Gastric and Large Colon Impactions Combined With Aggressive Enteral Fluid Therapy May Predispose to Large Colon Volvulus: 4 Cases.
Authors: Giusto Gessica, Cerullo Anna, Gandini Marco
Journal: Journal of equine veterinary science
Summary
# Editorial Summary Large colon impactions are commonly treated with aggressive enteral fluid therapy—typically 8–10 litres of water administered via nasogastric tube—yet this case series raises an important caution about unintended consequences. Giusto and colleagues reviewed laparotomy records from a teaching hospital (2012–2019) and identified four horses that developed large colon volvulus shortly after receiving high-volume enteral fluid therapy for presumed impaction; all four presented with sudden, severe abdominal pain unresponsive to analgesia within hours of treatment, and intraoperative findings confirmed volvulus alongside moderate gastric impaction in every case. The authors propose that aggressive nasogastric fluid administration in horses with concurrent gastric and colonic impactions may dangerously reduce available abdominal space, triggering displacement and twisting of the colon. Whilst this remains a small case series rather than a controlled study, the consistent clinical pattern—pain escalation immediately post-treatment rather than improvement—warrants reconsideration of fluid therapy protocols; practitioners should consider more frequent administration of smaller volumes and ensure thorough pre-treatment assessment to exclude concurrent gastric impaction before commencing high-volume enteral therapy for large colon colic.
Read the full abstract on PubMed
Practical Takeaways
- •When treating large colon impactions, consider administering smaller volumes of fluids more frequently rather than large single doses (8-10 liters) to reduce acute abdominal distension risk
- •Screen for concurrent gastric impaction before aggressive enteral fluid therapy, as the combination significantly increases volvulus risk
- •Sudden pain escalation unresponsive to analgesics after large-volume fluid administration warrants immediate surgical referral for volvulus evaluation
Key Findings
- •All 4 horses initially diagnosed with large colon impaction developed large colon volvulus after enteral administration of 8-10 liters of water
- •Sudden increase in pain occurred shortly after aggressive enteral fluid therapy in all cases, unresponsive to analgesia
- •Moderate gastric impaction was found intraoperatively in all 4 horses with large colon volvulus
- •Nasogastric administration of large fluid volumes with pre-existing gastric and colonic impactions may reduce abdominal space and predispose to volvulus