Current treatment of ascending colon volvulus in horses: a survey of ACVS Diplomates.
Authors: Fiege Jamie K, Hackett Eileen S, Rao Sangeeta, Gillette Shana C, Southwood Louise L
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Current Treatment of Ascending Colon Volvulus in Horses Ascending colon volvulus remains a challenging surgical emergency in equine practice, yet limited evidence exists regarding optimal treatment protocols. Fiege and colleagues surveyed 151 ACVS Diplomates experienced in equine gastrointestinal surgery to establish current clinical practices and outcomes, with respondents reporting median caseloads of 20 or fewer horses annually and survival rates clustering around 70%. Anatomic reduction—performed with or without concurrent pelvic flexure enterotomy—emerged as the most frequently employed technique, though no significant differences in survival were observed between surgical approaches (P = .27). Notably, respondents unanimously identified early surgical intervention as the critical determinant of survival, suggesting that time to theatre may outweigh specific surgical methodology. These findings provide valuable consensus data for equine practitioners managing this condition and underscore the importance of rapid diagnosis and referral in cases of suspected volvulus; future prospective studies comparing specific surgical techniques would substantially advance evidence-based treatment protocols for this high-mortality emergency.
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Practical Takeaways
- •Early surgical intervention is critical for ascending colon volvulus—delaying surgery likely reduces survival chances more than choice of surgical technique
- •Anatomic reduction is the standard treatment; pelvic flexure enterotomy may be added as needed, with no clear survival advantage of one approach over another
- •Expect approximately 70% survival with surgical treatment, but emphasize to owners that timing of surgery is the dominant factor in outcomes
Key Findings
- •Median estimated survival rate for surgically treated ascending colon volvulus was 70% across surveyed ACVS Diplomates
- •Anatomic reduction with or without pelvic flexure enterotomy was the most common surgical treatment approach
- •Early surgical correction was identified as the single most important factor impacting survival, though specific surgical technique was not associated with survival differences (P = .27)
- •Most surveyed surgeons encountered ≤20 cases of ascending colon volvulus per year