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desensitisation with these protocols, neither reported any
visceral pain reactions during surgery suggesting there may be
some advantages to using paravertebral anaesthesia, which
may block visceral afferent activity in the spinal nerves.No dif ficulty was encountered decompressing the
proximal small intestine through to the ileocaecal junction
although relatively little fluid distension was present in the
distal jejunum and required only a single pass to milk the
contents into the caecum. Dealing with more signi ficant
distension typically associated with strangulating lesions,
however, is expected to be far more challenging (Coomer
et al. 2016). The presence of the mesocolon was not a
notable hindrance to milking intestinal contents from the left
fl ank into the caecum on the right side, presumably following
a path under or behind its caudal limit.
The more common indications for a standing flank
laparotomy (Graham and Freeman 2014) are being
increasingly replaced by, or combined with less invasive
laparoscopic techniques (Smith et al.2005; Rocken et al.
2007; Kelmer 2009; Goodin et al.2011; Witte et al.2013).
Laparoscopic instruments were not available but could have
helped improve visualisation of abdominal contents to
exclude other possible gastrointestinal lesions and direct tissue
handling more accurately. The ability to differentiate between surgical and medical
colic cases has improved with an increased understanding of
gastointestinal pathophysiology (Singer and Smith 2002) and
abdominal ultrasound has increased the sensitivity of
detecting speci fic intestinal lesions (Klohnen et al.1996;
Beccati et al.2011; Busoni et al.2011). We are therefore
better equipped to identify lesions that could be
appropriately or even preferentially managed through a
standing flank approach as illustrated by this case report. The
ability to accurately quantify abdominal lesions
preoperatively and the availability of hand assisted
laparoscopic techniques to improve visualisation, may
contribute to the flank approach becoming a more
favourable technique in select colic cases. This would avoid
the risks associated with general anaesthesia that are
particularly important in late pregnant mares and aged or
debilitated patients that represent an even higher
anaesthetic risk than normal (Coomer et al.2016). Although
there are currently few candidates for standing colic surgery,
increased reporting of this approach will help establish more
effective anaesthesia protocols to optimise perioperative
analgesia.
Authors ’declaration of interests
No con flicts of interest have been declared.
Ethical animal research
No ethical review information has been declared for this case
report.
Source of funding
None.
Authorship
All authors were involved in the case reported and have
read and contributed to the editing of the manuscript.
Manufacturers' addresses
1Baxter Healthcare Ltd, Sydney, New South Wales, Australia.2Schering-Plough Animal Health Ltd, Auckland, New Zealand.3Bayer New Zealand Ltd, Auckland, New Zealand.4Caledonian Holdings Ltd, Auckland, New Zealand.5Norbrook New Zealand Ltd, Auckland, New Zealand.6Zoetis, Auckland, New Zealand.7Fort Dodge Animal Health, Auckland, New Zealand.8CEVA Animal Health Ltd, Glenorie, New South Wales, Australia.9Kruuse UK Ltd, UK.10Ethicon, Johnson & Johnson Medical Ltd, New South Wales,
Australia.
11B.Braun, Auckland, New Zealand.12Bomac Laboratories Ltd, Auckland, New Zealand.13Platinum Performance Inc., Buellton, California, USA.
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534 EQUINE VETERINARY EDUCATION / AE / OCTOBER 2018

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