Less than 10% of colics are surgical. Of course if you find yourself in a place where your horse falls into that 10% category you may want to read ahead. Colic is a general term for abdominal pain. Most of the time, horses colic because they have gas distention within the colon or an impaction of ingesta which may obstruct the bowel. Most of the time horses respond to conservative treatment which may include hand walking, a dose of non-steroidal anti-inflammatory medication and even oral fluids or mineral oil via a nasogastric tube (tube through the nose into the stomach). In the more unusual case of a surgical colic, there are some things you should know.
An exploratory laparotomy is used to both definitively diagnose and treat surgical causes of colic. It is often impossible to know for sure what the cause of colic is without opening the horse. This is indicated if the horse is deteriorating or fails to improve despite treatment.
Colic requiring surgery can include a strangulating obstruction, an entrapment of bowel, a displaced colon, some impactions and many other lesions. In these cases, time is of the essence. The longer a piece of bowel is deprived of blood and therefore oxygen, the more compromised it becomes to a point where it is no longer viable. In that case, the only option for survival is to resect or remove the necrotic bowel and anastamose or reattach the healthy gut. This is a very serious surgery and is not without potential complications. Often times the lesion is not necrotic and is viable. In these cases, the primary cause is addressed and the horse is recovered. Often times during surgery a procedure called an enterotomy is performed. This is where the colon is exteriorized and placed on a sterile table. An incision is made into the colon and water is used to flush the ingesta out of the colon. This is done to treat impactions secondary to displacements, to empty the gut to allow it to “rest” and to decrease back pressure to allow ingesta to flow freely through the gastrointestinal tract.
After colic surgery, horses must recover from anesthesia. This can be very serious, as only so much can be done to control a horse recovering from anesthesia. Rarely, catastrophic injury can be sustained in recovery necessitating euthanasia. Once recovered, the horse usually needs some level of intensive care for at least 24 hours. Depending on the lesion, a horse may improve dramatically over the days following surgery and go home quickly. Other times, however horses are very sick after surgery. This is most-often a cause of endotoxemia.
Endotoxemia is a result of toxins, produced by bacteria which normally live in the bowel, being released systemically. When the bowel is compromised, the integrity of the gut wall becomes weakened which may allow the toxins to escape the bowel. Systemic effects of endotoxemia may be limited but can ultimately lead to complications resulting in the death of the horse. We do everything we can to reduce the effects of endotoxemia but unfortunately even with advances in this area, horses are still very susceptible to this sequela.
Once the patient has recovered and gone home, usually they
stall-rested for a month with hand walking. The following two months
consist of slow progression to turn-out and riding. Most horses are
back to work within 3 months of surgery.