Prospective survey of veterinary practitioners’ primary assessment of equine colic: clinical features, diagnoses, and treatment of 120 cases of large colon impaction

Abstract

BackgroundLarge colon impactions are a common cause of colic in the horse. There are no scientific reports on the clinical presentation, diagnostic tests and treatments used in first opinion practice for large colon impaction cases. The aim of this study was to describe the presentation, diagnostic approach and treatment at the primary assessment of horses with large colon impactions.MethodsData were collected prospectively from veterinary practitioners on the primary assessment of equine colic cases over a 12 month period. Inclusion criteria were a diagnosis of primary large colon impaction and positive findings on rectal examination. Data recorded for each case included history, signalment, clinical and diagnostic findings, treatment on primary assessment and final case outcome. Case outcomes were categorised into three groups: simple medical (resolved with single treatment), complicated medical (resolved with multiple medical treatments) and critical (required surgery, were euthanased or died). Univariable analysis using one-way ANOVA and Tukey’s post-hoc test, Kruskal Wallis with Dunn’s post-hoc test and Chi squared analysis were used to compare between different outcome categories.Results1032 colic cases were submitted by veterinary practitioners: 120 cases met the inclusion criteria for large colon impaction. Fifty three percent of cases were categorised as simple medical, 36.6% as complicated medical, and 9.2% as critical. Most cases (42.1%) occurred during the winter. Fifty nine percent of horses had had a recent change in management, 43% of horses were not ridden, and 12.5% had a recent / current musculoskeletal injury. Mean heart rate was 43bpm (range 26-88) and most cases showed mild signs of pain (67.5%) and reduced gut sounds (76%). Heart rate was significantly increased and gut sounds significantly decreased in critical compared to simple medical cases (p<0.05). Fifty different treatment combinations were used, with NSAIDs (93%) and oral fluids (71%) being administered most often.ConclusionsLarge colon impactions typically presented with mild signs of colic; heart rate and gut sounds were the most useful parameters to distinguish between simple and critical cases at the primary assessment. The findings of seasonal incidence and associated management factors are consistent with other studies. Veterinary practitioners currently use a wide range of different treatment combinations for large colon impactions.

Horse owners’ knowledge, and opinions on recognising colic in the horse

“…These are non‐specific mild signs, which may be seen in normal horses, but are also potential signs of colic. They may be the only signs in less severe types of colic, such as large intestinal impactions , or early signs of other severe conditions, such as colitis or peritonitis. Again, this highlights potential issues around decision‐making for horses showing less severe or non‐specific signs of colic.…”

Retrospective evaluation of treatment of horses with colic over a period of 15 years

“…Finally, in period C (1999 -2000), heart rate was also found to be useful as a prognostic indicator. Heart rate has previously been identified as a factor in differentiating critical from non-critical colic cases (Jennings et al 2014, Curtis et al 2015 and has been found to predict mortality in colic cases (Puotunen-Reinert and Huskamp 1985, Orsini et al 1988, Reeves et al 1989, Furr et al 1995 There was a statistically significant difference in blood pH between survivors and non-survivors, and acidosis was associated with increased odds of death, although it is unclear whether this difference is clinically relevant, as mean values for both groups were within the reference range. The higher blood lactate concentration in non-survivors would likely…”

Clinical Management of a Complete Gastrointestinal Obstruction and Ileus in A Geriatric Female Asian Elephant (Elephas maximus)

“…Ceftiofur sodium (Naxcel; Zoetis, Kalamazoo, MI 49007, USA), 1.1 mg/kg IM q 24 hr (Dumonceaux, Isaza, Koch, & Hunter, 2005) was given for seven days to prevent infection from a potential compromised bowel wall. Gastrointestinal sounds and heart rate are the most important primary measurements for distinguishing between simple and critical colic in horses (Jennings, Curtis, Burford, & Freeman, 2014). In our patient, the heart rate was difficult to auscultate and the auricular vein could not be easily assessed due to a previous injury to the ears.…”