Surgical Findings Impact Prognosis in New World Camelids Undergoing Exploratory Laparotomy for Suspected Proximal Gastrointestinal Obstruction
Fausto Bellezzo, Brad B. Nelson, Timothy N. Holt, Kelsea A. Sholty, Eileen S. Hackett
Background
Proximal gastrointestinal (GI) obstruction is a recognized but variably understood cause of colic and poor clinical condition in New World camelids (llamas and alpacas). Limited data had previously identified trichophytobezoars and other causes, but prognostic indicators were unclear due to small sample sizes and heterogeneity in reported cases. This study aimed to comprehensively analyze clinical, surgical, and diagnostic data from a large population of camelids undergoing exploratory laparotomy for suspected proximal GI obstruction, and to identify factors associated with survival.
Methods
This retrospective study analyzed records from 110 camelids (97 alpacas, 13 llamas) that underwent exploratory laparotomy between 2001 and 2020 at Colorado State University. Data included signalment, clinical signs, diagnostics, surgical findings, and outcomes. Multivariable logistic regression identified factors associated with survival to discharge, and Kaplan-Meier survival curves compared long-term outcomes based on surgical diagnoses. Post-discharge follow-up was obtained via owner communication.
Results
Proximal GI obstruction was confirmed in 88/110 camelids; of these, 56 had trichophytobezoar obstruction, primarily in the duodenum. Overall hospital survival was 58%. Survival was significantly higher in camelids with trichophytobezoars (73%) compared to those with other proximal GI disorders (47%) or non-GI conditions (36%). Multivariable analysis showed that higher serum albumin increased the odds of survival (OR ≈15), while elevated fibrinogen and phosphorus decreased survival odds. Median survival time for discharged patients with trichophytobezoars was 1,808 days versus 23 and 4 days for the other two groups. Common causes of non-survival included peritonitis, aspiration pneumonia, and surgical complications.
Limitations
The retrospective nature limits control over variable standardization. Decisions for euthanasia may reflect clinician or owner judgment not solely tied to disease severity. Post-discharge survival data relied on owner reports, which may introduce recall bias. Despite its size, the study is still constrained by the rarity of the condition and diversity of surgical pathologies.
Conclusions
Exploratory laparotomy for proximal GI obstruction in New World camelids carries a fair overall prognosis, but outcomes vary significantly by surgical diagnosis. Trichophytobezoar obstruction is the most favorable scenario, with improved short- and long-term survival. Serum biomarkers (albumin, fibrinogen, phosphorus) may aid in prognostication. Early surgical intervention, especially via right paracostal laparotomy, is recommended when trichophytobezoar obstruction is suspected.
Operative images from 4 of the 110 New World camelids admitted to a veterinary teaching hospital that underwent exploratory laparotomy for suspected proximal gastrointestinal obstruction between January 2001 and December 2020. Four identified lesions are depicted. A—Trichophytobezoar obstruction of the duodenum (arrow). Note distention of the third gastric compartment and duodenal ampulla associated with the luminal obstruction and relative emptiness of the descending duodenum distal to the obstruction. B—A duodenoduodenal adhesion (arrow) is evident resulting in extraluminal obstruction. C—Jejunal obstruction results in 2 visually distinct populations of jejunum. Oral to the obstruction is distended with gas and fluid (arrow), and aboral is relatively empty of contents. D—Focal jejunal stricture (arrow) is visible resulting in obstruction.
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