MED­I­CAL FRONT

EQUUS - - Equus -

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New re­search from Cal­i­for­nia has iden­ti­fied a sign---ac­cu­mu­lated gas--that may be par­tic­u­larly use­ful in pre­dict­ing whether a case of sand colic will re­quire surgery.

Char­ac­ter­ized by in­ter­mit­tent gut pain and di­ar­rhea, sand colic oc­curs when large quan­ti­ties of sand, in­gested when graz­ing, set­tle in a horse’s large colon. Med­i­cal treat­ment in­cludes ad­min­is­ter­ing fluid in­tra­venously, along with lax­a­tives to help move the sand through the di­ges­tive sys­tem. If those mea­sures fail or if the pain be­comes se­vere, surgery to man­u­ally re­move the sand may be re­quired.

To bet­ter un­der­stand the fac­tors that in­flu­ence whether a case of sand colic will be re­solved with med­i­ca­tion alone or re­quire surgery, re­searchers at the Uni­ver­sity of Cal­i­for­nia—Davis re­viewed the records of 153 horses ad­mit­ted to the clinic for sus­pected sand colic be­tween 2004 and 2014. They de­ter­mined the sever­ity of sand ac­cu­mu­la­tion by re­view­ing

ra­dio­graphs and cal­cu­lat­ing the square area of vis­i­ble sand. They also noted whether gas ac­cu­mu­la­tion was de­tected in the ini­tial exam, ei­ther on ra­dio­graphs or though rec­tal pal­pa­tion.

Gas can ac­cu­mu­late for a va­ri­ety of rea­sons, says Is­abelle Kil­coyne, MVB, DACVS. “The gas buildup can be be­cause the sand is caus­ing an ob­struc­tion, thus pre­vent­ing it pass­ing through. Or some­times the colon can be­come dis­placed and, be­cause it is weighed down by the sand, it makes it more dif­fi­cult to flip back to the right place, some­what caus­ing an ob­struc­tion, too.”

In their re­view of the records, the re­searchers also de­ter­mined which horses ended up be­ing sent to surgery for sand re­moval and which cases re­quired only med­i­cal man­age­ment to re­solve. They found that horses who showed in­creased gas ac­cu­mu­la­tion were sig­nif­i­cantly more likely to re­quire surgery, but there was no cor­re­la­tion be­tween the amount of sand and the need for sur­gi­cal in­ter­ven­tion.

Re­gard­less of treat­ment, the prog­no­sis for the horses with sand colic was very fa­vor­able, with 94.8 per­cent treated med­i­cally and 94.7 per­cent treated sur­gi­cally sur­viv­ing to be dis­charged. This, says Kil­coyne, was not un­ex­pected: “Gen­er­ally any con­di­tions of the large colon do well, say, com­pared to small in­testi­nal prob­lems.”

Kil­coyne says that while gas ac­cu­mu­la­tion can be a use­ful de­tail for a vet­eri­nar­ian in­ves­ti­gat­ing sand colic, it is only one in the larger pic­ture. “It is a clin­i­cal sign to com­bine with oth­ers,” she says. “It is a pa­ram­e­ter that may sug­gest to the clin­i­cian that there is pos­si­bly more go­ing on than just a rou­tine sand im­paction, such as a dis­place­ment.”

Ref­er­ence: “Clin­i­cal findings and man­age­ment of 153 horses with large colon sand ac­cu­mu­la­tions,” Vet­eri­nary Surgery, Au­gust 2017

Re­gard­less of treat­ment, the prog­no­sis for the horses with sand colic was very fa­vor­able, with 94.8 per­cent treated med­i­cally and 94.7 per­cent treated sur­gi­cally sur­viv­ing to be dis­charged.

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