Cecal impaction is the most common pathologic condition of the cecum in horses, accounting for 40% to 50% of horses with cecal disease, 5% of horses with intestinal impaction, and 2% of horses referred for treatment of colic.1,2,3,4,5 Cecal rupture has been reported to occur in as high as 57% of horses with cecal impaction.4 The pathogenesis of cecal impaction is likely multifactorial, varying from one case to the next, and the underlying cause in any individual case is typically unknown. Anecdotally, cecal impaction has been associated with poor dentition, coarse roughage intake, decreased water consumption, administration of nonsteroidal anti-inflammatory drugs, and infestation with Anaplocephala perfoliata.2,3,4 Cecal impaction has also been identified in horses that have been hospitalized for diseases unrelated to the gastrointestinal tract, predominately musculoskeletal abnormalities.4 Most of these horses had recently undergone general anesthesia and were receiving nonsteroidal anti-inflammatory drugs as part of their treatment regimen. Cecal dysfunction secondary to abnormalities in cecal motility, as opposed to mechanical obstruction by firm ingesta, is thought to play a role in the development of cecal impaction in these horses.
Medical and surgical treatment of horses with cecal impaction have been described.3,4,6-8 Medical treatment includes administration of fluids, laxatives, and analgesics and withholding of food until rectal examination confirms resolution of the impaction. Surgical treatment includes typhlotomy with or without a cecal bypass procedure.3,4,7-10 Unfortunately, there is limited published information regarding the shortand longterm outcomes of horses treated medically or surgically for cecal impaction. Although some authors recommend that surgical treatment be reserved for horses refractory to medical treatment or with severe cecal distention, other authors recommend earlier surgical intervention.3,4,9,11 Additionally, in those horses in which surgery is performed, a decision must be made as to whether to perform a cecal bypass procedure to prevent recurrent cecal impaction secondary to motility dysfunction.5,9-11 The purpose of the study reported here was to determine shortand long-term outcomes, including recurrence rates, for horses with cecal impaction treated medically or surgically.
Epi-Info, version 3.3.2, CDC, Atlanta, Ga. Available at: www.cdc.gov/EpiInfo/. Accessed Feb 9, 2005.
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White NA. Epidemiology and etiology of colic. In: White NA, ed. The equine acute abdomen. Philadelphia: Lea & Febiger, 1990;49–64.
Roberts CT, Sloan DE. Cecal impactions managed surgically by typhlotomy in 10 cases (1988–1998). Equine Vet J Suppl 2000;32:74–76.
Craig D, Pankowski R & Car B, et al. Ileocolostomy}a technique for surgical management of equine cecal impaction. Vet Surg 1987;16:451–455.
Ross MW, Tate LP & Donawick WJ, et al. Cecocolic anastomosis for the surgical management of cecal impaction in horses. Vet Surg 1986;15:85–92.
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Cohen ND, Gibbs PG, Woods AM. Dietary and other management factors associated with colic in horses. J Am Vet Med Assoc 1999;215:53–60.
Beroza GA, Barclay WP & Phillips TN, et al. Cecal perforation and peritonitis associated with Anaplocephala perfoliata infection in three horses. J Am Vet Med Assoc 1983;183:804–806.
White N, Lessard P. Risk factors and clinical signs associated with cases of equine colic, in Proceedings. 32nd Annu Meet Am Assoc of Equine Pract 1986;637–644.
Hackett R. Cecal impaction. In: White NA, Moore J, eds. Current practice of equine surgery. Philadelphia: JB Lippincott, 1990;331–334.
Ross MW, Orsini JA, Ehnen SJ. Jejunocolic anastomosis for the surgical management of recurrent cecal impaction in a horse. Vet Surg 1987;16:265–268.
Gerard MP, Bowman KF & Blikslager AT, et al. Jejunocolostomy or ileocolostomy for treatment of cecal impaction in horses: nine cases (1985–1995). J Am Vet Med Assoc 1996;209:1287–1290.
Symm WA, Nieto JE & Van Hoogmoed L, et al. Initial evaluation of a technique for complete cecal bypass in the horse. J Am Vet Med Assoc 2006;35:674–677.