51 PubMed.
  • Baker W T, Frederick J, Giguere S, Lynch T M, Lehmkuhl H D & Slone D E (2011) Reevaluation of the effect of phenylephrine on resolution of nephrosplenic entrapment by the rolling procedure in 87 horses. Vet Surg 40 (7), 825-9 PubMed.
  • Frederick J, Giguere S, Butterworth K et al (2010) Severe phenylephrine-associated hemorrhage in five aged horses. JAVMA 237 (7), 830–834 PubMed.
  • Marien T, Adrianssen A, Hoeck F V & Segers L (2001) Laparoscopic closure of the renosplenic space in standing horses. Vet Surg 30, 559-563 PubMed.
  • Hardy J, Minton M, Robertson J et al (2000) Nephrosplenic entrapment in the horse: a retrospective study of 174 cases. Equine Vet J (32), 95–97 PubMed.
  • Van Haverveld P D, Cox J & Biller D S (1999) Phenylephrine HCl as a treatment of nephrosplenic entrapment in a horse. Equine Vet Educ 11 (6), 282-284 VetMedResource.

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