1

Equine Abdominal Surgery for Colic

Elyssa Schwarz

VET 221

November 27, 2016

 2

Equine Abdominal Surgery for Colic

Equine Colic is, according to (Bassert, 2014), any condition that causes abdominal

pain. Colic is a leading cause of mortality among horses and has been estimated to cost the US

equine industry $115.3 million per year. Owners rank colic as a high priority equine health

concern and it is a frequent reason for veterinary attendance, (Scantlebury, 2014). There are

various causes of colic: distension of the gut, pulling at the root of the mesenteric artery,

ischemia or infarction, and enteritis or ulcerations, (Holtgrew-Bohling, 2016). These can be

caused by fluid, sand, or gas impacting the intestines, a twisting of the intestines, inflammation

of the GI tract, and numerous other ways. (Holtgrew-Bohling, 2016). A large number of colic

cases will heal on their own or with minimal treatment, but others require surgery to fix the

problem.

Surgery is required for colic when minimal treatment such as analgesics, hand walking,

or sedation are not effective. Usually the horse will exhibit signs of pawing, stretching out,

showing the flehmen response, or standing quietly and not eating. They also may have an

elevated heart rate of greater than 50 bpm or may attempt to repeatedly lie down and stand up, or

even roll around while recumbent and bang their head against the ground. In some cases, no

amount or type of sedation will help. In these cases, surgery must be performed quickly, as the

condition can be life threatening. (Bassert, 2014). Sometimes, if surgery is not an option, the

horse may even have to be euthanized.

The most common patient positioning for colic surgery is dorsal recumbency. The DVM

will cut directly into the ventral abdomen, moving from the umbilicus toward the xiphoid until

they have an incision large enough. The DVM will then do a thorough exploration of the GI tract
 3

until the abnormality is found and corrected. (Bassert, 2014). Suction is usually needed during

the procedure to aspirate fluid or to decompress gas coming from the GI tract. (Bassert, 2014)

Prior to surgery, if the owner calls before bringing the horse in, the tech must make sure

to inform the owner not to give pain medication to the animal, as this may mask signs of colic,

leading to a difficult diagnosis (Holtgrew-Bohling, 2016). They also should advise the owner to

remove food and water sources from the horse, and they should try to keep their horse from

rolling around. This can be avoided by hand walking the horse until it can be seen by the DVM.

It is also the techs job to make sure the exam room is prepped and ready for the patient when it

arrives at the clinic. (Holtgrew-Bohling, 2016).

Before surgery is indicated, there are a lot of steps that must be gone through to

determine if surgery is the best option. McCurnin says that the first thing the technician must do

when a horse arrives at the clinic is to do an immediate visual assessment of how much pain the

animal is in and how severe the situation is. After this, the patient should be moved to the

examination room, where the technician will take the history of the patient. This history,

according to McCurnin, involves information about general husbandry and management, such as

the horses environment, feeding schedule, and the parasite control methods used. It also

involves history related to the colic episode such as how long it has been going on, what and

when the horse has been eating and drinking, and when the horses last defecation was etc. These

things can tell what type of colic the horse may be experiencing, and how bad the situation is.

After history is taken, the tech will perform a full physical exam of the horse. This

involves assessing how much pain the horse is in due to body language and behaviors. They must

then take the temperature of the horse, the pulse rate and rhythm, and the respiratory rate. The

mucus membrane color must be assessed, along with the capillary refill time, GI motility, and
 4

any self-trauma that may be present on the horse. The complete absence of GI sounds in a

colicky patient is a significant finding, (Bassert, 2014). Sometimes, large volumes of gas may

be present in the lumen which can stretch the bowel. To detect this, the tech must simultaneously

auscultate the abdomen and percuss it, listening for a ping sound (Bassert, 2014).

After the physical exam is performed, a colic workup will have to be done to make sure

that the problem really is colic. A blood sample will be taken and a Complete Blood Cell Count

and Packed Cell Volume will be performed, along with a biochemical profile, Total Protein,

lactate, and fibrinogen (Bassert, 2014). Nasogastric intubation should be done to give the gas and

ingesta building up in the stomach a place to exit. This can save the horses life, as the horse is

not able to vomit this up. Medication can also be given through the NG tube to deposit them

directly into the stomach. A rectal exam should also be performed. This allows you to perform an

abdominal palpation and also allows a fresh fecal sample to be collected and grossly examined

for consistency, color, odor, blood, mucous strands, and parasites, (Holtgrew-Bohling, 2016).

A fecal exam and culture should also be performed to examine for parasites and the presence of

sand in the feces.

Other diagnostic methods include abdominal ultrasounds, radiographs, gastroscopy,

thermography, laparoscopy, and abdominocentesis. Abdominal radiographs are often used in

foals because they are smaller, and lack solid intestinal contents. This makes it easier to diagnose

by radiograph. Ultrasound is also helpful, especially in conditions located close to the abdominal

wall, as it may have some difficulty penetrating deep into the horses abdomen. (Holtgrew-

Bohling, 2016). Abdominocentesis allows the abdominal fluid to be evaluated. Care must be

taken to follow aseptic technique and to do a proper surgical scrub, as the abdominal cavity is

normally a sterile environment. The fluid is removed, and then examined for abdominal clarity
 5

and color. Levels of protein, glucose, and lactate are measured and a cell count, cytologic exam,

gram stain, and culture are performed. (Bassert, 2014).

After diagnostic workup is done, the DVM will be able to make a diagnosis. If colic

surgery is indicated, the tech will need to get to work with patient preparation. They will need to

go through all the preparation for general anesthesia. They must place an IV catheter, administer

perioperative medication, place an endotracheal tube, wash out the horses mouth, clip the hair,

prepare the anesthetics, prepare the incision site, and open surgical packs (Bassert, 2014). The

ventral abdomen will be clipped from the xiphoid area to the inguinal region; this is done all the

way from one flank to the other. A surgical scrub is performed to remove dirt and debris and the

hooves are picked out and cleaned as well. Another surgical scrub should be done right before

the horse goes into surgery, and the patient will then be draped with towels. (Bassert, 2014).

Throughout these procedures, aseptic technique must be very carefully maintained. The

technician must make sure the IV catheter is properly placed, making sure not to touch the

incision site. All hair clippings must be vacuumed away and a proper surgical scrub must be

done. Surgical packs too must be opened away from the patient, being careful not to touch

anything or contaminate instruments.

Before surgery is performed, the technician should get the surgical pack and all the

instruments ready There are quite a few instruments included in colic surgery. The book Equine

Acute Abdomen, lists a number of these instruments including: Backhaus towel clamps, #3 and

#4 scalpel handles and blades, Adson-Brown and Rat tooth tissue forceps, Mayo dissecting

scissors, Metzenbaum scissors, suture scissors, Mayo-Hegar needle holders, Mosquito forceps

Kelly forceps, Bulb syringes, Decompression tubing and needles, 4 by 4 sponges, Babcock

intestinal forceps, Allis tissue forceps, Carmalt forceps, and Fogarty intestinal clamps. A
 6

common suture material used is synthetic absorbable. Stapling instruments can also be used as

they allow the DVM to close an incision in hard to reach places such as a bowel. They are fast,

so they can also shorten anesthesia time. (White, 2009).

There are a few other things needed for equine colic surgery. An anesthetic machine is

needed to keep the patient under general anesthesia. Endotracheal tubes are needed as well as a

hoist to place the patient in the proper position. Foam padding and paddles are required to

support the horse and basic monitoring equipment is needed to monitor the horse under

anesthesia. It is also helpful to have warm fluid bags ready to packed along the horse to raise

body temperature in the case of hypothermia. (Holtgrew-Bohling, 2016).

It is the role of the LVT during surgery to assist the veterinarian in every way possible.

Colic is a challenging surgery, and the LVT must be ready to jump in whenever they are needed.

They may have to open surgical packs, provide sutures for the DVM, prepare any equipment the

DVM might need, and even irrigate the bowel with fluids whenever it is needed (Markwell,

2016). The tech also has a role in making sure aseptic technique is followed. They must always

remain cautious when moving over or around a sterile field, and they are the ones preparing the

surgical packs and drapes. This too must be done aseptically, and surgical conscience must be

followed.

There are many different medications that can be used for colic surgery. Premedications

will be given before the surgery to reduce the pain the horse will feel when it wakes up from the

anesthetic. Possible premeds to give are NSAIDs such as Banamine, or Opioids such as

Butorphanol. Banamine can be given IV, PO, or IM and treats GI pain and endotoxemia.

Butorphanol can be given IV or IM and is also used for pain relief. NSAIDs are ideal because

they are anti-inflammatory and analgesic and they treat the source of the pain as well as the pain
 7

itself. (Bassert, 2014). When using Banamine for colic surgery however, it must be used with

caution because it may mask the behavioral and cardiopulmonary signs that are associated with

endotoxemia or intestinal devitalization. There are also possible interactions with other NSAIDs.

Butorphanol must be used cautiously in patients that have hypothyroidism, severe renal

insufficiency, Addisons, and who are geriatric or severely debilitated. (Plumbs Online). Other

drugs such as Penicillin and Gentamycin can be given prior to surgery to prevent infection

(Baumwart, 2015).

It is the LVTs job to make sure the proper drug concentrations and doses are drawn up

and prepared for the DVM. The must be sure to check the patients six rights to make sure the

horse is receiving the right drug and dosages. They also must be aware of the side effects of the

drugs so that if something goes wrong, they are able to react quickly. Aseptic technique must also

be followed carefully to prevent contamination of the sterile needle before injection and to make

sure drugs are not mixed. The skin can also be scrubbed with alcohol before injection to help

with contamination.

There are also multiple induction agents that can be given to horses to induce anesthesia.

Induction should be performed in a padded stall to reduce risk of injury to the horse. A few

examples of induction agents are Ketamine, given as a bolus, and Guaifenesin, infused under

pressure, followed with Ketamine as a bolus injection. (Thomas, Lerche, 2011). According to

Plumbs Therapeutics Online, Ketamine is used as a rapid acting anesthetic. It can increase heart

rate, blood pressure and myocardial oxygen consumption, so careful monitoring must occur.

Also, excessive dosages close to recovery should be avoided to reduce the potential for muscle

rigidity or CNS excitement (Plumbs Online, n.d.). It should be used carefully with other drugs.

Guaifenesin is used to induce muscle relaxation and restraint as an adjunct to anesthesia for
 8

short procedures in large and small animal species, (Plumbs Online, n.d.). It must be given IV

because it can cause significant tissue damage if given perivascularly, (Plumbs Online, n.d.).

Careful monitoring MUST be present as dramatic muscle relaxation can occur and follow up

with Ketamine must be timed perfectly.

During this procedure, the LVTs job is to make sure proper monitoring is done. Because

timing is so important, the LVT must know exactly when to give drugs and must know the

horses vital signs at all times. The LVT also must make sure there is proper padding under the

horse, so tying up is avoided. They should also make sure the proper drugs and dosages are

drawn up to give to the DVM. Aseptic technique is important here to, to make sure needles stay

sterile and to make sure that drugs are administered with the correct technique.

During anesthesia, constant monitoring is extremely important. The patient needs to be

watched carefully to make sure hypothermia, hypoventilation, hypotension, and bradycardia do

not develop. The patients temperature, pulse rate and rhythm, respiratory rate and depth,

capillary refill time, and mucous membrane color should be monitored carefully. (Holtgrew-

Bohling, 2016). Fluid bags can be used to warm the patient and blankets can be used to cover

them in order to prevent hypothermia. Less commonly, hyperthermia can occur and the patient

must be cooled down quickly.

There are various ways to monitor the patient without the use of equipment. These

methods include palpation to feel the pulse, checking the patients eye position and reflexes, and

listening to the lungs and taking the temperature with stethoscopes and thermometers. The LVT

must also watch the patient for signs that they may be waking up. Signs may include movement

and the increase in respiratory rate, heart rate, and blood pressure. (Holtgrew-Bohling, 2016).
 9

Use of equipment can also be used to monitor patients. Electrocardiograms may be used

to monitor the cardiac activity of the horse and blood pressure monitoring can be done with a

intraarterial catheter and pressure transducer, or with a Doppler ultrasound unit and inflatable tail

cuff over the coccygeal artery. (Holtgrew-Bohling, 2016). A pulse oximeter may also be used to

measure the amount of oxygen in the bloodstream and a ventilator may be used to prevent

hypoventilation. The LVT would be responsible for monitoring the patient, either with or without

equipment. They would be the ones to alert the DVM if the patient is experiencing problems, or

if the patient begins to wake up. (Holtgrew-Bohling, 2016). Aseptic technique must also be

followed here to prevent contamination of the surgical field, and when moving around the patient

and the doctor.

After surgery, the technician plays an important role in monitoring the patients recovery.

Because horses are flight animals, they have the instinctive need to stand as soon as they wake

up from the anesthesia. Because of this, horses should recover in a padded stall where it will be

extubated and continuously monitored. Care should be taken when removing the ET tube. The

horses neck must be kept in a position that does not occlude breathing, and the horse must be

watched to make sure it swallows. This needs to be done when the horse shows signs of waking

up. If the horse is struggling to breathe, a nasogastric tube should be placed. Sometimes, a horse

may need to be kept on oxygen until it is extubated, or it may need help getting up with ropes

and pulleys.

While the horse is in recovery, the LVT should watch respiratory rate and pulse rate and

should look at the eyes to determine the depth of anesthesia the horse is still in. Further sedation

may be needed if the horse tries to struggle as it wakes up. The LVT should remain outside of the

stall as much as possible as the horse recovers for their own safety. (Bassert, 2014). They also
 10

must make sure things are done as aseptically as possible. The tubes used must be clean and

properly placed without being contaminated by the environment.

One the horse can stand, it should be examined for trauma and the IV catheter should be

checked and flushed. If the horse is able to walk steadily, it can be returned to its stall. The horse

should then be placed in a stall without bedding or muzzled for a few hours to prevent them from

eating. Water is not withheld. (Holtgrew-Bohling, 2016) The horse should also be monitored for

signs of neuropathy during this period. (Thomas, Lerche, 2011).

Even after the horse returns home, it will need special care. Owners should be instructed

to confine their horse to a stall for at least a month after surgery. If no complications occur, the

horse can be let out into a small paddock for another month or two. The horse can be ridden

about three months post-op as long as it heals properly and the veterinarian allows it. (Baumwart,

2015). Owners should also be instructed by the LVT on how to prevent their horse from getting

colic again. Colic can be prevented by establishing and adhering to a set daily routine, feeding a

high-quality forage, dividing rations into smaller, frequent meals, routine deworming, providing

daily exercise, making gradual feed and exercise changes, providing fresh clean water, reducing

stress, monitoring horses for signs, and by keeping accurate records, (Holtgrew-Bohling, 2016).

These are only a few of the ways colic can be prevented. There are, in fact, many ways that

owners can prevent colic from occurring again. They need to carefully monitor their horses and

the environment their horses are in.

Unfortunately, colic is a relatively common condition in horses. Although it can be

serious, it can often be treated. It takes effort from a lot of people but it is often successful.

Early recognition of colic by horse-owners and subsequent timely veterinary attendance is

essential to increase the chance of a successful outcome, (Scantlebury, 2014).

 11

References

Bassert, J. M., & Thomas, J. A. (2014). McCurnin's Clinical Textbook for Veterinary

Technicians (8th ed.). St. Louis, MO: Elsevier.

Baumwart DVM, DACVS, C. (2015, October). The Dreaded C-Word. In AVS Equine Hospital.

Retrieved from https://www.avsequinehospital.com/news/thedreadedcword.html

Holtgrew-Bohling, K. (2016). Large Animal Clinical Procedures for Veterinary Technicians (3rd

ed.). St. Louis, MO: Elsevier.

Markwell, H. (2016, October 22). The Vet Tech's Role in Colic Surgery. In TheHorse. Retrieved

from http://www.thehorse.com/articles/34699/the-vet-techs-role-in-colic-surgery

Plumb's Veterinary Drugs. (n.d.). Retrieved November 25, 2016, from

https://www.plumbsveterinarydrugs.com/#!/home

Scantlebury, C., Perkins, E., Pinchbeck, G., Archer, D., & Christley, R. (2014, July 7). Could it

be colic? Horse-owner decision making and practices in response to equine colic. BMC

Veterinary Research. Retrieved from PubMed (PMC4122872).

Thomas, J. A., & Lerche, P. (2011). Anesthesia and Analgesia for Veterinary Technicians (5th

ed.). St. Louis, MO: Elsevier.

White, N. A., Moore, J. N., & Mair, T. S. (2009). Equine Acute Abdomen (pp. 483-485). N.p.:

CRC Press.