Molly is an 18 year old Thoroughbred cross mare. One Friday night, Molly’s owner, Debra, gave Banamine to her per her veterinarian’s instructions as she did not eat and was lying down a lot and looking at her belly. Her veterinarian was called to the farm on Saturday morning to examine her as she appeared to be more uncomfortable. Her veterinarian examined Molly and performed a rectal examination. A pelvic flexure impaction was diagnosed on the rectal exam. The veterinarian passed a stomach tube, administered mineral oil and water and placed an intravenous catheter to administer 10 liters of fluid. Molly appeared slightly better for much of the day. At 4:00 pm, Debra paged her veterinarian again saying she appeared more painful than before. Molly’s veterinarian knew Molly was enrolled on SSEC’s Colic Assistance Plan and informed Debra that the best thing for Molly and for Debra’s finances was to take Molly to SSEC for further care.
The Colic Assistance Plan requires an examination and enrollment form along with a fee of $149.00. Upon admission to SSEC, a deductible payment of $500.00 is made which then covers the next $3,000.00 worth of medical and/or surgical services.
Upon Debra and Molly arriving at the SSEC, they were greeted by Dr. Bueno, a board certified surgeon, and his team of technicians and intern Dr. Julia Rando. Molly was immediately examined.
The colic work up revealed a large colon impaction of the pelvic flexure (firm and encompassing much of the large colon). Blood work showed good hydration, elevated total bilirubin (commonly seen with horses that are not eating) and slightly elevated blood lactate (an indication of decreased blood flow to the bowel).
An ultrasound examination showed good motility to the small intestine, and no obvious displacements or masses. A belly tap was normal with no indications of inflammation.
Initial treatment included aggressive intravenous fluid therapy with hypertonic saline followed by 30 liters of Plasmalyte, oral fluid therapy with endolytes and mineral oil. Tranquilizers and pain killers were given as needed to control Molly’s abdominal pain.
Repeat rectal examinations were performed to evaluate the status and resolution of the large colon impaction over the next few days. After several days in the hospital under intensive care her impaction gradually resolved. Molly was gradually returned to feeding to make sure that she would not colic during this transition phase. Molly did well, returned home within a week and will slowly return to exercise over the next few days.
Large colon impaction is the second most commonly reported cause of colic in horses (gas colic being most common), and it is the most common type of simple obstruction. It represents approximately 13.4% of colics examined at referral centers. Several risk factors have been identified including cribbing, recent changes in exercise, lack of deworming in the last 12 months, travel, lameness, lack of dental care, poor quality water and feedstuff, among others. Large colon impactions usually affect horses older than 1 year, although miniature horses may be predisposed to them.
Differential diagnoses include displacements (partial twist) which can occur along with an impaction and small intestine obstruction which can cause dehydration of the colonic contents.
Treatment includes fluid therapy (oral and/or intravenous), pain relief, and oral solutions to help dissolve and push the impaction (cathartics). Feed is also withheld until the impaction is resolved. Sometimes surgical evacuation of the large colon is recommended if the condition is not responding to medical therapy.
Molly’s bill for her 6 day stay at SSEC totaled $3, 176.00. Debra needed only to pay $176.00 when Molly was discharged as the Colic Assistance Plan and her deductible covered the first $3,000.00. Needless to say, Debra was extremely happy she had chosen to enroll Molly in the Plan!
The prognosis for impactions is good to excellent with most horses responding well to medical therapy. The sooner they are treated and the more aggressively they are treated, the more likely they are to respond and the sooner the pain and discomfort will cease. In one study, only 24 of 147 horses required surgery. Indications for surgery included uncontrollable pain, deteriorating cardiovascular status, and any indication of bowel compromise (changes in belly tap, increasing blood lactate in spite of aggressive fluid therapy).
It is important that the horses with large colon impactions are monitored/examined frequently because rapid changes can occur and in these cases surgery may become a necessity. Medical treatment of colics can be as expensive as or more expensive than colic surgery and the final outcome can be unrewarding if there is severely compromised bowel or rupture of bowel, which is fatal.
One week later, Molly is back to herself. She is taking Debra on trails and has started back in lessons. Debra reported, “She is such a big part of my life, and I am so glad to have her back. Thank God I bought that Colic Plan because my husband and I would have had a hard time coming up with the finances just for another farm visit or two, never mind the hospitalization! Thank you to Dr. Bueno and the whole team at SSEC.”