Clinical and diagnostic findings, treatment, and short- and long-term survival in horses with peritonitis: 72 cases (2007-2017).
Authors: Arndt Stefanie, Kilcoyne Isabelle, Vaughan Betsy, Dechant Julie E
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Peritonitis in Horses – Diagnosis and Prognosis Peritonitis represents a serious but manageable condition in equine practice, with infectious agents being the primary culprit (43% of cases with a definitive diagnosis), followed by trauma and gastrointestinal disease, though nearly 40% of cases remain idiopathic even after thorough investigation. This retrospective analysis of 72 horses over a decade demonstrated that peritoneal fluid analysis—specifically nucleated cell counts and culture—was essential for confirming diagnosis and substantially improved prognostic accuracy, distinguishing this approach from reliance on clinical signs alone (which commonly presented as colic in 48% of cases). Despite the severity of the condition, outcomes were encouraging: 83% of horses survived to hospital discharge, and of the 49 with long-term follow-up data, 88% remained alive one year post-discharge, with positive peritoneal fluid cultures, prior colic history, and specific haematological variables (such as peritoneal protein levels and cell differentials) emerging as significant predictors of non-survival. For equine professionals managing acute abdominal cases, these findings underscore the critical importance of performing peritoneal analysis early in investigation—cytology and culture should be considered non-negotiable diagnostic steps—as obtaining this information not only establishes diagnosis when clinical signs are ambiguous but also enables evidence-based prognostic counselling and treatment optimisation. The high proportion of idiopathic cases suggests that further investigation into underlying causes remains warranted, particularly regarding subclinical infectious agents and conditions that may not manifest as primary gastrointestinal rupture.
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Practical Takeaways
- •Peritoneal fluid analysis is essential for diagnosing peritonitis and predicting prognosis—perform abdominocentesis promptly in colic cases with concerning clinical signs
- •Most horses with peritonitis have a reasonably good prognosis (83% short-term survival, 88% long-term survival), which should inform owner counselling during acute cases
- •Consider infectious causes as most likely, but recognize that 39% of cases remain idiopathic even after investigation—supportive medical management remains critical
Key Findings
- •Colic was the most common presenting complaint in 48% (34/72) of peritonitis cases
- •A definitive diagnosis was achieved in 61% of cases, with infectious agents being the most common identified cause (31/72)
- •83% of horses (60/72) survived to hospital discharge, with 88% (43/49) alive at 1-year follow-up
- •Peritoneal fluid analysis variables and history of colic were significant predictors of survival outcome