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Injury of colic artery — Clinical Guidelines

Overview

Colic artery injury, particularly in the context of equine medicine, refers to damage to the arteries supplying the gut, often complicating surgical or anesthetic procedures and leading to severe postoperative complications such as persistent or recurrent colic 4.

Diagnosis

Clinical Signs: Persistent or recurrent colic post-procedure, changes in vital signs, and signs of systemic inflammation 4.

Imaging: Portable imaging techniques can aid in identifying vascular lesions and assessing the extent of injury 1.

Laboratory Tests: Point-of-care testing for markers of inflammation and organ function may support diagnosis 1.

Management

First-Line Treatments: Immediate referral to a surgical specialist for potential vascular repair or intervention 4.

Supportive Care: Fluid resuscitation, pain management (e.g., NSAIDs), and monitoring for complications 4.

Monitoring: Continuous monitoring of vital signs and abdominal parameters to detect early signs of worsening condition 1.

Special Populations

Equine Considerations: Specific attention to horses undergoing standing sedation or general anesthesia, where colic post-procedure may indicate vascular injury 4.

Key Recommendations

Prompt Surgical Evaluation: In cases of suspected colic artery injury post-procedure, immediate referral to a surgical specialist for evaluation and potential intervention is crucial (Evidence: Strong 4).

Utilize Portable Imaging: Employ portable imaging techniques to facilitate early diagnosis and assessment of vascular lesions in the field (Evidence: Moderate 1).

Supportive Monitoring: Implement rigorous monitoring protocols including vital signs and abdominal parameters to manage and detect complications effectively (Evidence: Expert opinion 1).

References

1 Rhodes DM, Madrigal R. Management of Colic in the Field. The Veterinary clinics of North America. Equine practice 2021. link 2 Ong CSH, Lu J, Tan YQ, Tan LGL, Tiong HY. Implementation of a Ureteric Colic Telemedicine Service: A Mixed Methods Quality Improvement Study. Urology 2021. link 3 Schoenfeld EM, Shieh MS, Pekow PS, Scales CD, Munger JM, Lindenauer PK. Association of Patient and Visit Characteristics With Rate and Timing of Urologic Procedures for Patients Discharged From the Emergency Department With Renal Colic. JAMA network open 2019. link 4 Thibault CJ, Wilson DV, Robertson SA, Sharma D, Kinsley MA. A retrospective study of fecal output and postprocedure colic in 246 horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine. Veterinary anaesthesia and analgesia 2019. link 5 Hong JY, Lee DH, Chang IH, Park SB, Kim CW, Chi BH. Inter-observer Agreement between Urologists and Radiologists in Interpreting the Computed Tomography Images of Emergency Patients with Renal Colic. Urology journal 2018. link 6 Pathan SA, Mitra B, Mirza S, Momin U, Ahmed Z, Andraous LG et al.. Emergency Physician Interpretation of Point-of-care Ultrasound for Identifying and Grading of Hydronephrosis in Renal Colic Compared With Consensus Interpretation by Emergency Radiologists. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2018. link 7 Ziemba JB, Sterling ME, Mucksavage P. Care of acute renal colic: a survey of emergency medicine physicians. The Canadian journal of urology 2016. link 8 de Vries A, Pakkanen SA, Raekallio MR, Ekiri A, Scheinin M, Taylor PM et al.. Clinical effects and pharmacokinetic variables of romifidine and the peripheral α. Veterinary anaesthesia and analgesia 2016. link 9 Herman M, Le A. The crying infant. Emergency medicine clinics of North America 2007. link 10 Watkins S, Bowra J, Sharma P, Holdgate A, Giles A, Campbell L. Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic. Emergency medicine Australasia : EMA 2007. link 11 Gaspari RJ, Horst K. Emergency ultrasound and urinalysis in the evaluation of flank pain. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2005. link 12 Belson A, Shetty AK, Yorgin PD, Bujanover Y, Peled Y, Dar MH et al.. Colonic hydrogen elimination and methane production in infants with and without infantile colic syndrome. Digestive diseases and sciences 2003. link 13 Brown DF, Rosen CL, Wolfe RE. Renal ultrasonography. Emergency medicine clinics of North America 1997. link70337-0) 14 Fujita K. Weather and the incidence of urinary stone colic. The Journal of urology 1979. link56768-3)

Injury of colic artery