Nonstrangulating intestinal infarctions associated with Strongylus vulgaris: Clinical presentation and treatment outcomes of 30 horses (2008-2016).
Authors: Pihl T H, Nielsen M K, Olsen S N, Leifsson P S, Jacobsen S
Journal: Equine veterinary journal
Summary
# Editorial Summary Strongylus vulgaris is becoming increasingly problematic in horses managed under routine parasite surveillance programmes, with nonstrangulating intestinal infarction emerging as a significant complication that clinicians may overlook. This retrospective analysis of 30 cases (2008–2016) characterised the clinical and pathological presentation of this condition, which typically manifests as mild colic lasting over 24 hours accompanied by peritoneal fluid white blood cell counts exceeding 5 × 10⁹/L, elevated serum amyloid A concentrations, and positive S. vulgaris-specific antibody titres, but without signs of shock or strangulated intestine. Medical management alone proved universally unsuccessful, whilst exploratory laparotomy identified the lesions in 21 horses; of the nine cases undergoing intestinal resection, three horses (33%) survived to discharge and returned to work for at least two years. The key clinical implication is that in regions where S. vulgaris remains endemic, nonstrangulating intestinal infarction warrants serious consideration in the differential diagnosis of persistent mild colic with peritonitis, particularly when conventional indicators of strangulation are absent—and that surgical intervention with resection offers the only realistic chance of survival, though careful case selection remains essential given the high intraoperative euthanasia rate observed in this cohort.
Read the full abstract on PubMed
Practical Takeaways
- •In regions with endemic S. vulgaris, suspect nonstrangulating intestinal infarction in horses presenting with mild colic lasting >24 hours and concurrent peritonitis—early recognition is critical as medical treatment alone does not succeed
- •Surgical intervention with intestinal resection offers the only realistic chance of survival (33%), so consider laparotomy in suitable candidates rather than medical management alone
- •Test for S. vulgaris-specific antibodies and monitor peritoneal fluid WBC and SAA concentrations to support diagnosis and guide treatment decisions
Key Findings
- •Nonstrangulating intestinal infarction presents with mild colic >24 hours duration, elevated peritoneal fluid WBC (>5×10⁹/L), and increased serum amyloid A concentration with positive S. vulgaris-specific antibodies
- •Medical treatment alone (9 horses) had 0% survival rate
- •Surgical resection of infarcted intestine achieved 33% survival (3 of 9 horses), with survivors returning to athletic function for ≥2 years
- •Eleven of 21 horses undergoing exploratory laparotomy were euthanized intraoperatively due to presumed poor prognosis