Equine Colic

Surgical Complications and Post-Operative Care

General post-operative colic complications include :

  •  Postoperative ileus (reflux)
    • Risk Factors: Small intestinal lesions, torsions
    • Prevention: Early referral, minimize tissue handling during surgery, post-operative analgesics and anti-inflammatories such as Banamine and lidocaine CRI.  Additional prokinetics such as metoclopramide, erythromycin and neostigmine have been used with variable efficacy across studies. Early feeding is considered beneficial but has to be balanced with trauma to any enterotomy incision.
  •  Diarrhea
    • Risk Factors: Large colon lesions (volvulus, sand impactions, enteroliths), small colon lesions, Salmonellosis
    • Prevention: One study showed administration of Biosponge for three days reduced the risk of post-op diarrhea in horses undergoing large colon colic surgeries
  • Endotoxemia / SIRS
    • Risk Factors: Strangulating lesions
    • These horses can often be very sick after surgery and require intensive care and management
    • Prevention: Early referral, aggressive treatment with antibiotics, polymyxin B and plasma
  •  Laminitis
    • Risk Factors: Strangulating lesions, endotoxemia, SIRS
    • Prevention: Early referral, antimicrobial therapy, anti-endotoxin drugs (polymyxin-B, plasma), ice boots (variable evidence for the efficacy of ice boots), heparin.
  • Adhesions
    • Risk Factors: Being a horse, small intestinal surgeries, resection and anastomosis
    • Prevention: Several techniques have been proposed with variable efficacy including: peritoneal lavage, 1% high molecular sodium carboxymethylcellulose (belly jelly), hyaluronate/SCMC sprays or membranes
  • Incisional infections
    • Risk Factors: Clean contaminated surgeries, environmental contamination
    • Prevention: Aseptic surgical techniques, adherence to appropriate antimicrobial therapy pre- and post-op, placement of a stent bandage over the incision during recovery
  • Incisional hernias
    • Risk Factors: Incisional infections, repeat laparotomy
    • Prevention: Belly bandage or hernia belt may be beneficial. Restrict “bouncing” for the first 60 days after surgery.
  • Continued or recurrent pain
    • Risk factors : ongoing damage, adhesions, ileus
    • Treatment : nasogastric intubation to relieve fluid, treatment for ileus; repeat laparotomy

Post-Operative colic complications

Prognosis:

This is highly dependent on the type of colic, severity of disease, and post-operative complications.  Most studies have combined large and small intestinal lesions together when estimating prognosis and survival rates.

For horses allowed to recover from anesthesia, short term survival rate for small intestinal surgeries has been reported to by 68% to 100%.

76%-86% of horses discharged from the hospital returned to training after one year and 65-84% achieved the same or better performance.

Age is not associated with an increased risk of post-operative complications.  Horses with concurrent diseases such as PPID may have an increased risk of infection or delayed healing.

Suggested Reading:

Fifty Years of Colic Surgery

Non-complicated Post-Operative Care:

In non-complicated colic surgeries (often large colon displacements or impactions), horses will be maintained on intravenous antibiotics and analgesics for 72 hours.  During this time, if there is no signs of post-operative colic or reflux, they will be slowly re-fed and monitored for colic signs.

Average regimen after discharge

  • First 30 days: Stall rest with hand walking the first 30 days after surgery. Hand walking, 10 minutes per walk, and hand grazing if grass is available, is recommended 3 to 4 times daily.
  • 30 to 60 days: Round pen or small paddock self-exercise is permissible from day 30 to day 60 after surgery if the incision is healing well. If a round pen or small paddock is not available, increase the time hand walking.
    • Malone keeps them stall rested for 60 days. We typically close with Vicryl which loses strength about day 28. Since the body wall takes 60 days to regain strength, she worries that they will overexercise if turned out.
  • 60 to 90 days: Gradually return to normal activity from day 60 to day 90 after surgery. If postoperative complications occurred, especially in the incision, additional rest is recommended.

 

License

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Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.