If your new foal develops a disease or medical problem that requires surgery, then time is of the essence. In his AAEP Convention presentation "Surgical Disease of the Neonate," Rolf Embertson, DVM, Dipl. ACVS, of Rood and Riddle Equine Hospital in Lexington, Ky., discussed a few abdominal and upper respiratory problems that might require surgery and gave veterinarians tips on how to perform some of the surgeries.

Abdominal Problems
"Duration of abdominal abnormalities usually plays a large role in the outcome," Embertson said. The time from recognition of abdominal pain to arrival of the foal at the clinic, to evaluation for surgery, to surgery preparation and execution could affect the prognosis dramatically.

Embertson said that the foal will be taken into surgery in the best possible condition. Intravenous fluids might need to be given, and electrolyte imbalances and acid-base abnormalities might need to be corrected before surgery. The foal might be given antibiotics and flunixin meglumine (Banamine), and a nasogastric tube will need to be put in place so that the stomach can be decompressed before anesthesia.

Embertson said the goal of any abdominal surgery is correction of the lesion with as little trauma as possible. The owner should be aware that in some surgeries, it might become necessary for the surgeon to remove the umbilical structures. Postoperative care can involve some restriction of milk intake, antibiotics, Banamine, and heparin. A post-surgical foal and his dam generally can be turned out with other mares and foals three to four weeks after surgery.

Upper digestive tract obstructions can be diagnosed using radiographic contrast study. On radiograph, the veterinarian will be able to see that a radiopaque suspension (one that shows up white on a radiograph) will have not left the stomach within 30-45 minutes. The exact location of an upper digestive tract obstruction can be found during surgery by palpation and visualization.  Usually in foals, the obstruction is found at the pylorus (the opening from the stomach into the intestine) or along the descending duodenum (the first part of the small intestine). To bypass a narrowed pylorus, a gastroduodenostomy (connecting the stomach to the duodenum) is performed, while a narrowed duodenum will require a gastrojejunostomy (connecting the stomach to the second part of the small intestine). These surgeries can be difficult, he said.

A foal with unrelenting pain from strangulation obstructions might need immediate surgery. "If the duration of the strangulation is less than approximately three hours or if the bowel is not tightly strangulated, the abnormality may possibly be resolved without resection of the bowel," he said. These obstructions can occur within the small and the large intestine.

Non-strangulating small intestine abnormalities requiring surgery include intussusceptions (telescoping of one part of intestine into another), impaction with ascarids or ingested feed, and enteritis (intestinal inflammation) with an obstruction. Non-strangulating obstructions in the large intestine include meconium (first feces) retention, large colon displacement, and segmental colonic atresia (missing a part of the colon).

Urogenital and Umbilical Abnormalities
During foaling, it is possible that the foal will rupture his bladder. Owners should be aware that even after one surgery, infrequently the repair site might leak, requiring another surgery. Surgeons might use a urinary catheter for two to three days to keep the bladder decompressed and help prevent the leakage problem. Uroperitonem (urine free in the abdomen) can also be caused by a leak in the urachus (the area between the bladder and the umbilicus) or at the uppermost part of the bladder. Resection of the umbilical structures and the tip of the bladder is usually necessary.

Patent urachus results in a loss of the seal at the apex of the bladder. Systemic antibiotics might help solve some cases. Umbilical evisceration, in which the small intestine falls through the umbilical opening, can happen if the body wall does not form properly at the umbilicus. If the organs are kept clean, surgery can restore the wall and help the foal have a normal life.

Embertson said that umbilical infections are usually treated medically, although surgery is sometimes needed.

Upper Airway Abnormalities
Embertson listed a few times when a foal would need surgery to repair an upper airway abnormality. Guttural pouch tympanitis causes throat swelling and upper airway noise due to an abnormality of the flap covering the guttural pouch opening. Laser surgery can be used to correct this problem.

Choanal atresia is a birth defect in which a membrane separates the nasal passage from the nasopharynx. Laser surgery can be done to cut a hole in this membrane; however, it is unlikely that the foal will be an athlete.

If milk comes out of the nostrils, the foal might have a cleft palate. Many foals will develop aspiration pneumonia from this abnormality and will have to be euthanized. Surgical repair is difficult, and Embertson said that prognosis for an athletic career is poor.

About the Author

Sarah Evers Conrad

Sarah Evers Conrad has a bachelor’s of arts in journalism and equine science from Western Kentucky University. As a lifelong horse lover and equestrian, Conrad started her career at The Horse: Your Guide to Equine Health Care magazine. She has also worked for the United States Equestrian Federation as the managing editor of Equestrian magazine and director of e-communications and served as content manager/travel writer for a Caribbean travel agency. When she isn’t freelancing, Conrad spends her free time enjoying her family, reading, practicing photography, traveling, crocheting, and being around animals in her Lexington, Kentucky, home.

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