Long-term survival in horses with strangulating obstruction of the small intestine managed without resection.
Authors: Freeman D E, Schaeffer D J, Cleary O B
Journal: Equine veterinary journal
Summary
# Editorial Summary Freeman and colleagues reviewed 35 cases of strangulated small intestine managed surgically without resection between 1996 and 2011, using clinical assessment methods to determine tissue viability rather than routine resective approaches. All horses survived to hospital discharge, though 31% developed postoperative complications; notably, only three cases (8.6%) required repeat surgery for persistent pain and decompression, and these responded favourably. Long-term follow-up data showed a median survival probability of 120 months, with ten deaths occurring after discharge but twelve horses remaining alive at follow-up intervals ranging from 20 to 192 months post-surgery. These findings suggest that subjective viability assessment—rather than prophylactic resection and anastomosis—can successfully preserve ischaemic but viable intestine, potentially reducing the morbidity and costs associated with anastomotic complications whilst improving long-term outcomes. The authors emphasise that early surgical referral may be key to preserving intestinal length and function, though they acknowledge that additional objective criteria are needed to confidently guide decision-making in cases with the most severe tissue changes.
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Practical Takeaways
- •Using a systematic viability assessment method during colic surgery can eliminate the need for small intestinal resection in many cases, reducing costs and complications
- •Early surgical referral is critical—these non-resection cases showed excellent long-term outcomes, suggesting referral before intestinal damage becomes irreversible improves prognosis
- •Most horses (31%) will develop post-operative complications but typically respond well to conservative management like decompression; only 8.6% required repeat surgery
Key Findings
- •100% survival to hospital discharge in 35 horses with strangulated small intestine managed without resection
- •Post-operative complications occurred in 31% of cases (11 horses), with 3 horses requiring repeat surgery for pain relief
- •Long-term survival median probability was 120 months, with 12 horses alive at follow-up ranging from 20-192 months post-surgery
- •Subjective clinical grading system for assessing intestinal viability allowed preservation of viable tissue and avoided resection-related complications