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Equine colic – to refer or not to refer?

THE differentiation between cases of equine colic that can be treated medically and those that require surgery is a dilemma that worries even experienced equine veterinary surgeons. This article surveys the methods currently available to assist the clinician in the field dealing with a horse showing abdominal pain. Moore (1986) noted that horses exhibiting the cardinal signs of pain which is unresponsive to analgesic therapy: discoloured peritoneal fluid with a high protein content; and tightly distended intestines per rectum, do not provide a diagnostic dilemma, but this combination of clinical signs seemed to be the exception rather than the rule. If a diagnosis is not possible at the first visit, the examination should be repeated if possible at intervals of no more than two hours and the findings compared to those of the previous examinations. During this time it is important to avoid the use of flunixin meglumine as it may mask several of the signs on which recognition of the surgical case is based and lead to a fatal delay in embarking on surgery. Although there have been many instances where adhesions, peritonitis and other postoperative complications have made the effects of surgery worse than the original disease, substantial advances in surgical and anaesthetic techniques have enabled many more patients with surgical lesions to be treated with a greater chance of success. However, this progress has not been matched by advances in diagnostic procedures. The large size of equine patients has precluded the use of many of the newer and more exciting diagnostic methods adopted in human medicine. Hence the decision to operate remains difficult.