Updated 2/24/08
Colic Surgery at Thal Equine
WHAT IS COLIC?
Colic is a general term that refers to a horse’s way of showing abdominal pain, which can be
caused by any of a large number of possible problems in the abdomen, mostly related to the
intestine, but sometimes not. There are two general classes of intestinal colic:
Intestinal dysfunction. This category includes many conditions including colitis (inflammation
of the colon), parasite damage, primary gas distension, and spasmodic colic. Most of these colic
types are treated medically, not surgically. Many horses with mild intestinal dysfunction resolve
with conservative treatment. These are the horses that may be “fixed” by a shot of banamine.
Problems involving intestinal dysfunction are much more common than those involving
intestinal accidents.
Intestinal accidents. This category includes physical obstruction of the intestine from
impaction, displacement, entrapment or torsion of any of the many parts of the intestine.
COLIC PAIN
Colic pain is shown by many behaviors unique to a horse. Examples from mild to severe include
curling the upper lip, grinding the teeth, stretching, looking at the side, lying down, rolling,
kicking at the belly, pawing, and other signs. It is impossible to tell from the severity of pain
what type of problem is causing colic. Sometimes, more severe pain is associated with more
severe problems, but this is not always the case.
DIAGNOSIS
The goal of the veterinary examination is to try and determine the specific cause of the colic.
Once this diagnosis is made, a treatment plan can be formulated and a prognosis given. We use
the degree and duration of pain, the results of a physical exam, response to treatment, rectal
exam, blood work, abdominal tap and other diagnostics to form a picture of what we think is
happening.
Surgical opening of the abdomen (exploratory laparotomy) is described as “the ultimate
diagnostic tool.” Until we explore the abdomen, we can only make an educated guess as to what
is causing a horse colic pain. It is not unusual to be surprised when we open the abdomen and
sometimes we find multiple related (or unrelated) problems.
THE DECISION FOR COLIC SURGERY
If you are considering surgery, and your horse is insured, you need to notify your insurance
company immediately.
The decision for colic surgery should not be taken lightly. Colic surgery is a major undertaking
for all involved. The better informed you are, the better the experience will be for everyone.
1
Updated 2/24/08
There are no guarantees when it comes to colic surgery. Ask us any questions you might have
before surgery. Communication is key!
QUESTIONS YOU SHOULD BE ASKING:
Do we have a diagnosis? At this stage we either have an idea of what is wrong with your horse
and how severe it is, or cannot diagnose the problem because it may be complex or beyond the
scope of our diagnostic tools. As stated above, we can never be sure about a diagnosis until we
explore the abdomen in surgery.
Do we have a prognosis? We may be able to give you an idea of prognosis with (and without)
surgery based on our diagnosis. Once the abdomen has been explored surgically we can give you
a more precise prognosis.
Why are we considering surgery? There are several possible reasons to be faced with having to
make the decision of whether or not to perform colic surgery:
a.
b.
c.
d.
Colic pain that is unresponsive to medication, difficult to control, or increasing in
severity.
Physical exam, rectal exam, nasogastric intubation, abdominocentesis, blood work
have been done. After examining these results of these and other pertinent
diagnostic tests, it is the veterinarian’s opinion that surgery is the best if not only
approach.
A specific surgical condition is definitively diagnosed on rectal exam. Surgery is
the only option for treatment.
Conservative treatment and intensive care have been unsuccessful in treating the
condition. The problem is the same or is worsening and we must explore the
abdomen as the next step in treatment. Euthanasia is the only other option.
WHAT HAPPENS IN COLIC SURGERY?
Colic surgery involves the physical correction of intestinal problems which are causing signs of
abdominal pain. This usually means the correction of “intestinal accidents” as mentioned above.
Following initial evaluation and stabilization, the horse is groomed and its abdomen is clipped
and prepared for surgery. A catheter is placed in the horse for injection of intravenous
medications. The horse is then placed in a padded induction/recovery room and given
intravenous medications to induce anesthesia. An endo-tracheal tube is then placed through the
mouth into the trachea for ventilation.
Heavy hobbles are then placed on the legs and hooked to a hoist and the horse is lifted and rolled
on a trolley to the surgery table. Here the horse is placed on a ventilator and anesthesia machine.
An incision about 12” -16” long is made on the lowest part of the belly. The abdomen is
explored manually until a diagnosis is made or confirmed. Whatever correction is necessary is
then made.
2
Updated 2/24/08
A few miscellaneous examples of colic surgery procedures include:
a.
b.
c.
Untwisting of the large colon in a horse with large colon volvulus. Following this
it may be necessary to remove much of the colon if it appears severely damaged
at surgery.
Removal of a section of dead small intestine that has been strangulated by a fatty
tumor (lipoma) and re-attachment of healthy intestine.
Removal of a hard feed impaction from the small colon of a pony.
These are just examples. There are countless other procedures and combinations of procedures.
COST AND PROGNOSIS OF SOME COMMON COLIC SURGERY PROCEDURES:
Type of colic
Exploration of the
abdomen only
Small colon
impaction
Large colon
displacement/
impaction
Cost
$1800.00$3500.00
$5000$6500.00+
$5000.00$6500.00
Prognosis
n/a
Strangulating large
colon volvulus
Small intestinal
resection/anastamosis
Cecal impaction
- $6000$9500.00+
$6000$10000.00+
$5500.00+
10% -85% [65%]
survival to discharge
10%-85% [65%]
survival to discharge
65% survival to
discharge
75% survival to
discharge
85%- 90% survival
to discharge
Factors affecting
How hard it is to make
diagnosis.
infection or colitis Duration,
location
Duration, specific type of
impaction or displacement,
damage to colon
Damage to colon, duration
Amount and location of
affected intestine, duration.
Duration, damage to cecum
**Costs include surgery and post-operative care. The reason a “+” is present in front of the higher range is to
account for the possibility of complications or extenuating circumstances.
**. We can give you a general idea of cost before surgery. Once we open the abdomen, we can give you a better
idea of survival percentage and expected cost. Once a diagnosis is made and costs and survival percentage are
discussed, a decision can be made as to whether to continue with the surgery or to euthanize the horse on the table.
It is important to realize that the above percentages reflect the survival to discharge from the
hospital. A percentage of horses that survive colic surgery and return home will not be alive 1
year later. It is important to know this.
Intestinal damage from the original condition, recurrence of that abdominal problem or others,
and other complications are responsible for this. The percentage of survival long term depends
on many factors. You should ask about these factors before you agree to colic surgery.
3
Updated 2/24/08
RECURRENCE
If we fix the problem in the abdomen, what are the chances that this will happen again?
Recurrence is more likely with some lesions. You should be aware of the general recurrence rate
for the specific problem that we treat. A few percentages include:
Large colon volvulus: 5% non broodmare & 15+% in a broodmare recurrence rate.
Left dorsal displacement of large colon: 5%-20% recurrence rate.
COMPLICATONS
Anesthesia. Anesthesia poses a substantial risk. Horses with severe intestinal problems are often
in shock and this makes administering anesthesia difficult and riskier. Horses can also suffer
from muscle damage from pressure during surgery.
Recovery. Horses can injure themselves in recovery from anesthesia. We have a special assisted
recovery system that we feel improves the quality of recovery.
Postoperative Complications. Postoperative complications are linked to the type of colic, the
duration of colic, the physiologic condition of the horse and the findings at surgery. Some of the
more frequent postoperative complications include peritonitis (infection of the abdominal
cavity), colitis (inflammation of the large intestine which can lead to severe diarrhea), laminitis,
ileus (paralysis of the intestine following surgery), and adhesion formation between the intestine
and other organs. Horses can be very ill for days after surgery and almost always require
intensive care.
Hospital Stay. The duration of the hospital stay depends on factors like the type and duration of
colic, the severity of intestinal damage and occurrence of complications. Average hospital stay
after surgery is 7 days.
Post-Operative Care. Strict stall confinement is required until the abdominal incision heals. This
is typically 60 days of stall confinement with hand walking, then 30 more days in a stall and run,
also with walking. It takes months for the abdominal incision to heal with much strength. Until
healing of this abdominal wall takes place, exercise at speed must be avoided to prevent
breakdown of the incision from stress. Skin staples or sutures are removed at about 14 days after
surgery.
During this time it is important that you monitor the horse carefully for any signs of a problem
including:
a. Inappetence or depression. Any change of attitude.
b. Swelling or drainage at the incision site.
c. Colic signs.
d. Signs of laminitis, i.e. stiffness or soreness when walking
4
Updated 2/24/08
Any of these signs warrants a call to us for discussion. Your horse’s diet and management may
be modified according to our recommendations.
PAYMENT OPTIONS & DEPOSIT REQUIRED
A $3500.00 deposit is required before we place your horse on the surgery table.
The balance owed is due following surgery, but no later than when the horse is discharged.
If your horse is covered by Preventicare, you are still required to make a deposit of $3,500.00
and pay your colic surgery bill as you would normally. Preventicare reimburses you later.
We accept cash, personal checks, Visa and MasterCard. We also accept CareCredit, a line of
credit extended to pre- approved clients to finance their veterinary bills. Ask us for details.
WHY IS COLIC SURGERY SO EXPENSIVE?
Colic surgery requires a team of highly trained staff working in unison. Often colic surgery is
performed at night or on weekends and holidays, which means that staff must be compensated
extra for after hours and overtime wages.
Colic surgery requires a very large investment in equipment and medications up front by the
hospital. Equipment such as gas anesthesia machine, mechanical ventilator, a specialized
hydraulic surgery table, electric hoist to lift the horse onto the table, padded recovery room, and
numerous smaller equipment, disposable supplies such as sterile drapes and gowns and large
volumes of medications all add up to a huge investment by the hospital which must be accounted
for and passed onto you.
Colic surgery requires tremendous post-operative care 24-hours monitoring for several days
following surgery. Typically horses are kept on 40-80 liters of IV fluids per day at a cost of
$600-$1000.00/day. In addition, horses that are very ill following the recovery from more severe
conditions may require plasma at a cost of $200-$300.00/ liter. This follow up care also requires
numerous late night hours from trained staff and veterinarians.
For the reasons we have described, colic surgery is very expensive no matter where you go. Our
prices are comparable to most other similarly equipped equine clinics across the country.
If you have any questions about colic surgery, please communicate with us. Good
communication is paramount to mutual understanding and successful outcomes.
5