Incidental finding of a perforating foreign body (wooden stick) in the jejunum during surgical intervention for colic in a horse

Colic is the leading problem affecting equines worldwide. The primary cause of colic is gastrointestinal disease. Intestinal perforation due to a foreign body is relatively rare in horses and may present with signs of colic, with or without signs of endotoxemia (1). When horses fail to respond to medical treatment or show signs of colic that do not respond to analgesia, exploratory laparotomy is indicated. Our case report aimed to describe the clinical presentation, diagnosis, and treatment of a perforating foreign body in the intestine (jejunum) of the horse. A 13-year-old Italian Saddle mare was brought to the clinic with acute abdominal pain, that did not respond to analgesics. On clinical examination, the subject presented with temperature of 38.8 °C, heart rate of 53 beats per minute, mucosal congestion, capillary refill time (CRT > 3 s), Packed Cell Volume (PCV) of 35%, total protein (TP) of 8 g/dL, white blood cell count of 16,600/mm³ and lactate levels of 15 mmol/L. Abdominal palpation per rectum revealed distension of the intestinal loops, which could not be attributed to any pathology of the large intestine. An ultrasound scan was therefore performed, revealing several loops of tightly distended small intestine; consequently, the provisional diagnosis oscillated mainly between a strangulating mesenteric lipoma and entrapment of the small bowel in the epiploic foramen. Based on the severity of pain and clinical parameters, an exploratory laparotomy was immediately performed, under general anesthesia. On inspection of the abdominal cavity, it was observed that all the intestinal loops were correctly positioned; however, a mass of approximately 5 cm was identified at the level of the jejunum, involving the intestinal loop, the omentum and the mesentery. A surgical assessment of the affected intestine was performed, and an enterectomy with end-to-end anastomosis was carried out. The decision was supported by intraoperative thermographic monitoring, which highlighted temperature variations between the intestinal stumps (35.5 °C, range 34.6–36.0 °C) and the affected segment (34.1 °C, range 33.1–34.6 °C), with a = 1.3 °C. Postoperative dissection of the resected mass revealed the presence of a plant-based foreign body (wooden stick) located in the perimesenteric region, associated with an occlusive granulomatous inflammatory reaction in the jejunum and sequestrum formation (3). This case emphasizes that foreign body injury should be included in the differential diagnosis of small intestinal colic, especially when a focal inflammatory mass is encountered during surgery. While resection is the definitive treatment, intraoperative tools like thermography can objectively assist in assessing tissue viability, ensuring a safer surgical outcome.