A cross-sectional study of colic in horses on thoroughbred training premises in the British Isles in 1997

The aim of this study was to estimate the incidence of colic in horses in Thoroughbred training premises in 1997 in the British Isles. The seasonal pattern and outcome of colic episodes were also investigated, together with any association between premises level variables and colic. Data were collected by a postal questionnaire. The results showed a colic incidence density of 7.19/100 horse years (s.e. 0.42) and a cumulative incidence of colic of 5.80% (s.e. 0.30). Premises were grouped according to whether they had more Flat than National Hunt horses (Flat premises) or more National Hunt than Flat horses (NH premises). A similar rate of colic episodes was found in each group. However, significantly higher cumulative incidences of one episode of colic were found in the Flat premises and of multiple episodes in the NH premises, respectively. The outcome of each episode of colic showed spontaneous recovery in 28.7%, medical recovery in 63.1%, surgical recovery in 2.0% and death in 6.2% of cases. This indicated an overall mortality rate from colic of 0.45 deaths/100 horse years. The seasonal pattern of episodes of colic showed a spring and autumn peak, with significant differences in the seasonal pattern between the Flat and NH premises. Relative risk analysis and logistic regression modelling with random effects showed significant associations between the number of episodes of colic and the number of horses on the premises (allowing for the number of horses on each premises, the larger premises had a decreased risk of colic). After adjusting for the number of horses, 3 other variables were associated with colic; Flat premises (with an increased risk), the owner being the sole person looking after the horses (a decreased risk) and the premises being a combined training and breeding establishment (a decreased risk).     

Evaluation of activated neutrophils in the blood of horses with colic

OBJECTIVE: To evaluate the activation status of neutrophils in blood samples obtained from horses with naturally occurring colic associated with strangulating obstruction, nonstrangulating obstruction, or inflammatory bowel disease. ANIMALS: 30 horses with naturally occurring colic and 30 healthy control horses. PROCEDURE: Activation status of neutrophils was determined by assessing the number of neutrophils that could pass through filters with 5-microm pores, cell-surface CD11-CD18 expression, and alterations in size and granularity of neutrophils. RESULTS: Horses with impaction or gas colic did not have evidence of activated neutrophils. Horses with inflammatory bowel disease consistently had evidence of activated neutrophils, including decreased leukocyte deformability, increased CD11-CD18 expression, increased neutrophil size, and decreased neutrophil granularity. Horses with strangulating colic had variable results. Of horses with strangulating colic, 7 of 14 had marked changes in filtration pressures, 5 of 14 had increased CD11-CD18 expression, 6 of 14 had changes in neutrophil size, and 5 of 14 had changes in neutrophil granularity. Among horses with strangulating colic, changes in deformability, size, and granularity of neutrophils correlated with an adverse outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Activated neutrophils were detected in all horses with inflammatory bowel disease and a few horses with strangulating colic. Correlation of activated neutrophils with horses that had strangulating colic that died or were euthanatized indicates that activated neutrophils are a negative prognostic indicator. Additional studies are needed to determine whether activated neutrophils contribute directly to the adverse outcome in horses with strangulating colic.     

Partial gastrectomy and total splenectomy for the treatment of a gastric mass in a horse

A 9-year-old cob mare with a history of recurrent colic presented during an acute colic episode. Ultrasonography revealed a mass emanating from the greater curvature of the stomach and was tightly adhered to the cranial edge of the spleen. Partial gastrectomy and total splenectomy were performed via a midline celiotomy incision. The mass was subsequently confirmed to be granulomatous inflammation, postulated to be secondary to a penetrating injury to the stomach. Post-operatively, the mare had episodes of recurrent colic that were successfully managed with optimisation of the horse's diet and feeding regime. At 10 months’ post-operatively the mare was managed on full turn out, with no evidence of colic and had returned to the previous level of ridden work. The horse then presented 14 months post-operatively with severe colic due to a large colon impaction and displacement and was euthanased. This is the first report to describe successful partial gastrectomy as a treatment option for a gastric mass in the horse.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival

REASONS FOR PERFORMING STUDY: Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis. OBJECTIVE: To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed. METHODS: History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection. CONCLUSIONS: This study identified various factors that appear to predispose horses to long-term complications after colic surgery. POTENTIAL RELEVANCE: Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.     

Analysis of peritoneal fluid as a diagnostic aid in grass sickness (equine dysautonomia)

The analysis of peritoneal fluid is of value in the differential diagnosis of equine colic but its characteristics have not been evaluated in grass sickness. Peritoneal fluid was collected from 15 normal horses and from 11 cases of medical colic, 11 cases of surgical colic, 20 cases of acute grass sickness and 13 cases of subacute grass sickness. The fluid was analysed for its appearance, total and differential white cell count, specific gravity, total protein concentration and total and intestinal alkaline phosphatase activity. Fluid from cases of medical colic was normal in these respects. Surgical cases were unique in having bloodstained fluid with a high alkaline phosphatase activity. Grass sickness cases had a higher specific gravity and protein content than the cases of medical colic although the appearance of the fluid was similar. Grass sickness cases were distinguishable from cases of surgical colic on the basis of the appearance of the fluid and its lower alkaline phosphatase activity.     

A farm-based prospective study of equine colic incidence and associated risk factors

Abdominal pain (colic) in the horse is one of the most acute problems facing equine practitioners. Several causes and risk factors are associated with colic. The current study evaluated the incidence and associated risk factors of colic during a 1-year evaluation in horse farms of Kerman, Iran. The study investigated age, sex, breed, anthelmintic control program, and nutritional status of 128 horses of four breeds on six farms that took part in the study. The mean incidence density rate of colic in the horse population was 8.6% (11/128) in a year. Crossbred horses had more chance of developing colic (P < .05). Horses between the ages of 2 and 10 years also had more risk of developing colic (P < .05). There was no significant difference between sexes (P < .05), and nutritional factors were the most associated risk factors in the cases under study.     

Prevalence of Gastric Ulcerations in Horses with Colic

The goal of this study was to determine the prevalence of gastric ulcers in horses with acute abdominal crisis (colic) and to examine the temporal effect of hospitalization on ulcer development in equine patients treated for colic. In addition, other factors that may be associated with gastric ulceration were also explored. The study design was a prospective original study incorporating 169 horses that presented to the George D. Widener Hospital for examination. One hundred and twelve horses presenting with the chief complaint of colic were included in the study group, and 57 horses that presented for non-colic or nonemergency complaints were evaluated and included as case controls. Gastroscopy was performed on equine patients presenting with the chief complaint of colic or horses presenting for reasons other than colic (control); mucosal changes were scored 0 to 3. Additionally, horses presenting for colic were gastroscopically evaluated twice during a 5-day period. Medical records were reviewed for history, clinical findings, laboratory results, and treatment. Seventy-six of 112 horses presenting with the chief complaint of colic had gastric ulceration compared with 41 of 57 horses in the control group. There was a significant association between age of the patient and chief complaint (ie, colic vs control) and between breed and chief complaint. There was no association between gastric ulcer score and chief complaint (colic vs control). Thirty-eight of the 112 horses presenting with colic deteriorated in ulcer score while hospitalized. Using a Pearson chi-squared test, there was no statistically significant association between gastric ulceration with age, breed, or sex. Horses with gastric ulceration in the colic group had lower packed cell volumes compared with horses presenting with colic without gastric ulcers, and this was statistically significant (P < .001). The high incidence of gastric ulceration in the study and control groups supports the reports of other investigators that gastric ulcers in horses, no matter the presenting complaint, are widespread. There was a significant association between breed and chief complaint (P = .005); however, breed and outcome of gastric ulceration were not related (Thoroughbreds were the least likely breed to present for colic). Although a trend in increasing gastric ulceration was seen in hospitalized colic patients, it was not statistically significant. This suggests that horses that are hospitalized may be at increased risk for developing gastric ulcers because of stress, feed deprivation, and administration of treatment. Thus, horses that present for colic should be gastroscopically evaluated if clinical signs raise the index of suspicion for gastric ulceration.     

Rupture of the mesocolon as a cause of recurrent colic in a showjumper mare

An 11‐year‐old Italian Saddlebred showjumper mare was referred for investigation of recurrent colic. The mare had undergone surgery for left dorsal displacement of the ascending colon 5 years previously and had subsequently experienced several episodes of colic that had responded to medical treatment. Due to deterioration of the mare's clinical condition in the last episode, characterised by unrelenting pain and worsening of the cardiovascular parameters, the mare underwent repeat surgery for suspected colonic displacement. Exploratory laparotomy revealed a complete rupture of the mesocolon of the ascending colon. The mesocolon was repaired and the mare recovered uneventfully. She returned to training and competition and only a single episode of mild transient colic was recorded in the follow‐up.     

Analysis of Sodium Carboxymethylcellulose Administration and Related Factors Associated with Postoperative Colic and Survival in Horses with Small Intestinal Disease

Objective— To analyze the effect of the intraoperative use of sodium carboxymethylcellulose (CBMC) and related perioperative factors on postoperative colic and survival in horses that had abdominal surgery for colic.
Study Design— Retrospective study.
Animals— Horses (n=203) that had surgery for small intestinal disease; 33 horses had intraoperative administration of CBMC.
Methods— Information was obtained from medical records for 170 horses that had surgery for colic before use of CBMC and 33 horses that had intraoperative CBMC. Kaplan–Meier survival curves were used to estimate median survival time and a Cox proportional hazards model was used to estimate the hazard ratio for the effect of CBMC and other perioperative variables on survival.
Results— Seventy-five percent of horses administered CBMC survived to 180 days, whereas 75% of untreated horses survived 8 days (median survival time=18 days). Horses not administered CBMC were twice as likely to die compared with horses administered CBMC. Horses that had postoperative ileus (POI) were 1.4 times more likely to die than horses without ileus. Similarly, horses with signs of colic after surgery were 1.3 times more likely to die than horses without postoperative signs of colic.
Conclusions— CBMC administration is seemingly protective against death and prolongs survival when used intraoperatively in horses with small intestine disease, particularly horses with postoperative colic or POI. Both POI and colic increased risk of death after surgery.
Clinical Relevance— Intraoperative administration of CBMC in horses that have surgery for small intestinal disease may improve survival, possibly by reducing early adhesion formation.     

Intestinal carcinoid in a mare: an etiologic consideration for chronic colic in horses

Intestinal carcinoid, or argentaffinoma, should be an etiologic consideration for horses with chronic colic. A mare was referred with a history of chronic colic. Previously, the signs of colic had subsided in response to impiric treatment, but recent episodes of colic did not. Clinical signs and results of physical examination supported the finding of strangulating obstruction of the small intestine. Exploratory celiotomy revealed internal herniation with simultaneous volvulus of the jejunum and accompanying carcinoid.     

Plasma arginine vasopressin concentration in horses undergoing surgery for colic

Objective – To determine if horses before undergoing anesthesia for surgical correction of colic would have lower plasma arginine vasopressin (AVP) concentrations than healthy horses undergoing anesthesia for arthroscopic surgery, and would not increase their plasma AVP concentrations in response to anesthesia and surgery. Design – Prospective clinical study. Setting – University teaching hospital. Animals – Fourteen horses with colic and 8 healthy horses. Interventions – Horses with colic underwent anesthesia and surgery for alleviation of colic, and healthy horses underwent anesthesia and surgery for arthroscopy. Measurements and Main Results – Plasma AVP was measured perioperatively in horses with colic and in healthy horses. Before anesthesia, and 30 and 60 minutes after induction, horses with colic had greater median plasma AVP concentrations than control horses (P≤0.001); thereafter during anesthesia differences in AVP concentrations between the 2 groups were not significant. In the control group, plasma AVP concentration increased during 120 minutes of anesthesia; no such increase occurred in colic horses. Conclusions – Compared with healthy horses, horses with colic had higher preanesthesia plasma AVP concentrations that did not increase further in response to anesthesia and surgery. Exogenous AVP is associated with decreased splanchnic perfusion in a variety of animal species and, therefore, could be detrimental to horses with colic. Thus, it may be inappropriate to use exogenous AVP in support of blood pressure in anesthetized horses with colic. Further studies are warranted to define appropriate indications for the use of AVP in horses with colic.     

Case report of atypical infiltrative lipomatosis of the equine mesojejunum

A 25‐year‐old mare was examined for persistent colic. Over the previous month, the mare had experienced several episodes of mild recurrent colic. The episode of colic persisted for 18 h and the pain became unresponsive to analgesic therapy. Euthanasia was undertaken. Post mortem examination revealed an atypical infiltrative lipoma of the mesojejunum, confirmed histopathologically. To the authors' knowledge, this is the first case report of a diffuse infiltrative lipoma of the equine mesojejunum.     

Cortisol Circadian Rhythm Ratio: A Simple Method to Detect Stressed Horses at Higher Risk of Colic?

With the hypothesis that police horses with abnormal cortisol circadian rhythm (CCR) had more chance to develop colic, the aim of this study was to determine the CCR ratio in horses subjected to different housing and work conditions and to associate abnormal CCR ratio with incidence of colic. A total of 116 police horses belonging to four different groups were studied. In all, 31 were full-time stabled and performed urban patrolling activity, 27 were full-time stabled and performed equine therapy and sports activities, 25 were part-time stabled and performed urban patrolling, and 33 animals were kept full-time on pasture and did not perform any kind of work activity. Venous blood samples were collected between 6 and 7 am and also 8 hours later, and cortisol concentrations were determined by radioimmunoassay to calculate the CCR ratio. Annual colic incidences (6 months before and after the day on which CCR ratio was determined) were assessed by examining individual medical files. The overall incidence of abnormal CCR ratio (<0.30) was 63.3%, and 107 cases of colic were reported for this population with a mean incidence of 0.92 colic/horse/yr. Horses with abnormal CCR had 2.3 times more chance to have colic (95% CI: 1.07 to 5.28, P = .03) when compared with those with normal CCR. In conclusion, high incidence of abnormal CCR ratio indicates that police horses were under stressful conditions. Horses with abnormal CCR ratios were more prone to suffer colic episodes, indicating that CCR ratio determination could perhaps be useful in detecting horses at risk of colic.     

Correlation between colic and antibody levels against Anoplocephala perfoliata in horses in The Netherlands

The importance of Anoplocephala perfoliata in horses with colic was studied in 139 horses referred for colic and 139 control horses with no signs of colic for at least three years. The serodiagnostic method of Proudman and Trees, which measures the level of A. perfoliata antibody, was used to detect A. perfoliata infection. Thirty-two horses were examined at necropsy, to determine whether the presence of A. perfoliata in the ileocaecal region was associated with the A. perfoliata antibody level. The mean A. perfoliata antibody level was significantly higher in horses with colic than in horses without colic (P < 0.001), indicating a relationship between A. perfoliata infection and colic in general. There was no relation between age and A. perfoliata antibody level. The mean A. perfoliata antibody level in 12 horses with ileocaecal disorders was significantly higher than that in control horses (P < 0.001). Of the 32 horses examined at necropsy, 7 horses with tapeworms in the ileocaecal region had a significantly higher mean A. perfoliata antibody level than the 25 horses without the parasite (P = 0.030). Lastly, examination of faeces to detect the presence of A. perfoliata infection was not useful in the present study.     

Determination of the acid-base status in 50 horses admitted with colic between December 1998 and May 1999

The purpose of the present study was to investigate the acid-base status and the concentration of organic acids in horses with colic caused by various disorders. Blood samples were collected from 50 horses with colic and from 20 controls. No intravenous fluids had been given prior to sample collection. Identified causes of colic included gastric ulceration, small intestinal volvulus, cecal intussusception, cecal rupture, colonic impaction, left dorsal colon displacement, right dorsal colon displacement, colonic volvulus, colitis, peritonitis, and uterine torsion. Thirty-seven horses recovered from treatment of colic, 8 horses were euthanized, and 5 died. Most cases were not in severe metabolic acidosis. In previous studies, most horses presented for diagnosis and treatment of colic were in metabolic acidosis and in shock.     

Objective radiographic assessment of abdominal sand accumulation in horses.

Gastrointestinal sand accumulation is a common cause of equine colic. Subjective assessment of sand accumulation on abdominal radiographs has been used as a diagnostic aid; however, there is poor correlation between clinical, diagnostic, and surgical findings. The purpose of this study was to develop an objective method of assessing radiographic sand accumulation in order to improve the diagnostic utility of radiography for sand colic. Fifty-one equine abdominal radiographic examinations were reviewed, with approximately half of the imaged patients having a clinical diagnosis of sand colic. Initially, four observers independently reviewed these radiographic studies to subjectively decide whether or not sand accumulation was sufficient to cause colic. Subsequently, an objective scoring system was developed using various radiographic parameters that yielded a score ranging from one to 12 for quantity and apparent density of sand accumulation. Inter- and intraobserver results using the subjective scoring method had significant differences among all observers. Subjective assessment was also deemed to be inaccurate for colic prediction. Using the objective scoring system, there were no significant differences between or within the observers' results. A score of seven out of 12 was found to have an 83% likelihood of being associated with a positive diagnosis of sand colic. The designed objective scoring method creates a more uniform and accurate method to assess the sand accumulation.     

Survival rates and post-operative complications after equine colic surgery

SUMMARY A retrospective analysis of 74 cases that underwent surgery for colic was undertaken to determine short and long term survival rates and the incidence of postoperative complications. In 28 cases colic was related to small intestinal lesions and in 46 cases to large intestinal lesions. Pre-operative packed cell volume and heart rate were found to be inversely related to short-term survival. Twenty-five horses (34%) recovered from surgery and were discharged. Of 18 of these cases with available histories, 6 subsequently had one or more episodes of colic since surgery of which 5 eventually died or were euthanased due to further colic; the remaining 12 have remained free from recurrence of colic for longer than 6 months.     

Survey of complications and antimicrobial use in equine patients at veterinary teaching hospitals that underwent surgery because of colic

OBJECTIVE: To determine current practices regarding use of antimicrobials in equine patients undergoing surgery because of colic at veterinary teaching hospitals. DESIGN: Survey. SAMPLE POPULATION: Diplomates of the American College of Veterinary Surgeons performing equine surgery at veterinary teaching hospitals in the United States. PROCEDURE: A Web-based questionnaire was developed, and 85 surgeons were asked to participate. The first part of the survey requested demographic information and information about total number of colic surgeries performed at the hospital, number of colic surgeries performed by the respondent, and whether the hospital had written guidelines for antimicrobial drug use. The second part pertained to nosocomial infections. The third part provided several case scenarios and asked respondents whether they would use antimicrobial drugs in these instances. RESULTS: Thirty-four (40%) surgeons responded to the questionnaire. Respondents indicated that most equine patients undergoing surgery because of colic at veterinary teaching hospitals in the United States received antimicrobial drugs. Drugs that were used were similar for the various hospitals that were represented, and for the most part, the drugs that were used were fairly uniform irrespective of the type of colic, whereas the duration of treatment varied with the type of colic and the surgical findings. The combination of potassium penicillin and gentamicin was the most commonly used treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study document the implementation of recommendations by several authors in veterinary texts that antimicrobial drugs be administered perioperatively in equine patients with colic that are undergoing surgery. However, the need for long-term antimicrobial drug treatment in equine patients with colic is unknown.     

Laparoscopic closure of the nephrosplenic space for prevention of recurrent nephrosplenic entrapment of the ascending colon

OBJECTIVE: To evaluate outcome after laparoscopic closure of the nephrosplenic space in horses that had previous nephrosplenic entrapment of ascending colon (left dorsal displacement of the left colon; LDDLC). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Horses that had previous LDDLC. METHODS: Medical records of horses that had LDDLC and subsequent laparoscopic nephrosplenic space closure between 2002 and 2004 were retrieved. Follow-up information was obtained by telephone interview of owners. Preoperative versus postoperative comparisons were: incidence of LDDLC, incidence of colic signs, and incidence of ventral celiotomy. Data were analyzed using a chi2-square test with significance set at P<.05. RESULTS: Ten horses met the inclusion criteria. Mean follow-up was 22 months. No horses had recurrence of LDDLC; however, 3 horses had colic signs subsequently that required surgical intervention. Over the follow-up period there was a significant decrease in the total incidence of colic and ventral celiotomy. Technique modifications included use of different cannula site locations, use of polyglyconate suture material for nephrosplenic space closure, and development of a custom cannula. CONCLUSIONS: Laparoscopic nephrosplenic space closure prevented recurrence of LDDLC, and significantly lowered the overall incidence of colic and ventral celiotomy. The custom-designed cannula provided good access to the operative site and no complications were encountered with use of polyglyconate suture material for nephrosplenic space closure. CLINICAL RELEVANCE: Closure of the nephrosplenic space will prevent LDDLC; however, other surgical lesions can occur.     

Risk factors for equine acute abdominal disease (colic): Results from a multi-center case-control study

Many causal hypotheses for acute equine abdominal disease (colic) have been proposed. However, few epidemiologic studies have been undertaken to identify risk factors for the syndrome. Risk factors for equine colic were identified using a hospital-based, multi-center, case-control study. Horses admitted with abdominal pain to Cornell, Guelph, Ohio State, Pennsylvania or Tufts university veterinary hospitals between March and December 1991 were selected. Control horses were randomly selected from a list of all other non-colic admissions. The person(s) responsible for the day-to-day care of the horse completed a telephone questionnaire. Risk factors were identified using multivariable logistic regression analysis.

A total of 406 colic and 406 control horses were used in the final analysis. Age, breed, outdoor access (pasture or drylot), outdoor water supply, use of a daily worming product, amount of concentrates and whole-grain corn consumed, type of person responsible for the day-to-day care of the horse and previous colic history were all significantly associated with colic risk. Arabian horses were more than twice as likely to be colic cases (OR = 2.0, 95% CI = 1.0–3.9), whereas Standardbred horses were nearly half as likely (OR = 0.6, 95% CI = 0.4–1.0) to be colic cases compared with the comparison Thoroughbred group. Horses that had access to outdoor enclosures without a continuous supply of water were more than twice as likely (OR = 2.2, 95% CI = 1.2–4.3) to be colic cases compared with horses that had an adequate supply of water on outside enclosures. The use of a daily worming product for at least 60 days during the 12-month period prior to presentation was associated with a significantly lower colic risk (OR = 0.11, 95% CI = 0.02–0.55). Colic risk increased with greater consumption of whole-grain corn; however, when all non-roughage concentrate feeds were combined, colic risk decreased with increased intake of concentrates. Significant interactions were identified between age and drylot use and between the type of care-person responsible for the day-to-day care of the horse (owner or non-owner) and previous colic history.

The findings of this study illustrate the complex multi-factorial nature of equine colic and point towards the importance of the overall quality of stable management and care, as well as the type of outdoor enclosure (pasture or drylot), water access, carbohydrate intake, parasite control and intrinsic (breed-related) factors.