Colic Surgery, should I put my horse through it?
The term colic simply denotes abdominal pain within the horse’s abdomen. There are over 70 different types of colic a horse can get, some of which can be managed medically but some conditions, unfortunately require surgery to correct the condition and save the horse’s life. Broadly speaking colic can be considered as either a medical or surgical colic, depending on the cause of the colic and how the horse responds to treatment. A medical colic is one that has the potential to resolve with medical management which may involve just starving and walking the horse or may require a variety of drugs and fluid therapies. A surgical colic includes any type of colic where blood supply to the gut is compromised, certain specific conditions that have not had chance of resolution with medical management, conditions that fail to respond to medical management, or are so painful, it is in the best interest of the horse to operate.
Surgical colics account for approximately 10% of colic cases seen, however, this number varies geographically around the UK. There are certain clinical examination findings that indicate a horse requires referral to an equine hospital. It should be remembered that referring your horse to an equine hospital doesn’t mean your horse necessarily requires colic surgery.
In some instances, it is unclear what it causing the colic in your horse and referring your horse to an equine hospital allows the vets to perform additional diagnostic tests such as abdominal ultrasound, rectal ultrasound and abdominocentesis (taking a sample of the fluid within your horse’s abdomen). Referral then allows the vets to monitor your horse closely and repeat those tests to determine if the horse is getting better or worse.
Some horses with confirmed medical conditions will require intense medical management including; regular veterinary monitoring, intravenous fluid therapy, regular nasogastric tubing, rectal examination and abdominocentesis. All of which can be done far easier, and sometimes cheaper than managing the horse at home.
The added benefit of referring your horse to an equine hospital is that if the colic worsens and the horse does require surgery, your horse is already in the best place and surgery can happen without delay of travel and re-assessment. Speed is of paramount importance when dealing with a colic.
Now we have established that referring your horse to an equine hospital doesn’t automatically mean colic surgery, we can discuss, what if your horse does require colic surgery.
Colic surgery is a life-saving procedure, but is also one of the most challenging surgeries and it is not without risk or complications. Horses that do require colic surgery are usually very sick individuals and that makes the anaesthesia very challenging. It has been reported that one in a hundred horses die under anaesthesia, this is an old figure and anaesthetic death rates are thought to be lower now because of better monitoring and a better understanding of anaesthesia in the horse. However, because horses with colic are systemically ill, the anaesthetic is complicated and anaesthetic death rates of horses with colic are greater. If a horse with colic is operated on sooner rather than later, the horse will be healthier and there will be fewer anaesthetic complications and a lower anaesthetic risk. This again leads to the merit of early referral of a colic so they are in a facility where an operation can be performed. There is no association with age and anaesthetic risk, this is to say older horses are not at a greater anaesthetic risk compared to young horses.
Common surgical conditions include; a displaced colon, a large colon torsion and a small intestinal obstruction. A displaced colon can be managed medically, however, some displacements fail to resolve medically or if the horse is too uncomfortable to manage medically, the aim of the surgery is to manually lift the colon out of the horse and put it back in the correct location. A large colon torsion describes that the colon is not only displaced (in the wrong place) but twisted on itself and the blood supply to the gut has been compromised. These horses will be incredibly uncomfortable, and require to lift the colon out of the abdomen, un-twist the colon and place it back in the abdomen in the correct position. If the twist in the colon has compromised the blood supply to the gut for too long a period, the colon may need to be removed. Removing a section of the horse’s colon is an incredibly complex surgery to perform, and success rates are low in these kinds of surgeries. Thankfully, this is a rare occurrence as most colons only require un-twisting. A small intestinal obstruction is almost always surgical and requires identification of the reason for the obstruction and correcting that problem. If the small intestine’s blood supply has been compromised a section may need to be removed, this unlike the colon, is a more common procedure during colic surgery and although it too carries additional risks, most horses do well following a small intestinal resection.
Reasons for a small intestinal obstruction can be, but are not limited to; a twist in the small intestine around itself, a twist around a lipoma or a lipoma cutting off the blood supply, or an epiploic entrapment (the small intestine becomes trapped in a small hole within the abdomen and requires manual removal).
An uncomplicated surgical colic operation will cost in the region of £5,000 and this is the limit to most insurance claims. However, if your horse has a prolonged recovery or there are complications, or your horse requires a second surgery, then the cost will breech that £5,000 limit. Some insurers are now offering claims up to £10,000 so it is worth shopping around and considering this when taking out an insurance policy.
In summary, colic referral doesn’t definitely mean colic surgery but it has the added benefit that if your horse does need surgery they are in the right place. An early colic referral with aggressive medical treatment may prevent colic surgery and be cheaper than managing your horse at home. Speed is essential when dealing with a colic, call the vet early and refer early to give your horse the best chance. Don’t rule colic surgery out, there are many success stories following colic surgery, even in the older horse, however prognosis will depend on diagnosis.