Pelvic flexure impaction

Re: Pelvic flexure impaction

Julian Earl — Tue, 23 Apr 2013 14:20:59 GMT

I used to give about 1 litre of liq paraffin without apparent problems; re.50 litres of salt water, myabe I was exaggerating, but ceratinly a large bucket or two jug and funnelled via the stomach tube and stopping if any reflux seemed likely. The amount was diovided over two occasions if necessary split by an hour or two. However, after one dose, one had to make sure you don't stand behind the horse until it was relaxed and symptomatically better, certainly if there was any hint of a cough !

Re: Pelvic flexure impaction

Wren — Mon, 22 Apr 2013 15:20:09 GMT

Liquid paraffin is very, very rarely used now. The first faeces to be passed after the obstruction had cleared were always coated in it so owners always thought that the LP had done the job. I suspect the LP was just sitting behind the blockage and was one of the first things out so not actually cause and effect! Plus it was messy and horrid and left your stomach tube permanently greasy.

I use table salt - I buy a couple of 500g bags from Morrisons (37p each) and keep them in the car. I even use my own money! I used to use lectade but salt's an awful lot cheaper and appears to do the same job.

Julian - 50l is a huge amount! Over what sort of time period do you give that? A horse's stomach only holds about 15l and I rarely give more than about 8l of fluid by stomach tube on a single occasion.

Re: Pelvic flexure impaction

Michael Woodhouse — Sun, 21 Apr 2013 17:51:15 GMT

Julian - I gave 5L of warm water with 500g epson salts. It then had 25L of IV fluids.

My understanding was liq paraffin not a lot of use and absolutely contraindicated if any reflux. Tiny amount on the lungs = death.

Re: Pelvic flexure impaction

Julian Earl — Sun, 21 Apr 2013 12:03:59 GMT

Solving pelvic impactions is all about fluid input isn't it? Via stomach tube, plus drips if needs be, but stomach tube plus 50 litres of water with500g of sodium chloride salt or epsom salts to draw water ino the gut lumen. I usually add in a couple of litres of liquid paraffin or liq paraffin emulsion to the water for good measure. Vigorous stirring or shaking will get it mixed in with th water adequately well. I have never got the fluid volume in without a stomach tube. syringing by the owner is a theoretical option but inadequate in practice.

HTH.

Re: Pelvic flexure impaction

Michael Woodhouse — Sat, 20 Apr 2013 22:26:53 GMT

Thanks

Re: Pelvic flexure impaction

Elisabeth Knappett — Sat, 20 Apr 2013 22:26:07 GMT

Somewhere back in the office, when I'm back in (hopefully not this weekend!) I will see if I can post an attachment/link. The paper that outlines it all is in The Veterinary Journal 2011 188, 77-82 on Elsevier, paper by Busoni et al.

Re: Pelvic flexure impaction

Michael Woodhouse — Sat, 20 Apr 2013 22:18:58 GMT

Do you have a copy of the procedure. It looks interesting, but can't see the protocol online.

Re: Pelvic flexure impaction

Elisabeth Knappett — Sat, 20 Apr 2013 22:09:38 GMT

Bit late now, but as a matter of interest, is anyone routinely ultrasound scanning recurrent colic cases? The FLASH technique, I think? Supposedly gives good information even in relatively inexperienced hands, I've only done it on a CPD day but was wondering if it used in general practice?

Re: Pelvic flexure impaction

Rob Davis — Fri, 19 Apr 2013 12:26:00 GMT

[quote user="Michael Woodhouse"]

It's being/been buried

[/quote]

Black balaclava, torch and shovel.....

Re: Pelvic flexure impaction

Michael Woodhouse — Thu, 18 Apr 2013 12:28:21 GMT

It's being/been buried

Re: Pelvic flexure impaction

Wren — Thu, 18 Apr 2013 12:15:51 GMT

I often sneak off to the knackerman's for a peak inside. They will leave them on a hook, ready opened for me.

Re: Pelvic flexure impaction

Michael Woodhouse — Thu, 18 Apr 2013 09:58:25 GMT

[quote user="MeeraM"]

Any chance of doing a PM?

[/quote]

Don't think so. Owner sad, but understanding that we did what we could with no option to refer.

Re: Pelvic flexure impaction

MeeraM — Thu, 18 Apr 2013 09:39:57 GMT

Any chance of doing a PM?

Re: Pelvic flexure impaction

Michael Woodhouse — Thu, 18 Apr 2013 09:25:01 GMT

Thanks both of you but PTS this AM. Looking worse and more purple!

Rectal findings didn't really change. Other than initial faeces removed nothing in there.

Re: Pelvic flexure impaction

MeeraM — Thu, 18 Apr 2013 09:18:23 GMT

I'd second a PFI secondary to a proximal primary obstruction where reflux is present and signs are deteriorating. Could be GS but again I'd expect some other signs.

Re: Pelvic flexure impaction

Wren — Thu, 18 Apr 2013 09:04:09 GMT

What were the subsequent rectal findings? Have any faeces been passed yet? As you know reflux hugely unlikely if a primary PFI with no other problems. I'd be suspect of an obstruction much higher up. I'd be interested to know whether the impaction has softened or moved at all. I generally rectal every time I see a colic (have you tried the new Buscopan? It really does improve the rectal exam 'experience').

Spontaneous reflux is always a bad sign and grass sickness is always a differential for this. They present in a wide range of clinical signs although I have found in generl that they're pretty hard to get a tube down (usually a telling sign) and on rectal you do often get the classic hard mucus-covered droppings lurking in the rectum. They don't all have the muscle fasiculations or sweating.

If it's just a primary impaction (which this almost certainly isn't) I do warn people that the odd one takes 5-7 days to clear. I had one that took a week in one of my own horses.

You're kind of between a rock and a hard place here unfortunately. You may well not be able to provide a definitive diagnosis without referral but then again the outcome may well be the same whether the horse is referred or not.

Might be an interesting one to PM if it ends up not improving.