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Compendium October 2011 (Vol 33, Issue 10)

Clinical Snapshot: Acute Colic in a Paint Horse

by Adam Stern, DVM, CMI-IV, CFC, DACVP

    Case Presentation

    A 9-year-old paint gelding presented to the referring veterinarian with a history of acute colic. When examined, the horse was in severe abdominal pain. A nasogastric tube was passed, and no gastric reflux was obtained. Approximately 1 L of mineral oil was administered via the nasogastric tube. The horse was given a single injection of flunixin meglumine (dose unknown) and referred to the Oklahoma State University Boren Veterinary Teaching Hospital. The horse died in transit to the university. A photograph of the jejunum  (FIGURE A) was obtained at necropsy.

    1. What is your diagnosis?

    2. What were the possible causes of intestinal obstruction?

    3. What are some possible complications of small intestinal obstruction?

    Answers and Explanations

    1. This horse had multiple granulomas circumferentially around the proximal jejunum (FIGURE B) , and the small intestine (jejunum and duodenum) proximal to this site was markedly dilated by ingesta. In addition, the stomach was ruptured, and severe fibrinous peritonitis was present. It is theorized that the presence of the granulomas resulted in localized ileus, leading to rupture of the stomach. The lack of gastric reflux during examination by the referring veterinarian was likely due to rupture of the stomach before examination. Small numbers of fungal hyphae consistent with Aspergillus spp were identified histologically within the granulomas (FIGURE C) . Fungal cultures were not performed for this case; therefore, definitive identification of the fungus was not possible. In my opinion, the circumferential arrangement of granulomas was an uncommon lesion in this region. Several case reports have described small and large intestinal granulomas within the wall of the small intestine; however, gastric rupture was not listed as a sequela.

    2. Causes of small intestinal obstruction can be separated into multiple categories, including nonstrangulating (intraluminal or extraluminal) obstruction, strangulating obstruction, nonstrangulating infarction, and functional obstruction.1–3 Nonstrangulating intraluminal causes include ascarid impaction, ileal impaction, and scarring with secondary stricture of the intestinal lumen. Nonstrangulating extraluminal causes include abdominal adhesion, diverticular formation, and mesenteric abscessation. Strangulating causes include intestinal volvulus, intussusception, hernia (umbilical, scrotal, diaphragmatic, gastrosplenic), neoplasia (strangulating lipoma), and vaginal evisceration. Nonstrangulating infarction of the small intestine can occur secondary to cranial mesenteric arteritis due to Strongylus vulgaris or secondary to intussusception. A functional cause of small intestinal obstruction is ileus.

    3. Possible complications of small intestinal obstruction include rupture of the small intestine or stomach.

    1. Brown CC, Baker DC, Barker IK. Alimentary system. In: Maxie GM, ed. Pathology of Domestic Animals. 5th ed. Edinburgh, UK: Elsevier Saunders; 2007:86-99.

    2. Blikslager AT. Disease of the alimentary tract. In: Smith BP, ed. Large Animal Internal Medicine. 3rd ed. St. Louis: Mosby; 2002:649-653.

    3. Sysel AN. Small intestinal obstruction. In: Brown CM, Bertone JJ, eds. The 5-Minute Veterinary Consult. Philadelphia: Lippincott Williams & Wilkins; 2002:988-991.

    References »

    NEXT: Clinical Snapshot: Vomiting and Weight Loss in a Cat

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