Operative factors associated with short-term outcome in horses with large colon volvulus: 47 cases from 2006 to 2013.
Authors: Gonzalez L M, Fogle C A, Baker W T, Hughes F E, Law J M, Motsinger-Reif A A, Blikslager A T
Journal: Equine veterinary journal
Summary
# Large Colon Volvulus: Tissue Damage Predicts Survival Better Than Surgery Type Predicting which horses will survive large colon volvulus remains challenging for equine surgeons, yet accurate prognostication is crucial for informed decision-making with owners. Gonzalez and colleagues retrospectively analysed pelvic flexure biopsies from 47 horses undergoing colic surgery for volvulus of 360 degrees or greater between 2006 and 2013, using logistic regression to identify histological markers associated with hospital discharge. Breed (Thoroughbreds had poorer outcomes), an interstitium-to-crypt ratio exceeding 1·0 (indicating severe tissue oedema), and haemorrhage scores of 3 or above emerged as significant predictors of nonsurvival, with digitally quantified haemorrhage measurement showing the strongest association. Surprisingly, whether the surgeon resected the affected colon or managed it conservatively made no statistical difference to short-term survival, suggesting tissue viability at the time of assessment is more critical than the surgical approach selected. For practitioners involved in case management or referral decisions, these findings suggest that careful intraoperative assessment of mucosal integrity and bleeding—particularly when formally quantified—provides more reliable prognostic information than traditional parameters, potentially allowing more realistic owner counselling and reducing unnecessary surgical interventions in cases with extensive irreversible damage.
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Practical Takeaways
- •When presented with large colon volvulus, obtain and carefully assess pelvic flexure biopsies—quantified mucosal haemorrhage and interstitium-to-crypt ratio provide objective prognostic information that can guide owner counselling and decision-making
- •Consider Thoroughbred breed as a negative prognostic factor; this may warrant more cautious initial prognostication in this population
- •Decide on colonic resection based on clinical indications rather than expected impact on survival, as resection alone does not significantly alter short-term outcome in this cohort
Key Findings
- •Thoroughbred breed, interstitium-to-crypt ratio >1, and haemorrhage score ≥3 were significantly associated with nonsurvival (P = 0.04, 0.02, and 0.005 respectively)
- •Colonic resection was not significantly associated with short-term outcome (P = 0.92)
- •Digital quantification of haemorrhage area strengthened the prognostic association with nonsurvival compared to subjective scoring
- •Histomorphometric measurements of pelvic flexure biopsies can predict short-term outcome in large colon volvulus cases