Post-operative complications following diaphragmatic hernia repair in a 9-year-old hunter pony

Abstract

A 9-year-old hunter pony gelding presented to the Cornell University Hospital for Animals after a several-hour history of severe colic. The referring veterinarian had felt loops of distended small intestine on rectal palpation and obtained several liters of gastric reflux following passage of a nasogastric tube. The patient was dull and painful on presentation with a heart rate of 104 beats per minute. Ultrasound examination revealed distended loops of small intestine in the abdomen and identified a severely thickened segment of small intestine in the thorax just cranial to the diaphragm. A diaphragmatic hernia was presumptively diagnosed and the patient was immediately taken to surgery for further evaluation and repair. The surgery was uncomplicated, but over the next three weeks the patient developed several complications that were diagnosed and managed in turn, including endotoxemia, pleural effusion, post-operative ileus, incisional dehiscence, enteritis, and adhesion formation. This paper will focus on the pathophysiology, diagnosis, treatment, and prevention of many common post-operative colic complications.