Strangulating obstruction caused by intestinal herniation through the proximal aspect of the cecocolic fold in 9 horses.
Authors: Gayle J M, Macharg M A, Smallwood J E
Journal: Veterinary surgery : VS
Summary
# Herniation through the Cecocolic Fold: A Rare but Serious Colic Differential Strangulating obstructions caused by intestinal herniation through the proximal cecocolic fold represent an uncommon but catastrophic form of equine colic that warrants consideration in cases refractory to medical management. This retrospective analysis examined nine cases, predominantly involving ileal and distal jejunal incarceration, with surgical intervention requiring extensive resection (mean 3 m of small intestine; range 1.5–6.4 m) and jejunocecostomy reconstruction in six horses. Although initial surgical success was achieved in six cases with discharge from the hospital, long-term prognosis remained guarded, with two of the four horses available for follow-up ultimately euthanased at 12 and 18 months post-operatively due to recurrent colic signs. Anatomical examination revealed natural variations in cecocolic fold thickness across the equine population, which the authors postulate may predispose certain individuals to defect formation, though the aetiology remains poorly understood. For practitioners, recognition of this differential diagnosis combined with intra-operative knowledge that gentle traction perpendicular to the cecal base facilitates reduction of entrapped bowel can inform both medical decision-making and surgical planning in cases presenting with signs of strangulating obstruction unresponsive to conservative management.
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Practical Takeaways
- •Cecocolic fold herniation should be included in your differential diagnosis for acute strangulating colic in horses; early recognition and surgical intervention may be lifesaving
- •Even with successful surgical resection and anastomosis, expect cautious long-term prognosis—recurrent colic requiring euthanasia occurred in approximately 50% of discharged horses
- •During surgery for cecocolic fold herniation, apply traction perpendicular to the cecal base to facilitate gentle reduction and minimize additional bowel trauma
Key Findings
- •Herniation through the proximal cecocolic fold caused strangulation of ileum and distal jejunum in 8 of 9 horses, requiring mean small intestinal resection of 3 m (range 1.5–6.4 m)
- •Six of 9 horses were discharged post-operatively, but only 2 had long-term survival beyond 12 months; 4 were euthanatized within 18 months due to colic recurrence
- •Anatomic variations in cecocolic fold thickness were identified in necropsy specimens, suggesting structural differences may predispose to defect formation
- •Reduction of entrapped bowel was most effective when traction was applied perpendicular (90°) to the base of the cecum