Indications, complications, and outcome of horses undergoing repeated celiotomy within 14 days after the first colic surgery: 95 cases (2005-2013).
Authors: B. Dunkel, T. Mair, C. Marr, J. Carnwath, D. Bolt
Journal: Journal of the American Veterinary Medical Association
Summary
Repeated abdominal surgery within a fortnight is a serious complication of colic, and this retrospective review of 95 cases from three equine referral hospitals between 2005 and 2013 reveals just how guarded the prognosis becomes—only 23.9% of horses survived beyond six months post-discharge. Strangulating small intestinal lesions dominated the initial surgery (63.2% of cases), yet the second intervention was most frequently prompted by persistent gastric reflux (58.9%), suggesting that managing post-operative complications rather than addressing the original pathology often necessitates a return to theatre. Critically, intestinal resection emerged as the strongest negative prognostic indicator: whilst horses requiring resection during one or both procedures showed significantly reduced survival at discharge, three-month, and six-month timepoints, only two of thirteen horses needing resection at both surgeries survived long-term. Incisional complications compounded these challenges, with 68.4% of discharged horses developing infections and 31.6% experiencing incisional hernias or dehiscence. For practitioners involved in the perioperative management of these cases—whether in surgical aftercare, wound monitoring, or long-term rehabilitation—this data underscores that repeat celiotomy demands intensified scrutiny of tissue viability decisions and scrupulous attention to post-operative wound management, particularly given the high infection burden observed in this population.
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Practical Takeaways
- •Horses requiring a second colic surgery within 14 days have a guarded prognosis for long-term survival (24% at 6 months); owners should be counselled accordingly before proceeding to second surgery
- •Intestinal resection during repeat celiotomy is a major negative prognostic indicator — bilateral or extensive resection cases are particularly unlikely to survive long-term and may warrant medical management discussion
- •Plan for significant post-operative wound management in repeat celiotomy survivors, as two-thirds will develop incisional infections and one-third incisional complications requiring careful monitoring and intervention
Key Findings
- •Strangulating small intestinal lesions were present in 63.2% (60/95) of horses at first celiotomy; persistent gastric reflux was the most common reason for second celiotomy at 58.9% (56/95)
- •Only 23.9% (22/92) of horses survived beyond 6 months post-discharge, indicating guarded long-term prognosis for repeated celiotomy cases
- •Intestinal resection during one or both surgeries significantly reduced survival rates at hospital discharge and at 3 and 6 months post-discharge, with only 15.4% (2/13) surviving 6+ months when resection occurred in both procedures
- •Post-operative complications were common: incisional infections in 68.4% (26/38) of survivors and incisional hernias/dehiscence in 31.6% (12/38)