Small Colon Faecalith with Large Colon Displacement in Ten Cases (2015-2023): A Detailed Case Description and Literature Review.
Authors: Scilimati Nicola, Cerullo Anna, Nannarone Sara, Gialletti Rodolfo, Giusto Gessica, Bertoletti Alice
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary Small colon faecaliths are notoriously difficult to diagnose ante-mortem, yet this ten-case series (2015–2023) presents evidence that they may precipitate large colon displacement or volvulus through a cascade of secondary changes: obstruction of the small colon leads to proximal fluid and gas accumulation, which distends the large colon and predisposes it to tympany-induced displacement. All five horses and five ponies presented with acute, refractory colic unresponsive to medical management and were initially suspected of primary large colon disease based on clinical signs, ultrasound findings, and rectal palpation; however, exploratory surgery revealed the concurrent presence of both a small colon faecalith and either right dorsal displacement or large colon volvulus in every case. This represents a previously unreported clinical association that challenges current diagnostic thinking—practitioners should consider that apparently primary large colon pathology may actually be secondary to an obstructive small colon lesion, particularly when pre-operative diagnostics point strongly to large colon involvement yet initial medical management fails. The practical implication is significant: recognising this aetiological relationship may alter surgical approach and post-operative management strategies, and the difficulty in ante-mortem faecalith detection makes a high index of suspicion and earlier surgical intervention warranted in refractory colic cases with concurrent large colon signs.
Read the full abstract on PubMed
Practical Takeaways
- •When horses or ponies present with colic signs unresponsive to medical treatment and large colon displacement or volvulus is suspected, consider that a small colon faecalith may be the underlying cause—this diagnosis is easily missed on ultrasound and rectal exam
- •Small colon obstruction from faecaliths can trigger secondary large colon tympany and displacement; suspect this cascade when pre-operative diagnostics suggest only large colon pathology
- •Be prepared to find incidental small colon faecaliths during exploratory surgery for large colon colic cases, as this combination appears more common than previously reported in literature
Key Findings
- •Small colon faecalith was incidentally detected in all 10 cases (5 horses and 5 ponies) presenting with large colon displacement or volvulus
- •Small colon faecalith obstruction likely predisposed to secondary right dorsal displacement or large colon volvulus through large colon tympany caused by ingesta fermentation
- •All cases required surgical intervention due to lack of response to medical treatment, with diagnosis of large colon pathology made during exploratory laparotomy
- •Small colon faecalith is difficult to diagnose preoperatively using ultrasonography and rectal palpation and may be an overlooked causative factor in large colon displacement cases