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==Introduction==

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Gastric impaction is rare in the horse.<ref>Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>  It can occur spontaneously as a primary condition but is often secondary to other disturbances in the intestinal tract of the stomach such as ulceration or fibrosis at the pylorus.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>  The condition typically causes mild to moderate colic that does not resolve with routine medical treatment.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>

|'''Colic<br>

'''Impaction<br>

'''Simple Obstruction'''

See also: '''[[Colic, Gastric Causes]]'''

Gastric impaction is rare in the horse.<ref>Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>  It can occur spontaneously as a primary condition but is often secondary to other disturbances in the intestinal tract of the stomach such as ucleration of fibrosis at the pylorus.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>  The condition typically causes mild to moderate colic that does not resolve with routine medical treatment.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>

==Aetiology==

==Aetiology==

The specific cause of the impaction is not always apparent<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref> but the obstruction typically consists of excessive dry, coarse ingesta such as straw bedding or poor quality forage.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>  It may also be composed of foreign bodies, ingested materials that form a mass (such as persimmon seeds or mesquite beans<ref>Kellam, L.L, Johnson, P.J, Kramer, J, Keegan, K.G (2000) Gastric impaction and obstruction of the small intestine associated with persimmon phytobezoar in a horse.  ''J Am Vet Med Assoc'', 216:1279-1281</ref><ref>Cummings, C.A, Copedge, K.J, Confer, A.W (1997) Equine gastric impaction, ulceration, and perforation due to persimmon (''Diospyros virginiana'') ingestion.  ''J Vet Diagn Invest'', 9:311-313.</ref><ref>Honnas, C.M, Schumacher, J (1985) Primary gastric impaction in a pony.  ''J Am Vet Med Assoc'', 187:501-502.</ref>) or feeds that tend to swell after ingestion.(151-4 in Sanchez) Gastric impaction may be the result of an gastric atony or defective secretion.<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

The specific cause of the impaction is not always apparent<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref> but the obstruction typically consists of excessive dry, coarse ingesta such as straw bedding or poor quality forage.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>  It may also be composed of foreign bodies, ingested materials that form a mass (such as persimmon seeds or mesquite beans<ref>Kellam, L.L, Johnson, P.J, Kramer, J, Keegan, K.G (2000) Gastric impaction and obstruction of the small intestine associated with persimmon phytobezoar in a horse.  ''J Am Vet Med Assoc'', 216:1279-1281.  In: Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref><ref>Cummings, C.A, Copedge, K.J, Confer, A.W (1997) Equine gastric impaction, ulceration, and perforation due to persimmon (''Diospyros virginiana'') ingestion.  ''J Vet Diagn Invest'', 9:311-313.  In: Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref><ref>Honnas, C.M, Schumacher, J (1985) Primary gastric impaction in a pony.  ''J Am Vet Med Assoc'', 187:501-502.  In: Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>) or feeds that tend to swell after ingestion.  Gastric impaction may be the result of a gastric atony or defective secretion.<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

===Predisposing factors===

===Predisposing factors===

*Inadequate water consumption.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*Inadequate water consumption.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*Secondary gastric impaction has been related to ragwort poisoning<ref>Milne, E.M, Pogson, D.M, Doxey, D.L (1990) Secondary gastric impaction associated with ragowort poisoning in three ponies.  ''Vet Rec'', 126(20):502-4.</ref>

*Secondary gastric impaction has been related to ragwort poisoning<ref>Milne, E.M, Pogson, D.M, Doxey, D.L (1990) Secondary gastric impaction associated with ragwort poisoning in three ponies.  ''Vet Rec'', 126(20):502-4.</ref>

==Clinical signs==

==Clinical signs==

The colic associated with gastric impaction varies from mild and chronic to acute and severe.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>  Other signs reported include:

The [[Colic Diagnosis - Clinical Signs|colic]] associated with gastric impaction varies from mild and chronic to acute and severe.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>  Other signs reported include:

*Anorexia

*Anorexia

*Lethargy

*Lethargy

*Salivation<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

*Salivation<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

*Insidious weight loss (if chronic)<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

*Insidious weight loss (if chronic)<ref name="Edwards">Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref>

*Spontaenous reflux with gastric contents visible at the nares (in severe cases)<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*Spontaneous reflux with gastric contents visible at the nares (in severe cases)<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

In mild cases where signs resolve spontaneously or with analgesics, owners my continue to feed the horse, which only serves to worsen the impaction.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

In mild cases where signs resolve spontaneously or with analgesics, owners my continue to feed the horse, which only serves to worsen the impaction.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*Infusion of balanced polyionic fluids such as saline<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> either directly into the impaction through the gastric wall (adjacent to the greater curvature) or via a nasogastric tube

*Infusion of balanced polyionic fluids such as saline<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> either directly into the impaction through the gastric wall (adjacent to the greater curvature) or via a nasogastric tube

*Massage of the stomach to reduce the impaction and aid movement of fluid into the ingesta

*Massage of the stomach to reduce the impaction and aid movement of fluid into the ingesta

*Impactions diagnosed at surgery may benefit from '''bethanechol''' at 0.2mg/kg SC every 8 hours to stimulate gastric motility.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*Impactions diagnosed at surgery may benefit from '''bethanechol''' to stimulate gastric motility.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*The stomach should be lavaged by nasogastric tube post-operatively and the horse starved for 48-72 hours.

*The stomach should be lavaged by nasogastric tube post-operatively and the horse starved for 48-72 hours.

*'''Gastroscopy''' is indicated to confirm resolution of the impaction and to identify any underlying causes in the stomach.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*'''Gastroscopy''' is indicated to confirm resolution of the impaction and to identify any underlying causes in the stomach.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

   

   

'''Gastrotomy''' has been attempted to remove impacted stomach contents but this has largely been unsuccessful (Huskamp 2000 in Edwards) and carries major risk including poor gastric motility and recurrence of the impaction.(Edwards 1997)

'''Gastrotomy''' has been attempted to remove impacted stomach contents but this has largely been unsuccessful<ref>Edwards, G.B (2003) 'Gastric Pathology' in Chuit, P, Kuffer, A, Montavon, S (2003) ''Congress on Equine Medicine and Surgery'', International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.</ref> and carries major risk including poor gastric motility and recurrence of the impaction.<ref>Edwards, G.B (1997) 'Diseases of the Equine Stomach'. In: ''Proceedings of the 5th Congress of Equine Med Surg'', 98-101.</ref>

==Prognosis==

==Prognosis==

Infusion followed by postoperative gastric lavage by stomach tube is usually successful.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>  Chronic cases carry a poorer prognosis.

Infusion followed by postoperative gastric lavage by stomach tube is usually successful.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>  Chronic cases carry a poorer prognosis. Untreated, gastric impaction may lead to [[Gastric Dilation and Rupture - Horse|'''gastric rupture''']] which is fatal.

 

 

==References==

==References==

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