Surgical treatment of epiploic foramen entrapment in 142 horses (2008-2016).
Authors: van Bergen Thomas, Haspeslagh Maarten, Wiemer Peter, Swagemakers Michaël, van Loon Gunther, Martens Ann
Journal: Veterinary surgery : VS
Summary
# Epiploic Foramen Entrapment: What the Surgical Evidence Tells Us Epiploic foramen entrapment (EFE) represents a surgical emergency with significant morbidity, as demonstrated in this retrospective analysis of 142 horses (145 surgeries) treated at a single referral centre between 2008 and 2016. The case cohort was heavily skewed towards Warmblood breeds (85%) and notably included a 60% incidence of windsucking or crib-biting behaviour, suggesting possible anatomical or behavioural predisposition factors worthy of further investigation. Whilst only 48% of horses survived to hospital discharge, those that did survive demonstrated median longevity exceeding 3193 days post-discharge, though this outcome was substantially compromised by the need for intestinal resection—a procedure required in 74% of cases involving ileal involvement and strongly associated with postoperative reflux, reduced discharge rates, and shortened post-operative lifespan. Notably, the type of anastomosis influenced reflux complications, with jejunoileostomy proving more problematic than jejunojejunostomy, and uncontrollable intraoperative haemorrhage occurred in 6% of cases. The 3% recurrence rate amongst surviving horses and the overall guarded prognosis warrant candid discussion with owners regarding realistic expectations, whilst the high prevalence of windsucking in affected horses merits investigation into potential preventive management strategies for this behavioural condition.
Read the full abstract on PubMed
Practical Takeaways
- •EFE carries a guarded prognosis—only 48% of surgical cases survive to discharge, so owners need realistic expectations before surgery
- •Horses requiring intestinal resection have worse outcomes than those with simple entrapment repair; discuss this distinction when counseling clients
- •Windsucker/crib-biters are overrepresented in EFE cases (60%), suggesting this behavioral trait may be a significant risk factor worth monitoring
Key Findings
- •145 surgeries performed on 142 horses with epiploic foramen entrapment showed 48% survival to discharge with 3% recurrence rate
- •Intestinal resection was associated with higher postoperative reflux rates and shorter post-discharge survival compared to non-resection cases
- •Warmblood horses represented 85% of surgical cases, with 60% having concurrent windsucking/crib-biting behavior
- •Left-to-right entrapment was universal and ileal involvement occurred in 74% of cases, with 6% experiencing uncontrollable intraoperative hemorrhage