Todayโs path rounds are on ๐ฌ๐ญ๐ซ๐๐ง๐ ๐ฎ๐ฅ๐๐ญ๐ข๐ง๐ ๐ฅ๐ข๐ฉ๐จ๐ฆ๐๐ฌ! Inspired by a case I had last week 
๐๐ก๐๐ญ ๐ข๐ฌ ๐ข๐ญ?
๐๐ญ๐ซ๐๐ง๐ ๐ฎ๐ฅ๐๐ญ๐ข๐ง๐ ๐ฅ๐ข๐ฉ๐จ๐ฆ๐๐ฌ are one of the many causes of colic in horses. In this condition, there is a ๐ฅ๐ข๐ฉ๐จ๐ฆ๐ (a benign tumour of fat) that is ๐ฉ๐๐๐ฎ๐ง๐๐ฎ๐ฅ๐๐ญ๐๐ (a long stalk with a mass on the end). Thanks to this long stalk, the mass can ends up wrapped around a piece of intestine, causing ๐ข๐ง๐๐๐ซ๐๐ญ๐ข๐จ๐ง (complete loss of blood supply).
๐๐ก๐จ ๐ ๐๐ญ๐ฌ ๐ข๐ญ?
This condition is pretty much exclusive to horses. Typically it is teenaged or older horses that get this condition, because the mass takes time to develop.
๐๐ก๐ฒ ๐ข๐ฌ ๐ญ๐ก๐ข๐ฌ ๐ ๐ฉ๐ซ๐จ๐๐ฅ๐๐ฆ?
Not having a blood supply to a tissue can cause a lot of issues. In this case, the blocked piece of intestine becomes ๐๐๐๐ฆ๐๐ญ๐จ๐ฎ๐ฌ (accumulation of excess fluid in the tissue), ๐๐จ๐ง๐ ๐๐ฌ๐ญ๐๐ (non-flowing blood in the vessels) and ๐ก๐๐ฆ๐จ๐ซ๐ซ๐ก๐๐ ๐ข๐ (leakage of blood into the tissue). With time, the tissue of the intestine becomes ๐ง๐๐๐ซ๐จ๐ญ๐ข๐ (cell death), and may even rupture causing feed material to be released into the abdomen.
๐๐ก๐ฒ ๐ฐ๐จ๐ฎ๐ฅ๐ ๐ญ๐ก๐๐ฌ๐ ๐จ๐ฎ๐ญ๐๐จ๐ฆ๐๐ฌ ๐ก๐๐ฉ๐ฉ๐๐ง?
When the intestine becomes entrapped, the first structures to get compressed are the veins, because they have very thin and deformable walls. Veins normally drain blood out of an area, so if they become obstructed, no drainage can occur (congestion), despite the arteries still providing new blood to the tissue. This leads to increased pressure within the vessels as they try to cope with all the fluid. Eventually, the vessels become leaky, allowing fluid to escape, causing edema. If the vessels become significantly damaged, then red blood cells may be able to escape as well, causing hemorrhage.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐๐ข๐๐ ๐ง๐จ๐ฌ๐๐?
Typically horses with strangulating lipomas present with severe colic signs. As part of a diagnostic workup, the veterinarian may be able to feel dilated pieces of intestine on rectal examination, or visualize them using an ultrasound. These horses may also have ๐ซ๐๐๐ฅ๐ฎ๐ฑ (excessive fluid in the stomach) on ๐ง๐๐ฌ๐จ๐ ๐๐ฌ๐ญ๐ซ๐ข๐ ๐ญ๐ฎ๐๐ข๐ง๐ (passing a tube through the nose into the stomach), because feed material is unable to move through the intestines. If there is a rupture of the intestinal wall, the veterinarian may also see feed material on ๐๐๐๐จ๐ฆ๐ข๐ง๐จ๐๐๐ง๐ญ๐๐ฌ๐ข๐ฌ (sticking a needle into the abdomen to collect a fluid sample).
At necropsy, this condition is quite visually striking! Because the intestine that is entrapped becomes hemorrhagic, the pathologist can very quickly identify the affected piece of intestine due to its dark red to black coloration. From there, identifying the lipoma is easy, as you just have to follow the hemorrhagic intestine to its โsourceโ.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐ญ๐ซ๐๐๐ญ๐๐?
These have to be treated surgically, in order to remove the lipoma and put the intestines back into their correct positions. Often, horses will have to have a ๐ซ๐๐ฌ๐๐๐ญ๐ข๐จ๐ง ๐๐ง๐ ๐๐ง๐๐ฌ๐ญ๐จ๐ฆ๐จ๐ฌ๐ข๐ฌ (removal of a piece of intestine) to remove the dead segment as well.
๐๐ก๐จ๐ญ๐จ๐ฌ
1) The abdomen of a horse with a strangulating lipomaโฆ can you see the affected piece of intestine?
2-4) Various examples of strangulating lipomas, with the lipomas and hemorrhagic intestine visible.
๐๐จ๐ฎ๐ซ๐๐๐ฌ
Maxie, G. Jubb, Kennedy and Palmerโs Pathology of Domestic Animals, Volume 2. Sixth Edition.
Photos 1-3 courtesy of University of Calgary Diagnostic Services Unit.
Photo 4 courtesy of Noahโs Arkive.
