Enteroliths in horses

Many cases of enteroliths were reported in the nineteenth century but the number greatly decreased in the early twentieth century. However, in recent years the number of cases in certain parts of the United States such as California has greatly increased. The reasons for the increase are obscure. The intake of nitrogen, magnesium and phosphorus (the primary components of enteroliths) from water and food is likely to be a factor. Arabians may be more likely to develop enteroliths than horses of other breeds. A nidus such as a small stone is needed because a nidus has been found in every enterolith that has been examined. Further studies in which the effect of mineral intake and form of the mineral on enterolith formation are needed. Studies of enterolith formation in the past have all been retrospective. Models for the development of enteroliths are needed.     

Enteroliths in horses--a retrospective study of 30 cases.

In a retrospective study of selected cases, abdominal colic in 30 horses was attributed to enterolith obstructions of the large intestine. Obstructions caused by "true" enteroliths were confined to horses more than four years old. Prominent clinical features were recurrent mild abdominal pain, inappetance, gaseous distension and minimal intestinal motility. The various aspects of the clinical syndrome, including diagnostic problems and clinical management, are discussed. Most obstructing enteroliths were found near the beginning of the small colon and most horses contained only a single major concretion. Enteroliths were formed by mineral deposition in concentric layers about a central nidus of ingested material and were spherical or tetrahedral in shape. Intestinal concretions were found to consist primarily of ammonium magnesium phosphate.     

Initial treatment of colic

This article discusses some of the rationales for the medical management of colic during the initial treatment period. The issue of colic pain control and the masking of clinical signs that may indicate severe gastrointestinal disease is addressed. Therapeutic considerations related to dehydration, metabolic imbalances, hemostatic disorders, antimicrobial therapy, fecal consistency, gastrointestinal decompression, and regulation of intestinal motility are reviewed.     

A Modified Teniotomy Technique for Facilitated Removal of Descending Colon Enteroliths in Horses

Objective—To describe a method for facilitating movement of enteroliths obstructing the proximal portion of the descending colon.
Study Design—Prospective report. Sample Population—15 horses.
Methods—A seromuscular incision through the antimesenteric taenia of the proximal portion of the descending colon was used to facilitate movement of enteroliths.
Results—Teniotomy allowed proximal descending colon enteroliths located within the abdomen or close to the abdominal wall to be advanced 4 to 15 cm in an aboral direction so that they could be exteriorized for safe removal.
Conclusions and Clinical Relevance
Teniotomy is a feasible method for mobilizing enteroliths in the proximal descending colon in locations that cannot otherwise be exteriorized.     

Prognosis in equine medical and surgical colic

A retrospective study was performed on 649 horses admitted to the Clinic of Equine Internal Medicine (Utrecht University) for gastrointestinal colic. The aim of this study was to provide a better guideline for determining prognosis in horses with colic. Short- and long-term survival were evaluated, and Cox regression analysis was performed to identify the clinical and clinicopathologic variables usable to predict survival. Intestinal displacements and strangulations were the most frequently diagnosed causes of colic. Regarding the surgically treated horses, 54% were discharged and 88% of these were still alive after 1 year. In comparison, 85% of medically treated patients were discharged and 93% were still alive after 1 year. Only 4.4% of all long-term survivors did not return to the expected level of performance, and 32% suffered from recurrent colic. Duration of colic signs, heart rate, intestinal motility, skin tenting, level of pain, and gross appearance of peritoneal fluid were shown to be significantly associated with survival. White blood cell count, packed cell volume, blood pH, and color of the mucous membranes did not show any prognostic significance. Thus, clinical variables appeared to be the most relevant predictors of the outcome of gastrointestinal colic.     

Fifty years of colic surgery

Colic surgery is one of few treatments in which a veterinarian can use a skill to save an animal's life from a deadly disease within a short timeframe. Unfortunately, such success is not achieved without considerable risk for surgical failure, which is responsible for most complications in the immediate post‐operative period. The last 50 years have witnessed considerable improvements in colic surgery, although a ranking of the most important ones might not meet with universal agreement. Teamwork plays a critical role in the final outcome, starting and finishing with the referring veterinarian and owner. These individuals are responsible for promptly transferring the horse to a surgical facility and then dealing with aftercare and delayed complications. The surgeon is responsible for the intervening steps, including the decision on the need for surgery, and works with the anaesthesiologist to help a metabolically challenged patient to tolerate surgery and anaesthesia. Although early referral and improved diagnostic procedures can have a positive influence on survival, perceived improvements in surgery and anaesthesia need to be reviewed with some circumspection. Although more rigorous definitions and statistical analyses used in recent studies can invalidate comparisons with older studies, complication rates appear to be on the rise, despite putative improvements in dealing with them. This trend tends to diminish the value of colic surgery through increasing costs, overreliance on post‐operative pharmacological management, growing pessimism, high rates of intraoperative euthanasia, and possibly reduced long‐term survival. Future efforts should address these concerns, mostly through emphasis on prompt referral, good surgical technique and reducing the cost of colic surgery to an affordable level that saves more lives.     

Hemostatic abnormalities in equine colic

Hemostatic profiles were determined in 30 horses with clinical colic. Blood samples were obtained at the time of the animal's admission, and the following hemostatic tests were done: blood platelet count, plasma fibrinogen, plasma antithrombin, prothrombin time, partial thromboplastin time, thrombin time, protamine sulfate test for soluble fibrin monomer, and fibrin-fibrinogen degradation products. The patients were categorized in retrospect, according to the cause of the colic: group 1--colic associated with colitis and/or severe diarrhea, group 2--colic associated with torsion or obstruction of the intestine, and group 3--colic associated with impaction of the intestine or the presence of enteroliths. Of the 30 horses with colic, 28 had at least 1 abnormality in their coagulogram--the most frequent abnormalities being high plasma fibrinogen concentration, high circulating soluble fibrin monomer, or a long partial thromboplastin time or thrombin time. The horses in group 1 seemed to have the most severe coagulopathies, as indicated by the average number of demonstrable abnormalities. The horses in group 3 showed the fewest abnormalities--usually a high plasma concentrations of fibrinogen and/or soluble fibrin monomer. The results indicated that hemostatic abnormalities are not uncommon in horses with gastrointestinal disease and colic--the degree of severity depending to some extent on the cause of the colic.