The word colic strikes fear in horse owners the world over. Many times, there is no obvious cause, but triggers can include spoiled feed, abrupt changes in feed, parasite infestation, sand ingestion, lack of water consumption, excess stress, or changes in the weather.
Colic is defined as any source of abdominal discomfort in the horse. The most important step any owner can take is to recognize the symptoms as early as possible and immediately call their veterinarian.
Pawing, rolling, looking at the abdomen, sweating, loss of interest in food and water, and absence of gut sounds in any of the four quadrants are common symptoms. The sooner the veterinarian gets involved in treatment, the better the horse’s chance of survival.
Board-Certified Surgeon Dr Weston Davis, of Florida’s Palm Beach Equine Clinic, explained that one of the biggest challenges in the sport horse population is determining surgical versus non-surgical colic cases.
“We do not want to put a non-surgical case through the risk of anesthesia and the months of healing time, so we try to spare that at all costs and determine the surgical cases as accurately as we can,” Davis said. “On the split side of that, we try to operate as quickly as possible on any horse that needs surgery and not miss any surgical lesion types.”
There are several methods for differentiating surgical cases. Simple physical exam findings, such as the color of the gums, heart rate, gut sounds, and level of pain can all be supportive of surgical necessity. A variety of tests may also include abdominal ultrasounds and rectal exams.
An Abdominocentesis (or belly tap) is performed on every questionable colic case, where fluid is collected from around the intestines and analyzed for color and character. A variety of other laboratory tests will be run on the fluid as well, with the aim of quickly determining if the horse’s bowel is compromised.
If surgery is necessary, there are a few different approaches that may be performed depending on the specific case.
For chronic colic cases, such as horses with longstanding, intermittent colic, an abdominal exploratory procedure may be done with laparoscopy. This option can be done with the horse standing and is a minimally invasive way to examine the full abdomen.
In most acute cases, further steps must be taken. If the veterinarian determines that the horse is a surgical candidate, the patient will go under general anesthesia. The surgeons try to make as small an incision as they can to perform the needed surgical correction.
“If we intervene early, we can take a strangulating or compromised lesion – one that most people understand as a twist – and we can go into the abdomen and correct the twist, reposition everything appropriately, explore the remainder of the abdomen to make sure nothing else is going on, and then close them up,” Davis said.
“Some of these surgeries can be as quick as 30 minutes and require just an untwisting, repositioning, and closure. The ones that are bad are the usually the cases that have a more severe twist or have been going on longer.”
In more severe or long-standing cases, the surgery can require a resection and an anastomosis procedure to excise a compromised or devitalized segment of the intestine. The surgeon then joins the healthy ends back together.
“Even more advanced procedures would be like a re-plumbing of the intestines,” Davis said. “One of the most common examples of this would be a patient with damage to the end of the small intestine, near or involving its junction with the cecum. In a case like this, we would perform a ‘jejunocestomy’ where we join another part of the small intestine to a different position on the cecum.”
After any surgery, there is a process of recovery. Traditionally, most horses will remain in the hospital for a few days. In the post-operative period, they generally receive fluids until they are ready to eat and drink, 3-5 days of antibiotics, and 5-7 days of anti-inflammatories.
“The recovery process is highly dependent upon how sick they are after surgery,” Davis said. “Some horses will bounce back and be home 48 hours later, but a very sick horse could potentially spend seven to ten days in the hospital until they are healthy enough to get off fluids and go home.”
After leaving the hospital, the horse is usually placed on one month of stall rest, followed by another month of turnout in a small paddock. In between eight to 12 weeks, the horse will usually be fully recovered and ready to start back to work.
With the sport horse in mind, the health of the abdominal incision and prevention of infection or hernias is very important. In most cases, the surgeon will recommend physical therapy and special exercises to re-strengthen the horse’s abdominal muscles so that it can get back to work quickly and have a strong abdominal musculature when it does.
“Making the horse walk backwards is one thing that will make them tighten and work their abdominal musculature,” Davis said. “Pinching or tickling around their tail head is another common exercise to make them do something similar to a stomach crunch.”
Davis said that with three Board-Certified Surgeons on staff, as well as a state-of-the-art hospital and the most advanced surgical equipment, the Palm Beach Equine Clinic has a very high success rate in saving horses from life-threatening colic.
“With the combination of quick surgical intervention, excellent surgical care, and specialized post-operative measures, PBEC has a very high rate of return to athletic performance for all of our colic cases,” Davis said.