Vets rush in
As Lambert backed the trailer up to the hospital doors and rolled to a stop, the veterinary team threw open the doors.
“I saw (Dottie) lying in the trailer not moving, with exposed intestines,” said Gaby Herrera, a fourth-year veterinary student on the case. “I thought she might have died or was actively dying.”
Dr. Julia Gaida, large animal surgery resident, headed straight to Dottie’s neck where she quickly got an IV catheter placed in the jugular vein for the anesthesia team, including anesthesiology resident Alexander Amalfitano, to administer painkillers.
“Whenever there is a down horse on arrival, the concern is the safety of the horse and the people,” Claude said. “The level of fear and/or pain for these down horses is very high and managing them can be dangerous and very unpredictable.”
As the IV and painkillers were going in, Kinsley began cleaning Dottie’s exposed intestines with saline solution.
“We then applied a plastic trash bag with towel clamps to the skin to hold the intestine and filled that plastic bag with some saline to bathe the intestine,” he said.
Dottie was anesthetized in the trailer, loaded onto a skid gurney and wheeled directly to the operating room.
In all the commotion, Dedera had climbed out of the horse trailer window to avoid being in the way. “I remember feeling so much relief when those vets rushed in. I did a deep sigh, and I just hugged myself: my part's done,” she said. “The responsibility is off my chest. It was the most peaceful thing, and the horse was still alive.”
In the OR
Prep for surgery is usually routine: shave and disinfect the surgical site then drape things off and get to work.
But in this case, the routine shave was actually “the most difficult part, because we needed to clip hair and do a sterile preparation for the incision,” Kinsley said. “That's really hard trying to make sure that you're not getting hair on the intestine that's sticking out to keep everything nice and clean.”
Kinsley and the team, including Gaida and certified veterinary technician Ranee O’Connor, did several preps. “I placed the intestines within a steel bowl with saline to allow it to soak,” he said. As it soaked, he gently washed it. Then that bowl was removed and replaced with a new sterile bowl filled with saline. “So, the intestines were lavaged multiple times,” he continued.
All in all, Kinsley estimates they used 30 liters of saline (think 15 large pop bottles) to remove any hair and caked on mud from the initial injury. Thankfully there was no puncture to the intestine itself.
Finally, the site was draped for surgery.
Kinsley and team made a separate 15-centimeter incision near the puncture site: “To be able to have a hand inside the abdomen, palpate the area where the intestine was going through, make sure there wasn't any foreign bodies or foreign materials within the abdomen,” he said.
They also made the puncture wound slightly larger to decrease the pressure on the exposed intestine.
“Then from inside the abdomen and outside the abdomen, we were able to manually replace the intestine within the abdomen, pull that back up, look at it again and lavage anything that we were worried about,” Kinsley said.
Once happy with the placement, they did a routine exploration of the rest of the abdomen to “make sure there wasn’t anything else going on,” Kinsley said. Finally, they pulled the intestine “back out to make sure that it looked functional and tested its functionality to make sure that it had motility associated with it and that the blood supply looked in good shape.”
The last steps were to do one last good washing of the abdominal area with saline, suction out the saline, coil the intestine back in its final spot and sew things up.
From start to finish, fourth-year veterinary students on the surgical and anesthesia rotations, including Katie Wentz and Herrera, helped with prep, monitored vitals and cared for Dottie during recovery under the guidance of certified veterinary technicians Shauna Felcher, Ami Gilkey and April Simons. “A well-trained team that knows their task and is prepared can make the most stressful situations go smoothly and it increases the likelihood of saving a life,” Herrera said.
Though a puncture wound like this is rare, Kinsley said it presented a great learning opportunity for the students for a more common disembowelment scenario: complications from a castration.
“They may see a horse post-castration with intestines sticking out of the castration site in which you would do the same things to ensure the health and well-being of the intestine that's sitting there,” he said. “And you'd refer it just like this horse came to us. So, try and support it in a way, protect it in a way and send it to us for surgical intervention.”
A little rest for the weary
Following the surgery, the veterinary team discovered that Dottie had also fractured the frontal bone of her sinus (likely during the fall or while thrashing in the trailer).
“We could hear air whistling through the bone,” as she recovered from anesthesia, Claude said. As intense as it sounds, the injury wasn’t bothering Dottie and the case notes indicate it should heal itself, and she’ll just need to be monitored for some sinusitis.
Dottie recovered over several days in the hospital. She had a bit of fever at first, but after that, things leveled off and she was soon back to her normal self.
She’ll need to be on stall rest for a few weeks before she’s turned out with the rest of the herd. Then from there, it’ll be a month before she’s ready to be eased back into work.
A week after Dottie was pulled out of the trailer and entered the hospital on a gurney, she was led back out the hospital doors by Dedera and easily hopped into the horse trailer.
“I did not think that we would see this day, quite honestly. It's a little overwhelming, the joy, but also the burden of the responsibility of now it's my turn again,” Dedera said.
Dottie leaves the hospital with Dedera, while Dr. Kinsley says goodbye.
OREGON STATE UNIVERSITY
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