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Case Report 

Complete small colon ablation and fixation of the mesocolon to 
the internal anal sphincter due to prolapse in a young draft 
horse 
Cristian Mihăiță Crecan 1, Valeria Ciulu-Angelescu 1 *, Alexandru Florin Lupșan 1 , Denisa Bungărdean1 , Zsofia 
Daradics2 , Mirela Alexandra Tripon3 , Iancu Adrian Morar 3, Cosmin Petru Peștean1 

1 Department of Anaesthesiology and Surgery, University of Agricultural Sciences and Veterinary Medicine 
of Cluj-Napoca, 400372 

2 Department of clinical sciences , University of Agricultural Sciences and Veterinary Medicine of Cluj-Na-
poca, 400372 

3  Department of Obstetrics and Reproduction, University of Agricultural Sciences and Veterinary Medicine 
Cluj-Napoca, 40037 

 
* Correspondence: valeria.angelescu@usamvcluj.ro; 

Abstract: A two-year-old draft stallion was referred for evaluation of a type IV prolapse. A thorough physical examination followed 
by blood tests was performed to assess the situation. Following the examination, it was concluded that the protruded small colon 
was devitalised, measured approximately one and a half meters and mesenteric and vascular injury were present. A standing surgery 
approach was chosen for the present case, in which the affected tissue was excised and the remaining mesentery was ligated to the 
internal anal sphincter to decrease pressure during straining in the physiological act of defecation. Six months later, after an une-
ventful recovery, the stallion was in good health and performing its reproductive duties. To our knowledge, this is the first report of 
a mesenteric fixation to the internal anal sphincter in a horse. The study confirms that this technique is a feasible method that can be 
used in the complete ablation of the small colon in prolapses. 

Keywords: small colon, prolapse, mesocolon, colonic fixation, ablation 

 
 

1. Introduction 
In horses, rectal prolapse frequently develops because of conditions that also 

cause prolonged and intense straining, such conditions usually have their origin in the 
gastrointestinal sphere some examples are intestinal parasitism, diarrhea, colitis, and 
proctitis. Other times, prolapse can develop secondary to conditions that increase ab-
dominal pressure, such as dystocia, constipation, colic, urinary tract obstruction, retained 
fetal membranes, foreign bodies, or obstructive rectal tumors. [1-8] There are factors that 
can predispose to rectal prolapse and they are usually related to the lack of good function 
in the rectum and the anal sphincter, such as loss of tone in the anal sphincter, loose at-
tachments of the mucous membrane to the muscular coat of the rectum, or loose attach-
ments of the rectum to perirectal tissues. [4] There are four different kinds of rectum and 
small colon prolapse in horses. Only the mucosa and submucosa prolapse through the 
anus in type I, but all layers of the rectal ampulla do so in type II. A variable portion of 
the small colon prolapses through the anus in type III, and the peritoneal rectum as well 
as a variable portion of the small colon prolapse through the anus in type IV. Most 

Received: 15.11.2023 

Accepted: 25.12.2023 

Published: 30.12.2023 

DOI: 10.52331/cvj.v28i3.58 

 

 

 

Copyright: © 2021 by the authors. 

Submitted for possible open access 

publication under the terms and con-

ditions of the Creative Commons At-

tribution (CC BY) license (http://crea-

tivecommons.org/licenses/by/4.0/). 



Cluj Vet J 2023, vol 28, issue 3 26 of 30 
 

dystocia mares have this latter kind. [1-6] Due to mesenteric and vascular damage, the prognosis is guarded to poor 
for types III and IV but good for types I and II. As soon as the prolapse is longer than 30 cm, a descending mesocolon 
rupture should be suspected. Additionally, the anal sphincter itself may mechanically compress, reducing venous 
return. [3],[4],[6] To avoid postponing the choice to intervene surgically, prompt detection of a ruptured mesocolon 
is essential. The likelihood of a favorable outcome can be decreased if the necrosis of the intestine is allowed to 
progress to the point of peritonitis. The absence of a viable distal small colon that can be accessible and connected 
to the proximal portion of the small colon via anastomosis is another potential issue with this condition. [6] 

2. Case presentation 

2.1. History 

A two-year-old stallion was referred to the veterinary center at Cluj-Napoca Faculty of Veterinary 
Medicine Equine Clinic for assessment following a rectum and small colon prolapse. According to reports, the 
prolapsed intestine extended approximately 1.5 meters. The owner reported that the stallion entangled itself 
with the rope that it was tied with, fell, and struggled unsuccessfully to get back up until the morning when 
it was found. 

2.2. Clinical findings 

Upon arrival, the stallion was in moderate pain, depressed but stable. Rectal temperature could not be 
taken. Mucosal membranes were pink, heart rate was 50 bpm, respiratory rate was 18 rpm, capillary refill time 
of 3 seconds, and the extremities had a normal temperature without perceptable pulse on the digital arteries. 
A type IV rectal prolapse (Figure 1.a.) measuring approximately 1.5 meters in length and with an edematous, 
red-purple color was observed extending to a point below the hock (Figure 1.b.). A complete blood count, 
chemistry profile, and electrolyte panel were performed. The tests revealed mild metabolic acidosis, slight 
ionic calcium and sodium imbalance, and blood glucose elevation. The creatine kinase levels were elevated 
up to 6 times over the superior limit. 

 

 
 

(a) (b) 

Figure 1. Preoperative assesment (a) Type IV rectal prolapse with an edematous, red-purple color extending to a point 
below the hock; (b) measuring approximately 1.5 meters 



Cluj Vet J 2023, vol 28, issue 3 27 of 30 
 

2.3. Preoperative management 

A catheter was aseptically inserted in the jugular vein and flunixin meglumine (1.1 mg/kg, Niglumin®) 
was administered. Cefquinome (1 mg/kg, Cobactan) was administered  intramuscularly. Afterward, the 
stallion was guided into a padded induction stall in preparation for the standing surgery to prevent accidents 
in case it became necessary to undergo general anesthesia due to pain and inability to remain in a standing 
position. There, fluid therapy was instituted with isotonic saline (NaCl 0.9%) and preparations for the surgery 
were started. The tail was braided and a tail bandage was applied to keep tail hairs out of the surgical field 
and to minimize contamination. The caudal gluteal region and the area at the base of the tail were clipped and 
aseptically prepared. An epidural anesthesia was performed using 8 ml of mepivacaine HCl (Mecain® 10 
mg/ml) in the sacrococcygeal space using an 21 gauge hypodermic needle. The anal sphincter was additionally 
infiltrated with 40 ml of lidocaine HCl (Lidobel®) for further analgesic effect. The prolapse was resolved using 
standing resection and anastomosis of the rectal prolapse as described in the literature [1][5] with the addition 
of fixating the mesocolon to the internal anal sphincter. 

2.4. Treatment 

To sustain the prolapse during dissection, two catheter stylets were inserted perpendicularly in the anal 
sphincter and healthy mucosa in order to insert stay sutures. Full circumferential incisions were made in the 
intussusceptions's exterior and inner walls, with a No. 24 scalpel blade. (Figure 2.) Along the way, bleeding 
mesenteric arteries were ligated with AssuCryl® PGA No. 2. At this point, the remaining mesentery was 
ligated to the internal anal sphincter using a simple interrupted suture pattern with AssuCryl® PGA No. 2. 
(Figure 3.) Afterward, a whole thickness simple interrupted pattern was used to appoint the proximal and 
distal ends. (Figure 4.) 

 

 
Figure 2. Full circumferential incisions in the exterior and inner walls 

 

 

 



Cluj Vet J 2023, vol 28, issue 3 28 of 30 
 

 
Figure 3. Schematic representation of the surgery (a) Small colon prolapse; (b) Full circumferential incision and stay 

sutures; (c) the mesentery ligated to the internal anal sphincter using a simple interrupted suture pattern; (d) 
end result, red arrow: internal anal sphincter; blue arrow: external anal sphincter 

 

Figure 4. Postoperative result 

2.5. Postoperative Care 



Cluj Vet J 2023, vol 28, issue 3 29 of 30 
 

After the surgery was completed, the stallion was admitted into the clinic for postoperative care for six 
days. immediately post-surgery, the stallion was administered 20 ml of tetanus antiserum, and a nasogastric 
tube was placed. Via the nasogastric tube, the horse was administered daily 3 liters of mineral oil for five days. 
Flunixin meglumine (1.1 mg/kg, Niglumin®) and cefquinome (1 mg/kg, Cobactan) were administered 
intravenously respectively intramuscularly daily for the entire duration of the stay in the clinic. 

2.6. Postoperative Results 

After a week spent in the clinic, the stallion was discharged and transported back to its owner's stable. The 
owner agreed to regular telephonic questionnaires about the horse's evolution. The recuperation was reported 
to be uneventful up to the 6 months postoperatively mark and normal reproductive duties were resumed. 

 

4. Discussion 
Ischaemic damage of the small colon can occur secondary to a rectal prolapse,[6] in the case we presented, 

the mesentery was stretched and presented multiple tears thus disrupting the vascular supply to the terminal small 
colon. The interruption of the blood supply to the section of the small colon that has prolapsed must be considered 
while treating intussusception and small colon prolapse. [9] The patient must be closely watched for indications 
of peritonitis if intussusception of the small colon is suspected, and additional testing by a midline exploratory 
laparotomy may be necessary.[9] Jacobs KA et al suggested that if the small colon loses its blood supply, a colos-
tomy should be considered because it is not surgically accessible enough to remove the small colon and connect it 
to the rectum.[9] The surgeon did not opt for a colostomy because we were able to connect the remaining intestine 
with the rectum and secure it with the remaining mesentery to the internal anal sphincter. It is the author's belief 
that securing the mesentery offered better stabilisation and decreased pressure during straining in the physiolog-
ical act of defecation. Similar approaches are used in humans with rectal prolapses, the differences consisting in 
the type of material used to achieve a better fixation. The rectum is fixated via a prosthetic rectopexy based on the 
notion that rectopexy via adhesion and fibrosis is viable, and that mesh fixation would be more successful than a 
simple suture.[10] Materials including fascia lata, nylon, polypropylene, marlex, polyvinyl alcohol, and polytape 
are utilized in the development of meshes and other prostheses to facilitate fixation.[10]  It was proven that using 
these methods improves fecal incontinence in most cases, however, opinions on the effects regarding constipation 
are divided.[10] In the case we are presenting, the owner did not report any episodes of constipation, normal bowel 
movement, and defecation being restored. The study confirms that this technique is a feasible method that can be 
used in the complete ablation of the small colon in prolapses. 

 

Author Contributions: Cristian Mihăiță Crecan, Valeria Ciulu-Angelescu and Cosmin Petru Peștean had equal contri-
bution. All authors have read and agreed to the published version of the manuscript. 

Funding: This research received no external funding 

Institutional Review Board Statement: Not applicable. 

Conflicts of Interest: The authors declare no conflict of interest. 

References 
 

1. Freeman, D.E. (2019) Rectum and anus. In: Equine Surgery, 5th edn., Eds: J.A. Auer and J.A. Stick, Elsevier, pp 632-645. 
2. Archer, D.C. (2013) Oral and gastrointestinal emergencies. In: Handbook of Equine Emergencies, 1st edn., Ed: D.C. Archer, 

Elsevier, St Louis. pp 59-84. 
3. Dallap Schaer, B. and Orsini, J.A. (2014) Gastrointestinal system. In: Equine Emergencies: Treatment and Procedures, 4th 

edn., Eds: J.A. Orsini and T.J. Divers, Elsevier, St Louis. pp 157-237. 



Cluj Vet J 2023, vol 28, issue 3 30 of 30 
 

4. Schumacher, J. (2002) Diseases of the small colon and rectum. In: Manual of Equine Gastroenterology, 1st edn., Eds: T. 
Mair, T. Divers and N. Ducharme, W.B. Saunders, St Louis. pp 299-315. 

5. Turner, T.A. and Fessler, J.F. (1980) Rectal prolapse in the horse. J. Am. Vet. Med. Ass. 177, 1028-1032. 
6. Buschiazzo, C. & Cancela, M. & Simian, M.. (2010). Permanent colostomy after small colon prolapse in a parturient mare. 

Equine Veterinary Education - EQUINE VET EDUC. 22. 223-227. 
7. Levine SB. Surgical treatment of recurrent rectal prolapse in a horse. J Equine Med Surg. 1978;2:248–249. 
8. Robert MP, Main de Boissiere M, Depecker MC, et al. Type IV rectal prolapse secondary to a long-standing urinary bladder 

lithiasis in a donkey. Equine Vet Educ. 2016;28:625–626. 
9. Jacobs KA, Barber SM, Leach DH. Disruption of the blood supply to the small colon following rectal prolapse and small 

colon intussusception in a mare. Can Vet J. 1982 Apr;23(4):132-4. 
10. Shin EJ. Surgical treatment of rectal prolapse. J Korean Soc Coloproctol. 2011;27(1):5-12. 
 

 
 


