signs included tachycardia, decreasing PCV/TP, abdominal discomfort, and incisional drainage. The hemoabdomen was confirmed by ultrasound or abdominocentesis [42]. Swirling, echogenic fluid is characteristic of hemoabdomen, and abdominocentesis will confirm the diagnosis (Figure 7.3). Blood loss into the intestinal lumen can be more difficult to detect until it is passed in the feces. Intraluminal blood loss should be suspected in horses that have had an enterotomy or large colon resection, and that have an acute, severe decrease in PCV along with tachycardia and melena within 72 hours of surgery [43].
Treatment
See “Fluid therapy and blood transfusion” and “Adjunctive systemic treatment” sections above.
Reoperation
Reoperation is often the last resort for postoperative hemorrhage, but should be considered early if there is unexpected postoperative hemorrhage and if there is a chance that a ligature may have slipped. A return to surgery may be needed if the patient is deteriorating despite medical therapy, although these patients are likely to be unstable under anesthesia [44]. If bleeding was detected at surgery but was inaccessible, or if the source of bleeding is unlikely to be accessible through the same surgical approach, an alternate approach is indicated. For example, a hemoabdomen post‐castration may be best treated through a standing laparoscopic approach [38].
Figure 7.3 Transabdominal ultrasound image showing cellular echogenic free fluid consistent with hemoabdomen.
Source: Courtesy of Teresa Burns.
In a case series at a level 1 human trauma center, reoperation for bleeding in trauma patients was prompted by direct signs, such as external bleeding or bleeding from drains, in 74% of patients. Indirect signs that led to reoperation included hemodynamic instability, decrease in hematocrit, and abdominal distention [44].
Expected outcome
Mortality in horses with hemorrhage after emergency celiotomy was reported to be 35%. Causes of death were hemorrhagic shock, septic peritonitis, and adhesions [42]. In a report of post‐castration complications, less than 2% of horses undergoing routine castration suffered from significant hemorrhage. In all horses, bleeding occurred within 4 hours of surgery, and all were treated by packing with sterile laparotomy sponges which were removed at 24–48 hours. One horse received aminocaproic acid [45].
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