Colic Surgery: What You Should Know

By Brian S. Burks, DVM, Diplomate, ABVP, Board Certified Equine Specialist

Fox Run Equine Center

 

Suddenly, you are faced with an enormous decision about your best horse. The choice is colic surgery or euthanasia. You only have a few minutes to decide, and the outcome is uncertain. Will he have a good quality of life? Will he return to his previous performance level?

You may not even know the veterinarian telling you about colic surgery. Should you proceed with surgery, a deposit of $5000.00 is required. The total cost may be $7000-$10,000, or more, if there are complications. What should you do? There is no time for me to tell a client everything they need to know. There are many things to think about prior to facing this difficult decision.

Equine Colic

Colic is a symptom- abdominal pain- not a diagnosis or disease. It is a sign of something wrong in the abdomen, or occasionally from other organs outside the abdomen. The equine intestinal tract is very complicated with stacked horse-shoe configurations and different sized lumens at various points. Colic signs include depression, loss of appetite, lying down, pawing, rolling, sweating, looking at the belly, stretching, and others.

Many times, colic is simple, and occurs due to a spasm or a gas pocket. This may require minimal treatment or even resolve on its own. Other times, aggressive medical therapy is required. Sometimes colic surgery is required to determine the cause and replace and/or repair the intestinal tract.

• Volvulus- a torsion or twist of the gut
• Small intestinal strangulation by a lipoma or other structure
• Colonic impaction- a build up a feed material, sand, or dirt in the colon
• Foreign body blocking the colon- an enterolith or another object
• Colonic displacement

Causes may vary with the breed and age of the horse. For instance, Ascarid impactions occur in weanlings and yearlings, whereas lipomas are most common. in older horses.

There are many other variations, and each comes with its own prognosis and estimated surgical cost. Large intestinal surgery usually has a better prognosis than small intestinal surgery and may cost less than a small intestinal strangulation requiring a portion of the bowel to be removed. It should be noted that colic surgery is a diagnostic test; until the surgeon explores the abdomen to find out what the trouble is, a definite diagnosis, prognosis, or cost estimate cannot be given.

The Veterinarian’s Advice

How does your veterinarian know your horse needs surgery?

• A diagnosis is made following the physical and rectal examination that requires surgery.
• Unrelenting pain, that cannot be controlled by medication
• Various diagnostic tests may add up, even when the horse does not appear that bad (especially if it has been given pain medication)
• Medical management has not corrected the problem

The field veterinarian must determine if the horse requires further evaluation at an equine surgical hospital. Part of that determination is you, the owner, about whether surgery is even an option. Sometimes, the only other option is euthanasia.

Diagnostic testing includes routine blood work, rectal palpation, abdominal ultrasound, abdominal tap, and occasionally radiographs (for smaller horses).

Your Decision

Here are some considerations when making this difficult decision:

• Diagnosis & Prognosis: What does the veterinarian think is wrong with your horse? How complicated will the surgery be and what is the likely prognosis? Recurrence?
• Anesthesia & Recovery: General anesthesia is required for colic surgery, and although the risk of this is small, it still exists.
• Cost: Can you afford surgery? Is your horse insured, and is there coverage for colic surgery? Colic surgery is expensive because it is performed in an equine hospital with professional staff, equipment, and experience to perform surgery and handle the intense after care required.
• Stress: Colic surgery is stressful for any horse owner.
• You may spend considerable time and resources treating on the farm, when early referral gives better prospects of a successful outcome.

COLIC SURGERY

When there is a colon torsion, the intestinal lining will only survive for 3-4 hours, so early and close referral is required. Such horses require immediate surgery and often do not survive a 3-4 hour trailer ride.

If you have decided to proceed with colic surgery, your horse is now being prepped for surgery. Then the entire abdomen must be clipped, the feet cleaned, and the mouth rinsed to remove any residual feed material so that it does not end up in the lungs. There is a team gathered around him for this intravenous catheter placement. Large bags of IV fluids are used, and medications are given prior to surgery. A nasogastric tube is left in place until after surgery. Soon, he will be taken into the surgery area.

Once anesthetized and gently lowered to the floor, he will be placed on a padded table, using hobbles and a hoist system. Your horse will be placed on his back and secured to the table. A ventilator will be used to deliver anesthetic gases and breathe for him, and other equipment will be used to monitor blood pressure and oxygen levels.

Once the surgical area (belly) is surgically prepped, a heavily gowned surgeon will place a full body drape prior to making a 10–12-inch incision on the mid-line of the abdomen. Then, a full abdominal exploration will take place to determine the problem; much of this is by feel as many structures cannot be pulled into plain view.

Colic surgery is a great physical undertaking. Heavy segments of bowel must be pulled out of the abdominal cavity and emptied and re-positioned. Once a diagnosis has been made, the surgeon may need to discuss the problem and prognosis. You should be prepared to euthanize your horse on the table, as some lesions are not reparable, or may exceed costs that you are able to incur.

Once a diagnosis has been made, repairs must then ensue. This may be as simple as placing the intestine back in its normal position, i.e., a partial torsion or twist, or some other displacement. Also, damaged intestine may need to be removed, a blockage of sand or other foreign objects removed or fluid moved out of the small intestine into the cecum. Surgical time ranges from 1 ½ to 4 or more hours. Once the intestine has been repaired and replaced, the abdomen is painstakingly closed with heavy suture. Post recovery, which is assisted, he will be taken back to his stall where post op care will begin.

 

POST OPERATIVE COMPLICATIONS

Survival rates for many types of colic surgeries are high; however, things can go wrong at many points of the process. Very ill horses may have trouble surviving anesthesia, horses can be injured during recovery, and for horses with complicated conditions the first week after surgery is critical, requiring intensive medical care, including large volumes of intravenous fluids. The horse is monitored frequently, every 1-4 hours, day, and night, to adjust treatment and look for early signs of complications.

Hospital stays can vary from a few days to a few weeks, depending upon the initial surgical problem. Complications include abdominal or incisional infection, laminitis, colic recurrence, reflux, and many others. For many horses, the intensity of treatment gradually reduces prior to discharge at 5-7 days post-surgery.

HOME CARE

Once the horse is home, there is usually about 4 weeks of complete stall rest, followed by 4 weeks of stall rest and hand-walking. This is followed by 4 weeks of turn-out in a paddock. They must not be allowed to move faster than a walk until the incision has gained sufficient strength to bear the weight of the organs and movement. The diet may be modified, and other specific treatments may be given to you.

CONCLUSION

There is a general belief that colic surgery is often not successful. More than thirty years ago, that was true, but anesthetics have improved, along with surgical techniques. Many types of colic surgery today have a good prognosis; however, you should remember that despite the investment of a great deal of time and money, fatal complications can occur. Think about all of this before you ever get into this situation.

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Dr. Brian Burks is the owner/veterinarian at Fox Run Equine Center, a 24-hour medical-surgical center near Pittsburgh, Pennsylvania. He is board certified by the American Board of Veterinary Practitioners (Equine Practice). This certifies him as an expert in all categories of equine practice.