Information available on duodenal impactions is limited. The authors present a case of a horse showing clinical signs likely indicating a small intestinal lesion, with anterior enteritis and a strangulating lesion as the most likely differentials. Due to diagnostics not strongly indicating either, the horse was initially monitored. With no clinical improvement after nasogastric decompression, anterior enteritis was considered unlikely and intervention was required. Exploratory laparotomy revealed an intraluminal obstruction oral to the duodenocolic ligament indicating a duodenal impaction. Manual decompression dislodged, broke apart and pushed the obstruction into the caecum. Postoperatively, ultrasonography revealed numerous intraluminal short linear hyperechoic foci consistent with foreign material, and gastroscopy revealed extensive grade 4 squamous ulceration. From the third day postoperatively droppings were passed containing hawthorn twigs, seeds and husks, concluding that was a duodenal hawthorn impaction. The horse responded well to surgical treatment and rehabilitated with no further abnormalities.