Decision making

• Goals of initial assessment:
  • Evaluate the severity of pain and degree of cardiovascular compromise.
  • Look for evidence of possible etiology.
  • Decide if surgery is indicated or not.

Reassess mild or moderate colic cases not less than every 2 h so that a decision to undertake surgery is made sooner rather than later. If pain is controlled, owner can assess regularly.

• Early and accurate diagnosis of gastrointestinal disorders will strongly influence the prognosis of surgical cases.

Print off the Owner factsheets on Colic - a serious belly ache and Emergencies - when to call your vet to give to your clients.

• Make decisions about laboratory tests and other examinations early in the course of assessment.
• About 6% of colic cases will require surgery.
• Most cases of colic will respond to conservative management.

Duration of pain before initial examination is often unknown.

• Pain relief   Anesthesia: analgesia - overview  and supportive fluid therapy   Fluid therapy: intestinal obstruction  are integral to management.
• Recurrent colic is defined as two or more episodes of abdominal pain separated by a period of more than a few days.

Initial evaluation

Diagnostic techniques

Medical management

Surgical management

Prognosis

Differential diagnoses

Further Reading

Publications

• Recent references from PubMed and VetMedResource.
• Findley J & Archer D (2014) Management of the surgical equine colic patient following hospital discharge. In Pract 36 (5), 229-236 VetMedResource.
• Salciccia A et al (2013) Sensitivity and specificity of blood leucocyte counts as an indicator of mortality in horses after colic surgery. Vet Rec 173 (11), 267 PubMed.
• Linnenkohl W, Mair T & Fews D (2013) Case report of atypical infiltrative lipomatosis of the equine mesojejunum. Equine Vet Educ 25 (5), 237-240 VetMedResource.
• de Bont M P, Malbon A J, Sardon D & Archer D C (2013) Caecal lipomatosis as a cause of colic in a 9-year-old gelding. Equine Vet Educ 25 (5), 241-244 VetMedResource.
• Freeman S & Issaoui L (2013) Code red for coli: Decision-making for acute abdominal pain in the horse. Equine Vet Educ 25 (5), 245-246.
• Durward-Akhurst S A et al (2013) Comparison of two antimicrobial regimens on the prevalence of incisional infections after colic surgery. Vet Rec 172 (11), 287 PubMed.
• Southwood L L (2012) Complicated colic case raises interesting questions: What can we learn? Equine Vet Educ 24 (11), 569-572.
• Santschi E M (2012) Equine colic caused by neoplasia. Equine Vet Educ 24 (9), 437-438 VetMedResource.
• Fielding C L & Dechant J E (2012) Colic in competing endurance horses presenting to referral centres: 36 cases. Equine Vet J 44 (4), 472-475 PubMed.
• Alexander G R & Haines G R (2012) Surgical colic in racing endurance horses. Equine Vet Educ 24 (4), 193-199 VetMedResource.
• Scantlebury C E, Archer D C, Proudman C J & Pinchbeck G L (2011) Recurrent colic in the horse: Incidence and risk factors for recurrence in the general practice population. Equine Vet J 43 (Suppl 39), 81-88 PubMed.
• Archer D C (2011) Chronic persistent colic: Can I have a retrospectoscope please? Equine Vet Educ 23 (6), 286-288 VetMedResource.
• Malamed R et al (2010) Retrospective evaluation of crib-biting and windsucking behaviours and owner-perceived behavioural traits as risk factors for colic in horses. Equine Vet J 42 (8), 686-692 PubMed.
• Hart S & Southwood L L (2010) The enigma of post-operative recurrent colic: Challenges with diagnosis and management. Equine Vet Educ 22 (8), 408-411.
• Torre F, Gasparin J & Andreasi B (2010) Rupture of the mesocolon as a cause of recurrent colic in a showjumper mare. Equine Vet Educ 22 (8), 403-407 VetMedResource.
• Arguelles D et al (2010) Peritoneal concentrations of transforming growth factor beta in horses with colic. Equine Vet J 42 (5), 451-455 PubMed.
• Monreal L et al(2010)Enteral fluid therapy in 108 horses with large colon impactions and dorsal displacements. Vet Rec166(9), 259-263PubMed.
• Sutton G A, Ertrzman-Ginsburg R, Steinman A & Milgram J (2009)Initial investigation of mortality rates and prognostic indicators in horses with colic in Israel: A retrospective study. Equine Vet J41(5), 482-486PubMed.
• Saulez M N, Burton A, Steyl J C A, Williams J H & Clift S J (2009)Perforation of the gastrointestinal tracts of four horses by metallic wires. Vet Rec164(3), 86-89PubMed.
• Robert M P, Benamou-Smith A E, Cadore J L, Rosengarten M S & Lepage O M (2008)Recurrent colics in a 9-year-old Arabian stallion due to several congenital anomalies. Equine Vet Educ20(11), 567-571VetMedResource.
• Johnson P J & Kellam L L (2007)Risk of colic associated with persimmon fruit ingestion. Equine Vet Educ19(11), 576-578VetMedResource.
• Coomer R (2007)Colic Part 7: Rectal examination 5: Management of rectal tears. UK Vet12(8), 5-8.
• Coomer R (2007)Colic Part 6: Rectal examination 4: Small colon and reproductive tract. UK Vet12(7), 5-9.
• Coomer R (2007)Colic Part 5: Rectal examination 3: Large colon. UK Vet12(6), 5-10.
• Coomer R (2007)Colic Part 4: Rectal examination 2: Small intestine and caecum. UK Vet12(5).
• Brunott A et al(2007)A colonic epidermoid cyst as a cause of chronic recurrent colic in a horse. Equine Vet Educ19(3), 123-128VetMedResource.
• Coomer R (2007)Colic Part 3: Rectal examination 1 - Normal findings and technique. UK Vet12(4), 5-6.
• Coomer R (2007)Colic Part 2: Physical evaluation. UK Vet12(3), 5-12.
• Coomer R (2007)Colic Part 1: History, pain and analgesics. UK Vet12(2), 5-10.
• Mair T S & Edwards G B (2007)Chronic and recurrent colic: challenging clinical syndromes. Equine Vet Educ19(3), 137-138.
• Walmsley J P (2007)Laparoscopy in horses with abdominal pain. Equine Vet Educ19(2), 64-66VetMedResource.
• Borer K E & Corley K T T (2006)Electrolyte disorders in horses with colic. Part 2: Calcium, sodium, chloride and phosphate. Equine Vet Educ18(6), 320-325VetMedResource.
• Borer K E & Corley K T T (2006)Electrolyte disorders in horses with colic. Part 1: Potassium and magnesium. Equine Vet Educ18(5), 266-271VetMedResource.
• Andersen M A, Clark L, Dyson S J & Newton J R (2006)Risk factors for colic in horses after general anesthesia for MRI or non-abdominal surgery: absence of evidence of effect from peri-anesthetic morphine. Equine Vet J38(4), 368-374PubMed.
• Perez Olmos J F, Schofield W L, Dillon H, Sadlier M & Fogarty U (2006)Circumferential mural bands in the small intestine causing simple obstructive colic: a case series. Equine Vet J38(4), 354-359PubMed.
• Semevolos S A et al(2006)Perforating jejunal diverticulosis in 2 horses. Equine Vet Educ18(3), 139-142.
• Blikslager A T (2006)Peritonitis in the horse. Equine Vet Educ18(3), 143.
• Soler-Rodriguez F et al(2006) Datura stramoniumpoisoning in horses: a risk factor for colic. Vet Rec158(4), 132-133PubMed.
• Proudman C J et al(2006)Pre-operative and anaesthesia related risk factors for mortality in equine colic cases. Vet J171(1), 89-97PubMed.
• Saulez M N, Cebra C K & Dailey M (2005)Comparative biochemical analysis of venous blood and peritoneal fluid from horses with colic using a portable analyser and an in-house analyser. Equine Vet J157(8), 217-223PubMed.
• Rendle D I et al(2005)End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study. Equine Vet J37(4), 356-359PubMed.
• Husted L et al(2005)Risk factors for faecal sand excretion in Icelandic horses. Equine Vet J37(4), 351-355PubMed.
• White N A et al(2005)Use of web-based data collection to evaluate analgesic administration and the decision for surgery in horses with colic. Equine Vet J37(4), 347-350PubMed.
• Latson K M et al(2005)Evaluation of peritoneal fluid lactate as a marker of intestinal ischaemia in equine colic. Equine Vet J37(4), 342-346PubMed.
• Ryan C A et al(2005)Pharmacokinetics and pharmacodynamics of pantoprazole in clinically normal neonatal foals. Equine Vet J37(4), 336-341PubMed.
• Little D, Tomlinson J E & Blikslager A T (2005)Post-operative neutrophilic inflammation in equine small intestine after manipulation and ischaemia. Equine Vet J37(4), 329-335PubMed.
• van Hoogmoed L M & Boscan P L (2005)  In vitroevaluation of the effect of the opioid antagonist N-methylnaltrexone on motility of the equine jejunum and pelvic flexure. Equine Vet J37(4), 325-328PubMed. 
• Tschetter J R et al(2005)Detection of differentially regulated genes in ischaemic equine intestinal mucosa. Equine Vet J37(4), 319-324PubMed.
• Mair T S & Smith L J (2005)Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 4: Early (acute) relaparotomy. Equine Vet J37(4), 315-318PubMed.
• Mair T S & Smith L J (2005)Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival. Equine Vet J37(4), 310-314PubMed.
• Mair T S & Smith L J (2005) Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 2: Short-term complications. Equine Vet J 37(4), 303-309PubMed.
• Mair T S & Smith L J (2005) Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: Short-term survival following a single laparotomy. Equine Vet J37(4), 296-302PubMed.
• Freeman D E & Schaeffer D J (2005) Short-term survival after surgery for epiploic foramen entrapment compared with other strangulating diseases of the small intestine in horses. Equine Vet J37(4), 292-295PubMed. 
• Senior J M, Pinchbeck G, Dugdale A H A & Clegg P D (2004) A Retrospective study into risk factors and prevalence of post-operative colic after orthopaedic surgery in horses. Vet Rec 155 (11), 321-325.
• Senior J M, Pinchbeck G L, Dugdale A H A & Clegg P D (2004) Retrospective study of the risk factors and prevalence of colic in horses after orthopaedic surgery. Vet Rec 155 (11), 321-325 PubMed.
• Hunt R J (2004) Surgical management of colic. J Equine Vet Sci 24 (5), 212-213.
• Bosch G & van der Velden M A (2004) Impaired growth and colic caused by congenital defects in the mesenteric attachments of caecum and colon in a yearling. Equine Vet Educ 6 (3), 151-154.
• van Der Linden M A et al (2003) Prognosis in equine medical and surgical colic. J Vet Intern Med 17 (3), 343-348 PubMed.
• McGowan C & Freeman S (2003) Abdominal pain in a aged pony. Equine Vet Educ 15 (4), 179-181.
• Kim L M, Morley P S, Traub-Dargatz J L, Salmon M D & Gentry-Weeks C (2001) Factors associated with Salmonella shedding among equine colic patients at a veterinary teaching hospital. JAVMA 218 (5), 740-748 PubMed.
• Steel D M & Gibson K T (2001) Colic in the pregnant and periparturient mare. Equine Vet Educ 3 (2), 122-135.
• Traub-Daragat J L et al (2001) Estimate fo the national incidence of and operation-level risk factors for colic among horses in the United States, spring 1999. JAVMA 219 (1), 67.
• Proudman C J (1999) The role of parasites in equine colic. Equine Vet Educ 11 (4), 219-224.
• Mee A M et al (1998) A retrospective study of mortality associated with general anesthesia in horses - emergency procedures. Vet Rec 142, 307-309 PubMed.
• Hughes F E et al (1998) A modified technique for extensive large colon resection and anastomosis in horses. Vet Surg 27, 127-131 PubMed.
• Tinker M K et al (1997) Prospective study of equine colic risk factors. Equine Vet J 29, 445-448 PubMed. 
• Tinker M K et al (1997) Prospective study of equine colic incidence and mortality. Equine Vet J 29, 448-453 PubMed.
• Hillyer M H et al (1997) Recurrent colic in the mature horse - a retrospective review of 58 cases. Equine Vet J 29, 415-420 PubMed.
• Mair T S et al (1997) Chronic colic in the mature horse - a retrospective review of 106 cases. Equine Vet J 29, 415-420 PubMed.
• Blikslager A T et al (1997) How important is intestinal reperfusion injury in horses? JAVMA 211, 1387-1389 PubMed.
• Dart A J et al (1997) Cecal disease in equids. Aust Vet J 75, 552-557 PubMed.

Other sources of information

• Manley W et al (2004) Nitric Oxide and Cytokine Levels may have a Prognostic Value in Equine Colic. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 194.
• Picavet M T (2004) A Retrospective Clinical Survey on the Outcome of 442 Colic Surgeries in Two Belgian Equine Referral Practices. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 193.
• Maranon G et al (2004) Evidence of Production of Nitric Oxide and Carbon Monoxide in Horses with Colic. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 191.
• Maranon G et al (2004) Arachidonic Acid Metabolites could be Implicated in Equine Colic. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 191.
• Verdegaal E J M M & van der Kolk J H (2004) Salivery Cortisol Concentrations in Healthy, Aged Horses, Horses with Hirsuitism and Horses with Colic. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 103-104.
• Proudman C (2004) Post-Operative Care of the Colic Patient. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 70.
• Mair T S (2004) BEVA Evidence-Based Medicine Colic Surgery. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 58-59.
• Blikslager A T (2004) Can the Prognosis for Colic Cases be Predicted from Post Operative Data? In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 56.
• Proudman C (2004) Long-Term Post Operative Survival of Colic Cases. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 54.
• Blikslager A T (2004) Colic in the Geriatric Horse. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 52.
• Zimmel D N (2003) How to Manage Pain and Dehydration in Horses with Colic. In: Proc 49th AAEP Convention. pp 127-131.

Further Information

• The Webinar Vet - Colic in our equine patients - a current perspective