Cecal Impaction: Surgery Can Make a Difference

Horses with life-threatening cecal impactions only have a fair prognosis after surgery, but those that survive to discharge have a good prognosis, reported a group of veterinarians led by Lewis C.R. Smith, BVetMed, CertES(Orth), MRCVS, from Rossdales Equine Hospital in the United Kingdom.

Cecal impactions are not particularly common--they represent only 5% of all large intestinal impactions at referral institutions. However, according to the study authors, "Progression of caecal impaction to rupture is a potentially life-threatening complication associated with the condition."

Surgical management of cecal impactions, according to the authors, "are challenging, and complications following simple typhlotomy (incising into the cecum) are common."

To better understand the short- and long-term outcomes and complications in horses undergoing surgery for cecal impactions at Rossdales Equine Hospital between 2000 and 2008, Smith and his colleagues reviewed the medical records of 20 horses. 

  • 16 of the 20 horses underwent a cecal bypass (a procedure that connects the ileum to the colon to bypass the cecum).
  • Three had a typhlotomy only.
  • One horse had a typhlotomy and a cecal bypass.
  • 5 of 20 horses had primary cecal impactions, while 10 of 20 had cecal impactions secondary to a previous orthopedic surgery. The remaining 5 horses had cecal impactions secondary to previous colic surgery.
  • 13 of 20 (65%) survived to discharge.
  • 11 of the 13 horses that survived to discharge survived long-term.
  • The 3 horses that had a typhlotomy alone (rather than a bypass) survived discharge and long-term.

Together, these data suggest that in horses with life-threatening cecal impactions, surgery is a reasonable option with fair to good outcomes.

The authors also noted, "Caecal bypass with ileal transaction is a useful technique for cases with caecal dysfunction and should be considered as a first-line procedure in horses where a single celiotomy (abdominal surgery) is the only option. Typhlotomy, although successful in 3/4 cases, still carries the risk of a second cecal impaction developing."

The study, "Outcome and long-term follow-up of 20 horses undergoing surgery for caecal impaction: A retrospective study (2000-2008)," will be published in an upcoming edition of the Equine Veterinary Journal.

The abstract is available online.

About the Author

Stacey Oke, DVM, MSc

Stacey Oke, MSc, DVM, is a practicing veterinarian and freelance medical writer and editor. She is interested in both large and small animals, as well as complementary and alternative medicine. Since 2005, she's worked as a research consultant for nutritional supplement companies, assisted physicians and veterinarians in publishing research articles and textbooks, and written for a number of educational magazines and websites.

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