Changes

Usually made at surgery.  Although early rectal examination may permit identification of the impaction low in the right caudal abdominal quadrant, subsequent distention of the jejunum may make this identification difficult or impossible. The most common differential diagnosis is proximal jejunitis, and distinguishing the 2 conditions can often be difficult. Because the horse’s condition initially may remain stable and the degree of abdominal pain may be mild, many horses with this condition are not referred for intensive care or surgery for >18 hr. The protein concentration of the peritoneal fluid may increase if the impaction has persisted for this long. Rectal palpation may identify loops of distended small intestine as the condition progresses.

Usually made at surgery.  Although early rectal examination may permit identification of the impaction low in the right caudal abdominal quadrant, subsequent distention of the jejunum may make this identification difficult or impossible. The most common differential diagnosis is proximal jejunitis, and distinguishing the 2 conditions can often be difficult. Because the horse’s condition initially may remain stable and the degree of abdominal pain may be mild, many horses with this condition are not referred for intensive care or surgery for >18 hr. The protein concentration of the peritoneal fluid may increase if the impaction has persisted for this long. Rectal palpation may identify loops of distended small intestine as the condition progresses.

==Treatment==

==Treatment==

Medical treatment may resolve the impaction(36) but '''surgery''' is typically required.  At surgery, fluids can be directly infused into the mass so that the impaction can be manually broken down.  '''Dioctyl sodium sulfosuccinate (DSS)''' may be included in the infusion to help disrupt the mass.  An enterotomy should be considered to evacuate impacted contents and reduce intestinal manipulation.

Medical treatment with fluids and liquid paraffin may resolve the impaction early on(36) but '''surgery''' is typically required.  At surgery, fluids such as saline or carboxymethylcellulose can be directly infused into the mass so that the impaction can be manually broken down and massaged into the caecum.  '''Dioctyl sodium sulfosuccinate (DSS)''' may be included in the infusion to help disrupt the mass.  An enterotomy in the distal jejunum should be considered to evacuate impacted contents and reduce intestinal manipulation. Ileus may develop after surgery. Depending on the degree of damage to the serosal surface of the small intestine at the time of surgery, complications may develop several weeks after surgery due to intra-abdominal adhesions.(Merck)

==Complications==

==Complications==