Multi-Institutional Retrospective Case-Control Study Evaluating Clinical Outcomes of Foals with Small Intestinal Strangulating Obstruction: 2000-2020.
Authors: Erwin Sara J, Clark Marley E, Dechant Julie E, Aitken Maia R, Hassel Diana M, Blikslager Anthony T, Ziegler Amanda L
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Surgical Outcomes in Foals with Small Intestinal Strangulating Obstruction Small intestinal strangulating obstruction (SISO) represents a surgical emergency in equines, and whilst adult cases have been reasonably well characterised, foals have historically been regarded with therapeutic pessimism due to assumptions of poorer prognosis. This multi-institutional retrospective case-control study examined surgical outcomes across five US academic referral hospitals between 2000 and 2020, directly comparing 41 foals (≤6 months old) with 105 matched adult cases (2–20 years) to test whether age-dependent survival differences actually existed. Remarkably, 96.0% of foals recovered from surgery survived to hospital discharge compared with 88.0% of adults; however, 39.0% of foal cases were euthanised intraoperatively versus 28.6% of adults, suggesting that case selection and decision-making at the operating table significantly influenced outcomes. Volvulus and intussusception predominated in foals, whilst volvulus and strangulating lipoma were most common in adults—a distinction with implications for pre-operative diagnostic planning. Although methodological limitations (incomplete records, modest sample size, no long-term follow-up) warrant cautious interpretation, these findings challenge the traditional narrative of poor prognosis in foals and suggest that referral for surgical intervention may be justified more often than current practice patterns reflect, provided appropriate case selection and perioperative management are employed.
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Practical Takeaways
- •Surgical treatment of foals with small intestinal strangulating obstruction has surprisingly good outcomes (96% survival to discharge), warranting increased optimism and referral for surgical intervention
- •Intraoperative euthanasia decisions occur in approximately 39% of foal cases and 29% of adult cases, suggesting careful preoperative assessment and communication with owners about prognosis is essential
- •Lesion types differ between foals and adults (foals more volvulus/intussusception; adults more lipoma-related), which may influence surgical approach and prognostic counseling
Key Findings
- •96.0% of foals (24/25) and 88.0% of adults (66/75) recovered from surgery for SISO survived to hospital discharge
- •16 of 41 foals (39.0%) were euthanized intraoperatively compared to 30 of 105 adults (28.6%)
- •Volvulus and intussusception were common lesions in foals, while volvulus and strangulating lipoma were common in adults
- •Short-term survival tended to be higher in foals than adults, contrary to initial hypothesis