EQUINE VETERINARY EDUCATION

Equine vet. Educ. (2002) 14 (1) 19-28

19

Satellite Article
Small colon obstructions in the mature horse
J. SCHUMACHER

AND

T. S. MAIR*

Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, Alabama
36849-5522, USA and *Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent ME18 5GS, UK.
Keywords: horse; small colon; obstruction; impaction; colic; enterolith; faecalith

Introduction
In this issue, Mair (2002) describes an unusual case of
small colon impaction associated with a granulosa cell
tumour in a pony mare. Small colon obstructions are
encountered quite commonly in practice and in this article
we describe the anatomy of the colon, together with the
clinical signs, diagnosis and causes and risk factors of such
conditions. We then consider the clinical implications
under the various categories of cause and pathogenesis.

Anatomy
The small (descending) colon originates at the aboral end of
the transverse colon, lies to the left of the root of the
mesentery and terminates at the pelvic inlet where it joins the
rectum. It is relatively long (2.5 to 4 m) and mobile within the
abdominal cavity, usually occupying the upper left quadrant,
together with the jejunum. The mesocolon of the proximal
portion of the small colon is short, but its length increases
caudally to 8090 cm, which allows it to move freely within
the abdomen (Getty 1975). Two wide muscular bands form
the characteristic sacculations of the small colon, in which
faeces accumulate in the form of faecal balls. One band is
concealed in the mesocolon and the other is situated along
the antimesenteric border. Blood is supplied to the small
colon via the left colic artery and cranial rectal artery.

Clinical signs of small colon obstruction

The clinical signs of small colon obstruction are variable and
can resemble those seen in many other types of colic. Some
cases of obstruction, such as enterolithiasis, can present
with acute signs of moderate to severe persistent pain due to
complete obstruction of the small colon.
In other cases of small colon obstruction the
development of clinical signs can be much slower, and early
signs, which include lethargy, dullness and inappetence, are
often vague and nonspecific. Because these obstructions
*Author to whom correspondence should be addressed.

affect the distal part of the intestinal tract, physiological

deterioration tends to develop slower than when the
obstruction affects a more proximal part of the tract.
As the condition progresses, more signs of obstruction
develop and may include mild to moderate abdominal
pain, anorexia, diarrhoea, decreased faecal production,
tenesmus, depression and abdominal distension.
Abdominal distension due to tympany is greatest when
obstruction of the small colon is total and completely
obstructed horses may show signs of more severe pain. The
average time between the onset of clinical signs and
evaluation at a referral surgical facility is usually greater than
24 h because of the relatively slow progression of clinical signs
(Edwards 1992; Rhoads 1999).

Diagnosis
Small colon obstruction can sometimes be diagnosed by
palpation of the abdomen per rectum but, in other cases,
may be confirmed only by exploratory celiotomy (laparotomy).
Ultrasonography of the abdomen can also be useful for
diagnosis (Freeman et al. 2001). The classical finding during
palpation per rectum indicative of small colon obstruction and
impaction is the identification of a solid sausage-like tube
of ingesta within a section of intestine that has a palpable
antimesenteric band. The normal sacculations of the small
colon are lost as it distends with faeces. The smaller diameter
of the small colon usually distinguishes impaction of this organ
from the more common impaction of the large colon, but the
diameter of the distended small colon can be as much as
10 cm (Freeman et al. 2001).
Identifying the antimesenteric band can be difficult,
especially when the small colon is maximally distended. Gas
distension of the large colon and caecum may also
sometimes be identified during palpation per rectum of
horses with impaction of the small colon. Palpation of an
obstructing enterolith may be possible in some cases.
However, in many cases, enteroliths are located in the
proximal small colon and the stone and associated
gaseous distension are out of reach of the examiner.
The absence of positive rectal findings, therefore, does not

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Small colon obstruction in the mature horse

Fig 2: Administration of an enema to a horse using an enema bell.

Fig 1: An enema bell, which is used for administering an enema.

rule out the possibility of enterolithiasis (Tennant et al. 1972;

Ferraro et al. 1973; Blue 1979).
Transrectal ultrasonography was reported to be helpful in
diagnosing strangulating obstruction of the small colon
(Freeman et al. 2001). In this report, increased intestinal wall
thickness and intestinal distension were identified in 2 horses
with strangulation of the small colon caused by
pedunculated lipomas.
Transrectal ultrasonography may be helpful in
differentiating surgical from nonsurgical conditions of the
small colon, but limited information is available about the
ultrasonographic appearance of small colon that contains a
simple obstruction. Transabdominal ultrasonography has
been shown to be a sensitive diagnostic test for differentiating
between strangulating and simple obstructions of the small
intestine (Klohnen et al. 1996). Although transabdominal
ultrasonography does not permit detailed examination of the
small colon, this technique may have applications in the
evaluation of ponies and miniature horses that are too small to
permit ultrasonographic examination per rectum.

Vascular lesions
Intramural haematoma
Mesocolic rupture
Nonstrangulating infarction

Strangulating obstructions
Volvulus
Hernias
Intussusceptions
Pedunculated lipomas
Arabians, ponies and American miniature horses
appear to be predisposed to diseases of the small colon
compared with other breeds (Dart et al. 1992). Female
horses and horses greater than age 5 years are also more
likely to be affected.
Diffuse faecal impaction of the small colon occurs
most commonly in ponies and miniature horses and more
commonly in females (Dart et al. 1992). Old horses are more
susceptible to disease of the small colon caused by
strangulating lipomas, foaling injuries and intramural

Causes and risk factors of small colon

obstruction
The following conditions are recognised as causes of small
colon obstruction in adult horses:

Simple obstructions
Diffuse faecal impaction
Focal simple obstructions
- Enteroliths
- Foreign bodies
- Faecaliths
- Phytoconglobates
- Bezoars
Obstruction by an ovarian pedicle
Pedunculated lipomas
Neoplasia

Fig 3: A faecal impaction of the small colon causing

disappearance of the sacculations usually present in the small
colon (courtesy of David Moll).

J. Schumacher and T. S. Mair

21

Fig 4: An enterolith removed from the small colon.

Fig 6: A faecalith causing obstruction of the small colon

(courtesy of Peter Rakestraw).

Fig 5: A haynet with deposits of mineral.

Fig 7: A faecalith removed from the small colon (courtesy of

Reid Hanson).

haematomas (Edwards 1992). Foreign body obstructions

occur most commonly in young horses (less than age 3
years). Geographical location is an important risk factor
for the development of enterolithiasis, the prevalence being
highest in the south-western states of the USA, especially
California, and in Florida and Indiana (Moore 1990). Other
risk factors for small colon obstruction include reduced
access to drinking water, poor dentition, ingestion of poor
quality feed, parasitic damage, intestinal neoplasia and
intestinal motility disorders (Moore 1990; Ruggles and Ross
1991; Rhoads 1999).

Faecal impaction of the small colon may be related (Keller

and Horney 1985; Moore 1990) to:

Diffuse faecal impaction

Faecal impaction is the most common disorder of the small colon
(Rhoads 1999). Ponies (especially Shetland ponies), American
miniature horses and Arabians, especially female Arabians,
appear to be affected by faecal impaction of the small colon
more commonly than are other breeds (Tennant et al. 1972;
Tennant 1975; Dart et al. 1992; Ragle et al. 1992). Impactions
are most common in aged horses and yearling ponies. One study
suggested that small colon impactions occur most frequently
during the winter and early spring (Tennant 1975).

ingestion of bedding or poor-quality hay

poor dentition
inadequate hydration
parasitic damage
disorders of intestinal motility
submucosal oedema

Horses develop impaction of the small colon most

frequently during the fall and winter, and this seasonal
predilection may be related to inadequate water consumption
or dietary changes. Old horses may be predisposed to
impaction of the small colon because of deterioration in
dentition and gastrointestinal function.

Clinical signs
Horses initially exhibit mild signs of colic. Deterioration in
physical condition progresses slowly and results from
distension of viscera with gas and fluid proximal to the
obstruction. Deterioration progresses slowly because the

22

location of the small colon at the distal end of the intestinal

tract provides a large space for ingesta and gas to accumulate
proximal to the obstruction.

Diagnosis
Diagnosis on the basis of clinical signs and clinicopathological
data is often difficult. Consistently observed clinical features of
affected horses are reduced production or absence of
faeces, and absent or reduced borborygmi. Abdominal
distension is often present, and nasogastric reflux can be
obtained occasionally. Although the heart rate is usually
high, clinicopathological data (i.e. packed cell volume,
electrolytes, total plasma protein) are usually normal.
Examination per rectum is often helpful. One or more
loops of tubular, firm, digesta-filled intestine can be identified
during examination per rectum, and the single, free taenial
band can often be identified on the colon, confirming
the segment of intestine involved. Submucosal oedema of
the rectum and small colon, cranial to the pelvic inlet, can
sometimes be palpated (Edwards 1992). We have often
observed that, after palpation per rectum of horses with faecal
impaction of the small colon, the palpation sleeve is
covered with flecks of blood.

Treatment
Affected horses may be treated medically or surgically, but
horses treated medically may have a higher long-term survival
rate (Ruggles and Ross 1991). Horses with mild impactions are
generally responsive to simple treatments, including the
administration of mineral oil or solutions of saline or
magnesium sulphate via nasogastric tube, but more severely
affected horses require more intensive therapy.

Medical treatment
Objectives of medical treatment of horses with faecal
impaction of the small colon are to maintain hydration,
stimulate gastrointestinal motility, soften the impaction by
the administration of osmotic laxatives or lubricants and
control pain (Ruggles and Ross 1991). Intravenous
administration of a balanced electrolyte solution can be used
to overhydrate the horse, which causes secretion of fluid into
the intestine to hydrate and soften the mass of ingesta
directly. Intestinal motility is stimulated by replacement of
fluids and potassium and calcium. The frequency of urination
can be used to assess clinically the success of administration
of fluids in causing overhydration.
Treatment of horses with faecal impaction of the small
colon by administration of an enema has been advocated
as a method of achieving hydration inexpensively and for
softening the impaction. Because of the risk of perforating the
small colon during administration of an enema, care should
be taken when administering an enema to a standing
horse (Edwards 1992). Enemas should not be administered
under pressure. An enema bell (Fig 1) can be used, which is

Small colon obstruction in the mature horse

inserted into the horses anus. Fluid is administered through

the bell by gravity flow, using a tube and funnel, until the
horse begins to strain (Fig 2). Administering epidural
anaesthesia before administering the enema may allow more
fluid to be administered before straining interferes with the
procedure. Even during surgery, an impaction of the small
colon is difficult to resolve by retrograde lavage and
transmural massage of the small colon.

Surgical treatment
The horse should be treated surgically when: 1) medical
management fails to resolve the impaction; 2) the abdomen
distends; 3) cardiovascular deterioration is detected; 4) the
nucleated cell count and concentration of total protein in the
peritoneal fluid increase, indicating early loss of intestinal
viability or 5) the horse remains painful even after
administration of analgesic drugs.
During celiotomy, the small colon is found to be packed
uniformly with ingesta, creating a tubular structure that has
none of the usual sacculations (Fig 3). Often the impaction
terminates at the pelvic inlet. The obstruction is cleared by
lavage introduced through a tube inserted through the anus
into the small colon. Insertion of the tube is aided by
transmural manipulation by the surgeon. Intraluminal lavage
with warm water and extraluminal massage by the surgeon
are used to relieve the obstruction (Meagher 1974).
Extreme care should be taken during manipulation of
the small colon to avoid intestinal rupture. Excessive trauma
to the intestinal wall may result in oedema which may predispose
to a recurrence of impaction (Edwards 1992). An alternative
technique to lavage via the anus is to perform lavage via an
enterotomy incision in the upacked segment of small colon; this
allows the impaction to be cleared with less trauma to the bowel
wall. To minimise early postoperative recurrence of small colon
impaction, the large colon should be evacuated through an
enterotomy at the pelvic flexure, if it is filled with ingesta.
Broad-spectrum antimicrobial agents should be
administered perioperatively. Metronidazole is effective
against anaerobic bacteria, which are in high concentration in
the small colon, and the authors have found this drug to be
useful in the postoperative period. Anorexia is an uncommon
adverse effect of metronidazole treatment (Sweeney et al.
1991). Fever, diarrhoea and laminitis are common
complications after surgery of the small colon and may
be related to increased absorption of toxins through the
inflamed intestinal wall. Horses undergoing surgery for
disorders of the small colon may be at high risk of developing
salmonellosis (Moore 1990; Edwards 1992), and antimicrobial
therapy may increase this risk by altering gastrointestinal flora.
The cause of the high incidence of salmonellosis in
horses treated surgically for impaction of the small colon is not
known. Feeding a complete pelleted diet for several weeks
after resolution of impaction may help to prevent re-impaction
by reducing colonic filling by increasing the concentration of
faecal water and by reducing resistance to flow through the
gastrointestinal tract.

J. Schumacher and T. S. Mair

Enteroliths
Enteroliths, or intestinal calculi, are mineralised concretions
(Fig 4) that develop in the large colon by concentric deposition
of salts around a central nucleus, usually a small silicon stone
or metal object (Ferraro et al. 1973; Blue 1979; Evans et al.
1981; Lloyd et al. 1987; Murray et al. 1992; Hassel et al.
1999). An enterolith can remain within the large intestine for
long periods without causing clinical signs of disease, and only
when it obstructs the lumen of the large/transverse or small
colon does the horse shows signs of abdominal pain.
Currently, enterolithiasis appears to be rare in the UK and
Germany but, in the 1800s, there were many reports of the
condition in England, especially in millers horses (Page 1856).
Enteroliths are most commonly seen in horses age 510 years
(Dart et al. 1992). The Arabian seems to be the breed most
commonly affected, and females of all breeds are more likely
than males to develop enteroliths (Lloyd et al. 1987; Dart et al.
1992; Edwards 1997).

Diagnosis
Diagnosis of obstructing enterolithiasis is based on clinical
signs and physical examination. An obstructing enterolith
blocks the passage of faeces but may allow the passage of gas
and intestinal lubricants, such as mineral oil. When mineral oil,
but not faeces, is passed, enterolithiasis should be suspected.
However, this sign is not diagnostic of enterolithiasis, since
other intestinal obstructions may also allow mineral oil to pass
to the rectum. An enterolith within the small colon typically
causes complete obstruction, and affected horses tend to
show signs of more severe abdominal pain than do horses
with partial or intermittent obstruction of the transverse or
right dorsal colon. Palpation of an enterolith in the small colon
is usually possible only when it is lodged in the rectum or distal
portion of the small colon. An enterolith in the proximal
aspect of the small colon is usually beyond the reach of
the examiner, and small colon distal to the enterolith is
usually flaccid and difficult to identify. If the enterolith has
lodged in the middle or distal portion of the small colon, loops
of gas-filled small colon may be recognised.
Diagnosis of enterolithiasis in horses showing clinical signs
of the disease can sometimes be confirmed by radiography
(Rose et al. 1980; Yarbrough et al. 1994). The large size of the
mature horse precludes obtaining radiographs that show
abdominal detail (Fischer 1997). Rare earth screens, highspeed film and an 8:1 focused grid should be used. Units with
an output of 600 mA may be required. The radiographic
technique with most conventional radiography units for an
average-sized horse requires an exposure time of up to 2 s.
Fischer (1997) reported the average exposure for the
mid-abdomen in his clinic to be 450 mA and 110 kVp.
Radiography is less helpful in the diagnosis of enterolithiasis of
the small colon than of the large colon (i.e. transverse colon),
and the absence of radiographic findings does not preclude
the presence of an enterolith. The incidence of failure of
radiographic examination to identify the presence of

23

enterolithiasis has been reported to vary between 2% (Rose et

al. 1980) and 13.4% (Yarbrough et al. 1994).

Treatment
Treatment of horses suffering from obstruction of the small
colon by an enterolith is to remove the enterolith through a
celiotomy. Before removing an enterolith it should be
moved a few centimetres distally or proximally, if possible, so
that the enterotomy can be made in a more viable portion of
intestine. Studies show that longitudinal enterotomies
made through the antimesenteric taenia of the small
colon are superior to those made adjacent to the taenia in
maintaining the diameter of the lumen, in ease of closure,
and in minimising interruption of the blood supply (Archer et
al. 1988; Beard et al. 1989). Enterotomy performed through
the antimesenteric taenia results in less haemorrhage and
less inflammation, and sutured incisions through the taenia
are stronger at 96 h than sutured incisions adjacent to the
taenia. Closure of the mucosa as a separate layer offers no
advantage or disadvantage to healing in normal horses
(Beard et al. 1989).
Complications associated with enterotomies of the small
colon include leakage, visceral adhesions and stricture
formation. Factors that may adversely affect the outcome of
surgery of the small colon in the horse include the small
colons relatively poor blood supply, its high concentration
of collagenase, its high intraluminal concentration of
bacteria (including large concentrations of anaerobic
organisms), its muscular activity and the presence of firm
faeces (Stashak 1982; Keller and Horney 1985). The
mesocolon of the small colon is relatively short, making
exteriorisation of the proximal and distal ends of the small
colon difficult or impossible. The risk of peritoneal
contamination is high if enterotomy or resection and
anastomosis are necessary for those parts of the small colon
that are difficult to exteriorise.
An enterolith in the proximal end of the small
colon must often be repelled into the right dorsal colon and
then into the left dorsal colon for removal through an
enterotomy. An enterolith can be most easily and safely
dislodged and repelled proximally by retrograde infusion of
water into the small colon. To repel an enterolith proximally,
a stomach tube is inserted into the rectum and passed into
the small colon. The tube is guided to the obstruction by the
surgeon and, while the small colon is occluded by holding it
tightly to the tube, water is infused into the intestine until
the lumen expands to a size large enough to allow the
enterolith to be dislodged proximally (Taylor et al. 1979).
The enterolith is then repelled into the left dorsal colon
where it can be removed safely via enterotomy remote from
the abdominal cavity.
If the enterolith cannot be repelled into the left
dorsal colon, a taeniotomy technique can be employed,
whereby the seromuscular layer of the antimesenteric taenia is
incised to increase the luminal diameter of the small colon
adjacent to the obstruction. Using this technique, a

24

Fig 8: A phytoconglobate (courtesy of Reid Hanson).

Small colon obstruction in the mature horse

Fig 11: An intramural leiomyoma of the small colon.

Fig 9: A faecalith being removed via an enterotomy made

through the antimesenteric taenia of the small colon.
Fig 12: A type IV rectal prolapse in a mare causing disruption of
blood supply to the small colon and rectum (courtesy of Peter
Rakestraw).

Prognosis

Fig 10: Completed closure of the enterotomy (from Fig 9).

seromuscular incision is made through the antimesenteric

taenia 1015 cm aboral to the site of the obstruction; the
incision is continued orally to the widest portion of the
obstruction using Metzenbaum scissors. The increased
luminal diameter provided by the seromuscular incision may
allow the enterolith to be advanced aborally until it can be
exteriorised for removal (Hassel and Yarbrough 1998).

The prognosis for survival of horses undergoing surgery for

enterolithiasis is determined by the cardiovascular status of the
horse and the integrity of the affected area of intestine. In a
recent study, 15% of 900 horses affected with enterolithiasis
of either the large or small colon experienced gastrointestinal
tract rupture that necessitated euthanasia (Hassel et al. 1999);
and the most common site of rupture was within the small
colon (71%). Short-term and one year survival rates for
Equidae undergoing surgical treatment for enterolithiasis of
either the large or small colon and recovering from
anaesthesia were excellent (96.2% and 92.5%, respectively)
and postoperative complications were uncommon.
To prevent recurrence of enterolithiasis after surgery,
the feeding area should be free of gravel or the horse should
be fed off the ground, and a type of hay other than alfalfa
should be fed. Changing the type of hay fed to the rest of the
herd should be considered. Colonic pH below 6.6 tends to
prevent the formation of enterolithiasis and, by decreasing the

J. Schumacher and T. S. Mair

25

Clinical signs

Fig 13: A lipoma causing strangulation of a section of small

colon (courtesy of Peter Rakestraw).

Foreign body obstruction usually results in a gradual

onset of vague signs of anorexia, dullness and
abdominal pain. If the obstruction is located in the most
distal part of the small colon, tenesmus may be observed.
Affected horses remain unresponsive to medical therapy. The
obstruction may be difficult to locate by palpation per
rectum, owing to its small size and tendency to lodge in the
proximal portion of the small colon. The obstruction is
usually associated with an impaction that extends into the
large colon. Complete obstruction results in prestenotic
tympany of the entire large colon which, in turn, results in
visible abdominal distension and severe, unrelenting signs of
colic (Edwards 1997). The distended pelvic flexure and
caecum can be palpated per rectum. Peritoneal fluid changes
are minimal, unless the colonic wall becomes necrotic, in
which case the total nucleated cell count and total protein
concentration both increase.

Treatment
The obstruction must be removed before the small colon
surrounding it becomes necrotic. At surgery, the obstruction
should be manipulated a few centimetres distal or proximal to
the site of obstruction so that the enterotomy can be made in
normal intestine. If the involved segment cannot be
exteriorised, however, the obstruction should be repelled
proximally by retrograde infusion of water into the small colon
and removed through an enterotomy at the pelvic flexure of
the ascending colon (Taylor et al. 1979).
Fig 14: Strangulated small colon caused by a pedunculated
lipoma (courtesy of David Moll).

amount of hay and increasing the amount of grain in the diet,

the pH of the colonic contents can be decreased (Murray et al.
1992). Adding 2 cups of vinegar to the diet is another method
of decreasing colonic pH. In the study by Hassel et al. (1999),
recurrence of enterolithiasis was identified in 7.7% of the
study population.

Faecaliths, phytoconglobates and bezoars

Faecaliths are discrete concretions of inspissated faecal
material that have become lodged in the lumen of the small
colon (Figs 6 and 7). The condition occurs most commonly in
ponies and in late autumn when the grass is coarse and the
weather is cool, reducing water intake. Faecalith impaction of
the small colon has been recognised as a common cause of

Foreign body obstruction

Foreign materials that obstruct the small colon include
nylon fibres from halters, haynets, twine, cords from tyres,
synthetic fencing material, disposable plastic sleeves and tops
of feed sacks (Boles and Kohn 1977; Gray et al. 1979). The
foreign material becomes coated with mineral precipitate,
increasing its bulk (Edwards 1997) (Fig 5). The resulting masses
are irregular, often containing projections that cause necrosis of
the obstructed intestine. The ingested foreign material may
remain within the large colon for a considerable period of time
before passing into and obstructing the small colon.
Obstruction of the small colon with foreign material generally
occurs in horses age 3 years or less, probably because young
horses are less discriminate in their eating habits.

Fig 15: An ovarian pedicle wrapped around a section of small

colon.

26

progressive, nonresponsive colic in American miniature foals

(Ragle et al. 1992).
Phytoconglobates are concretions of matted plant
residues formed into balls (Fig 8), and bezoars are a
combination of magnesium ammonium phosphate
crystals and plant fibre (phytobezoars) or hair
(trichobezoars). Phytobezoars, or oat stones, are most
often composed of matted oat hairs. They are permeated by
magnesium ammonium phosphate crystals to form calculi that
are relatively light and have an uneven, furrowed, velvettextured surface. The smooth surface of phytoconglobates
and bezoars may allow them to obstruct the lumen for
relatively long periods without causing severe damage to the
mucosa. Obstruction caused by ingestion of fibrous,
nondigestible material is seen most commonly in horses less
than age 3 years and in horses with poor dentition.
Treatment of horses affected by faecaliths,
phytoconglobates or bezoars is by surgical removal of the
obstructing mass (Figs 9 and 10). If the obstructed segment of
small colon cannot be exteriorised, the mass should be repelled
into the large colon by retrograde infusion of water and removed
through an enterotomy at the pelvic flexure (Taylor et al. 1979).

Obstruction by an ovarian pedicle

This condition is described in the accompanying case
report (Mair 2002).

Pedunculated lipomas
Pedunculated lipomas usually cause strangulating obstructions
(see below) but, occasionally, the small colon may become
entwined around the pedicle, forming a half-hitch (Edwards
1992). This results in obstruction of the lumen but with only
minimal interference to venous drainage. If the obstruction
occurs towards the distal end of the small colon, a distinct
constriction in the small colon may be palpated per rectum.

Neoplasia
Neoplasia affecting the small colon is rare. Both lymphoma
(King 1993) and leiomyoma (Haven et al. 1991; Mair et al.
1992) (Fig 11) have been reported to occur at this site.

Small colon obstruction in the mature horse

because the haematoma obstructs the lumen, examination

per rectum of affected horses may reveal tympany of the large
colon. The rectum is usually devoid of faeces, but various
amounts of clotted blood may be found. Treatment of horses
with the condition involves resection of the affected intestinal
segment followed by anastomosis of the proximal and distal
segments. At surgery, the lesion is recognised as a dense,
circumscribed mass attached to the wall of the small colon.
The prognosis is generally good, provided that the entire
lesion can be removed. If the affected segment cannot be
exteriorised, a colostomy may be necessary.

Mesocolic rupture
Mesocolic rupture and subsequent segmental ischaemic
necrosis of the small colon occur as a complication of
foaling. The condition is the result of direct trauma caused by
the foal as it positions itself for delivery. During late pregnancy,
the fetus is positioned ventrally but, during the first stage of
labour, the foal rotates into a dorsal position for delivery using
vigorous reflex movements of its neck and forelimbs. During
these movements, the small colon of the mare may become
trapped between uterus and dorsal portion of the body wall,
causing the mesocolon to tense and tear (Livsey and Keller
1986; Dart et al. 1991a).
Mesocolic rupture can also result from type IV rectal
prolapse, a condition sometimes associated with parturition.
The vascular arcade of the mesocolon may stretch and tear
when more than 30 cm of the rectum and small colon
prolapse through the anus (Fig 12).
Regardless of the cause of mesocolic rupture, infarction
results, causing functional obstruction and progressive signs of
colic. Segmental ischaemic necrosis of the small colon caused
by disruption of the mesocolonic vasculature should be
considered when examining a postparturient mare that shows
signs of abdominal pain. A consistent finding in affected
horses is failure of the horse to pass faeces.
Treatment involves resection of the infarcted colon. Access
to the viable portion of the small colon may be impossible,
however, especially if mesocolic rupture has occurred
secondary to rectal prolapse. In these cases, a colostomy or
rectocolostomy can be performed (Edwards 1997).

Nonstrangulating infarction of the small colon

Intramural haematoma
An intramural or submucosal haematoma is an uncommon
lesion of the small colon caused by haemorrhage beneath the
mucosa (Spiers et al. 1981; Pearson and Waterman 1986;
Edwards 1992). Haemorrhage within the intestinal wall
occludes the intestinal lumen and dissects along the
submucosa producing intestinal necrosis. The condition occurs
most commonly in old horses. Histology has not revealed the
cause, and the source of haemorrhage contributing to the
formation of mural haematoma is not usually evident during
gross or microscopic examination of resected colon.
The condition causes signs of abdominal pain and,

Segmental infarction caused by mesenteric thromboembolism

occurs uncommonly because the small colon receives most of
its blood supply from the caudal mesenteric artery, which
is rarely affected by occlusive verminous arteritis. Often,
during abdominal exploration or at postmortem examination of
horses affected by nonstrangulating infarction of the small colon,
no evidence of arteritis of the caudal mesenteric artery can be
found (Edwards 1992). Treatment of an affected horse is to
resect the infarcted segment and anastomose the proximal and
distal segments. If the affected segment of small colon cannot be
exteriorised, colostomy or transrectal exteriorisation followed by
rectocolostomy must be performed.

J. Schumacher and T. S. Mair

Strangulating lesions of the small colon

Segments of the small colon may strangulate when they
become involved in a volvulus or intussusception or, more
commonly, when they become entwined with a pedunculated
lipoma (Figs 13 and 14) or the pedicle of an ovary (Fig 15)
(Moore 1990; Mair 2001). Volvulus occurs when a segment of
intestine twists around its mesentery (Kirker-Head and Steckel
1988). Volvulus of the small colon has been associated with
adhesions and abscesses (Meagher 1972). It is not common,
however, presumably because the small colon is short and has
fixed proximal and terminal ends. Intussusception of the small
colon occurs rarely (Ross et al. 1988; Mair et al. 1992). In some
cases, the intussuscepted intestine may protrude through the
anus. The small colon can become entrapped and
strangulated by the inguinal ring, defects in the musculature
of the flank, omental tears, tears in the uterine broad
ligament, holes in the mesentery, and uterine and vaginal tears
(Edwards 1997).
Strangulating pedunculated lipomas are rarely seen in
horses younger than age 9 years and they most commonly
affect horses age more than 15 years (Dart et al. 1992).
Compared to other segments of the mesentery, the
mesocolon and mesorectum may be predisposed to formation
of lipomas because of the large amount of fat in these areas
but, even so, the small colon is much less likely than the small
intestine to become strangulated by a pedunculated lipoma. In
one review of 75 cases of intestinal obstruction caused by
pedunculated lipomas, 70 cases (93%) involved the small
intestine compared with only 5 cases (7%) affecting the small
colon (Edwards and Proudman 1994).
Signs of colic initiated by strangulation of the small
colon are sudden in onset, but the general clinical course of
physiological deterioration may occur more slowly than when
more proximal segments of the gastrointestinal tract become
strangulated. Serosanguinous fluid containing an increased
concentration of nucleated cells and total protein is obtained
during abdominal paracentesis of affected horses, and
tympany of the large colon and absence of faeces are evident
during examination per rectum.
Treatment is to reduce the volvulus or entrapment, resect
the infarcted segment of small colon and anastomose the
proximal and distal segments. Horses seem able to
compensate for the considerable loss of absorptive capacity
that occurs when a long segment of small colon is removed
(Dart et al. 1991b).

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