Medical management of sand enteropathy in 62 horses.
Authors: Hart K A, Linnenkohl W, Mayer J R, House A M, Gold J R, Giguère S
Journal: Equine veterinary journal
Summary
# Editorial Summary: Medical Management of Sand Enteropathy When sand accumulation is identified on radiographs in mature horses presenting with colic, medical management alone often achieves resolution without surgical intervention. Hart and colleagues reviewed 62 cases of sand enteropathy managed conservatively across three referral hospitals between 2000 and 2010, tracking clinical features, treatment protocols and outcomes through medical records analysis and logistic regression to identify prognostic factors. Ninety per cent of horses survived to discharge, and notably, half of the cases where repeat radiographs were obtained demonstrated radiographic improvement in sand burden following treatment—a finding that validates the non-invasive approach for uncomplicated cases. However, the critical clinical message emerged from the nine horses requiring exploratory laparotomy: all had colonic sand impaction, and seven harboured concurrent gastrointestinal lesions, with four requiring euthanasia due to disease severity or surgical complications. For equine practitioners, this work underscores that whilst straightforward sand enteropathy responds well to medical management supported by serial radiographic monitoring, persistent colic signs despite conservative treatment should prompt urgent surgical evaluation, as these horses likely have underlying pathology—such as displacement, strangulation or perforation—requiring immediate intervention rather than protracted medical management.
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Practical Takeaways
- •Medical management alone is effective for uncomplicated sand enteropathy in mature horses, with good survival rates and radiographic improvement in half of cases
- •Use serial abdominal radiography to monitor sand clearance and treatment response in medically managed cases
- •Horses showing persistent colic signs despite medical treatment should be referred promptly for exploratory surgery, as concurrent gastrointestinal lesions are likely present
Key Findings
- •90% of medically managed horses with sand enteropathy survived to discharge
- •50% of horses with repeat radiographs showed improvement in sand accumulation after treatment
- •All 9 horses requiring exploratory laparotomy had colonic sand impaction, with 7 having concurrent gastrointestinal lesions
- •Need for exploratory laparotomy was the strongest factor associated with nonsurvival