Equis ISSN 2398-2977

Colon: displacement - left dorsal

Synonym(s): Nephrosplenic entrapment, renosplenic entrapment

Contributor(s): Debbie Archer, Rachel Murray, Peter Rakestraw

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: increasing pain, reduced fecal output, tympany, 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).

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 is usally 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.

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 fromPubMedandVetMedResource.
  • Albanese V & Caldwell F J (2014)Left dorsal displacement of the large colon in the horse.Equine Vet Educ26(2), 107-111VetMedResource.
  • Monreal Let al(2010)Enteral fluid therapy in 108 horses with large colon impactions and dorsal displacements.Vet Rec166(9), 259-263PubMed.
  • Marien T, Adrianssen A, Hoeck F V & Segers L (2001)Laparoscopic closure of the renosplenic space in standing horses.  Vet Surg30, 559-563PubMed.
  • Van Haverveld P D, Cox J & Biller D S (1999)Phenylephrine HCl as a treatment of nephrosplenic entrapment in a horse.Equine Vet Educ11(6), 282-284VetMedResource.
  • Burba D J & Moore R M (1997)Renosplenic entrapment: a review of clinical presentation and treatment.Equine Vet Educ9(4), 180-184VetMedResource.
  • Parks A H (1996)Displacement of the large colon - conservative versus surgical management.Comp Cont Educ Pract Vet18(1), 84VetMedResource.
  • Kalsbeck H C (1989)Further experience with non-surgical correction of nephrosplenic entrapment of the left colon in the horse.Equine Vet J21(6), 442-443VetMedResource.


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