By Katherine Rivard, 2017
Saumur, a 22-year-old Morgan gelding presented one afternoon to the MSU Veterinary Medical Center’s Large Animal Emergency Service. He was down on the trailer, painful, and colicing. Colic is a clinical sign in horses that indicates severe abdominal pain, which can be caused for a number of reasons. Saumur’s owners first sensed something was wrong when he did not eat his breakfast that morning. After consulting their regular veterinarian, they decided to bring Saumur to MSU. Myself, Dr. Gallant, and a few other staff were able to get Saumur up, out of the trailer, and walking, but he was still in violent pain. Though he had a normal heart rate, he was covered in sweat from mane to tail, his gums were almost white in color, and he was in so much pain that he kept trying to throw himself on the ground.
To make Saumur more comfortable and keep everyone safe, we sedated Saumur and ran a few diagnostic tests to get a better idea of what was causing him to colic. On abdominal ultrasound, we saw dilated, fluid filled, small intestine with decreased motility, which is indicative of an acute blockage or constriction further down in the small intestine. His blood work came back with only slightly elevated values, indicating that we caught the problem early.
Based on Saumur's level of pain and diagnostic test results, an immediate abdominal exploration surgery was recommended. Once client consent was given, Saumur was started on antibiotics and prepped for surgery. During surgery, a lipoma was found strangulating the small intestine. Lipomas are benign fatty tumors that commonly develop in older horses. Lipomas grow on long stocks and hang like a ball at the end of a string from the mesentery in the abdomen. With a horse’s normal movement, lipomas can wrap around parts of the intestine, create a constriction, cut off the blood supply to the intestine, and stop the movement of ingesta through the intestine. After examining every inch of Saumur’s 70-foot small intestine to make sure there was no dead tissue, the lipoma was removed.
Saumur woke up from surgery quickly and uneventfully, and he looked pretty good before most of us left that night. However, around 2:00 a.m., a night technician noticed Saumur becoming mildly uncomfortable and that he had a high heart rate. They passed a nasogastric tube into his stomach and a large amount of reflux fluid was obtained. To reflux a horse is to help them to vomit. Horses cannot vomit on their own due to a strong band of muscle in their esophagus that acts as a one-way valve. If fluid or gas bloats the stomach, horses have no way to quickly relieve the pressure. The nasogastric tube stops the esophagus from closing off the stomach, which allows fluid and gas to be passed up.
Saumur’s reflux was a result of a common condition in horses called postoperative ileus. Disruption of normal gut motility, or ileus, is thought to be caused by inflammation that occurs after abdominal surgery. This disruption results in the build up of fluid in the stomach. Throughout the night, Saumur refluxed large amounts of fluid every few hours, producing a total of 11 gallons of net reflux! His IV fluids were increased to make sure he did not become dehydrated. The next evening, Saumur eventually stopped refluxing and was back on the road to recovery. Saumur spent three more days with us to monitor his progress, make sure he was eating well, and to gradually wean him off of his pain medications, fluids, and antibiotics.
Colics that are severe enough to go to surgery have increased complication risk and decreased survival rate. Saumur’s case showed what observant owners and a fast acting and dedicated medical team can accomplish.
Katherine Rivard is interested in small animal and small animal exotic medicine. She hopes to one day own a private practice.