On my second night on-call for large animal surgery, I got home at 10:30 pm after helping the technicians with evening treatments. I’d run a total protein and lactate on an abdominal fluid sample from a Clydesdale suffering from colic cross with a suspected pelvic flexure impaction. Although the results were normal, I had a feeling that the doctor might decide to take the horse to surgery because of his intractable pain.
Sure enough, I was woken up at 1:45 am and told to come in. Soon after I arrived, the doctor and I walked the horse to the induction room to meet up with the anesthesia and surgical teams. (I’m always amazed at how the induction and surgery prep run like an oiled machine, all the personnel weaving in and around each other to get everything ready.) I scrubbed in alongside the attending surgeon and the resident, donning an impressive amount of sterile gear: booties, leg covers, gown, waterproof plastic sleeves, double layers of gloves, cap, and mask. Since my job was to write the surgery report afterward, I had to pay close attention to what the surgeons were doing. I watched as the attending surgeon manually explored the abdomen, mapping out the location of the various organs and determining what structure(s) were causing the horse to colic. She determined there was an extensive small colon impaction, so large in fact that it displaced the pelvic flexure from its normal position. Also, the distal small colon was very inflamed, which probably caused the impaction. The irritated bowel wasn’t allowing feces to pass, causing a build-up and eventually an impaction as the feces dried out.
To prevent the impacted fecal material we were removing from falling into the open abdomen, the surgeons exteriorized as much small colon as they could, placing the loops on a sterile table to the side of the horse sleeping on his back. Then, they made a small opening into the bowel at a spot furthest from the open abdomen, flushing and massaging the impaction until it broke up. This is where I got to be useful: my job was to constantly rinse off the bowel loops and the surgeon’s hands, to prevent fecal contamination and stop bacteria from entering the bloodstream through the incision. We collected a stool sample to test for Salmonella because it can cause small colon inflammation and impaction.
Although my body was definitely complaining by the time the horse was fully recovered at 7:45 am, I learned a lot from that surgery.