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Also known as: '''''Colic — Impaction — Simple Obstruction — Small Intestinal Simple Obstruction — Small Intestinal Obstruction — Small Intestinal Impaction

 

| Also known as:

|'''Colic<br>

'''Impaction<br>

'''Simple Obstruction<br>

'''Small Intestinal Simple Obstruction<br>

'''Small Intestinal Obstruction<br>

'''Small Intestinal Impaction'''

 

   

   

==Description==

==Introduction==

 

The most common condition causing simple obstruction of the small intestinal lumen.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>

The most common condition causing simple obstruction of the small intestinal lumen.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>

==Signalment==

==Signalment==

Adult horses

Adult horses

==Aetiology==

==Aetiology==

 

In the southeastern United States, feeding of poor quality coastal Bermuda hay and lack of administration of the anthelmintic pyrantel pamoate have been implicated as risk factors.<ref>Little, D, Blikslager, A.T (2002) Factors associated with development of ileal impaction in horses with surgical colic:78 cases (1986-2000).  ''Equine Vet J'' 34(5):464-8.</ref>  It is proposed that when this forage has a high fibre content, there is an increased proportion of thin fibres which are prematurely swallowed.<ref>Blikslager, A.T (2010) ''Obstructive Disorders of the Gastrointestinal Tract'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Chapter 15, ''Saunders''.</ref> Sudden feed changes may also contribute.<ref>Parks, A.H.A, Allen, D (1998) ''The purported role of coastal Bermuda hay in the etiology of ileal impactions: results of a questionnaire (abstract), 6th Equine Colic Research Symposium'', University of Georgia, p37.  In: Blikslager, A.T (2010) ''Obstructive Disrodersof the Gastrointestinal Tract'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Chapter 15, ''Saunders''.</ref>  In the UK, infection with the tapeworm [[Anoplocephala|''Anoplocephala perfoliata'']] is an important risk factor.  Proudman and colleagues (1998) found that more than 80% of ileal impactions were associated with serological or faecal evidence of tapeworm infection.<ref>Proudman, C.J, French, N.P, Trees, A.J (1998) Tapeworm infection is a significant risk factor for spasmodic colic and ileal impaction colic in the horse.  ''Equine Vet J'', 30:194-199.</ref>  ''Anoplocephala perfoliata'' infects up to 60% of horses in some geographical areas and has also been implicated as a risk factor for bowel irritation and spasmodic colic.<ref name="Kania">Kania, S.A, Reinemeyer, C.R (2005) ''Anoplocephala perfoliata'' coproantigen detection: a preliminary study.  ''Vet Parasitol'', 127(2):115-9.</ref>Impaction may also develop secondary to spastic contractions of the ileal musculature against ingesta.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>

In the southeastern United States, feeding of poor quality coastal Bermuda hay and lack of administration of the anthelmintic pyrantel pamoate have been implicated as risk factors.<ref>Little, D, Blikslager, A.T (2002) Factors associated with development of ileal impaction in horses with surgical colic:78 cases (1986-2000).  ''Equine Vet J'' 34(5):464-8.</ref>  It is proposed that when this forage has a high fibre content, there is an increased proportion of thin fibres which are prematurely swallowed.(Bliks)  Sudden feed changes may also contribute.<ref>Parks, A.H.A, Allen, D (1998) ''The purported role of coastal Bermuda hay in the etiology of ileal impactions: results of a questionnaire (abstract), 6th Equine Colic Research Symposium'', University of Georgia, p37.  In:</ref>  In the UK, infection with the tapeworm [[Anoplocephala|''Anoplocephala perfoliata'']] is an important risk factor.  Proudman and colleagues (1998) found that more than 80% of ileal impactions were associated with serological or faecal evidence of tapeworm infection.<ref>Proudman, C.J, French, N.P, Trees, A.J (1998) Tapeworm infection is a significant risk factor for spasmodic colic and ileal impaction colic in the horse.  ''Equine Vet J'', 30:194-199.</ref>  ''Anoplocephala perfoliata'' infects up to 60% of horses in some geographical areas and has also been implicated as a risk factor for bowel irritation and spasmodic colic.<ref>Kania, S.A, Reinemeyer, C.R (2005) ''Anoplocephala perfoliata'' coproantigen detection: a preliminary study.  ''Vet Parasitol'', 127(2):115-9.</ref>Impaction may also develop secondary to spastic contractions of the ileal musculature against ingesta.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>

==Clinical Signs==

==Clinical Signs==

 

Typical [[Colic Diagnosis - Clinical Signs|signs]] associated with small intestinal obstruction:

Typical signs associated with [[Colic Diagnosis - Clinical Signs|small intestinal obstruction]]:

*Moderate to severe colic

*Moderate to severe colic

*Reduced [[Colic Diagnosis - Abdominal Auscultation|borborygmi]]

*Reduced [[Colic Diagnosis - Abdominal Auscultation|borborygmi]]

==Diagnosis==

==Diagnosis==

 

Early [[Colic Diagnosis - Rectal Examination|rectal examination]] may reveal the impaction low in the right caudal abdominal quadrant.  Subsequent distention of the jejunum will be palpable ''per rectum'' but may preclude palpation of the impaction, thus the definitive diagnosis is often made at surgery.  Many horses with ileal impaction are delayed in their referral because initially their colic is mild and their condition deceptively stable.  [[Colic - Peritoneal Fluid Analysis|Abdominocentesis]] may show an elevated protein concentration if the impaction has persisted for more than about 18 hours.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>  The most likely differential diagnosis is '''proximal jejunitis''', which can be challenging to rule out.

Early [[Colic Diagnosis - Rectal Examination|rectal examination]] may reveal the impaction low in the right caudal abdominal quadrant.  Subsequent distention of the jejunum will be palpable ''per rectum'' but may preclude palpation of the impaction, thus the definitive diagnosis is often made at surgery.  Many horses with ileal impaction are delayed in their referral because initially their colic is mild and their condition deceptively stable.  [[Colic Diagnosis - Abdominocentesis|Abdominocentesis]] may show an elevated protein concentration if the impaction has persisted for more than about 18 hours.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>  The most likely differential diagnosis is proximal jejunitis, which can be challenging to rule out.

==Treatment==

==Treatment==

[[Colic, Medical Treatment|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.Theileal impaction was reduced by extraluminal massage aided by admixing of intestinal fluid oral to the impaction or injection of fluids intraluminally and then movement of the ingesta into the cecum.  One horse initially treated by manual reduction required jejunocecostomy twice for management of recurrent ileal impaction.Ileal impactions can be successfully reduced by celiotomy and extraluminal massage and injection techniques to soften the ingesta for passage into the cecum without enterotomy or bypass techniques in most horses. (Hanson)

'''Surgical treatment''' comprises celiotomy followed by reduction of the impaction via extraluminal massage aided by admixing of the intestinal fluid oral to the impaction or injection of fluids intraluminally.  The ingesta can then be moved into the caecum.  Infusions into the impaction may include saline, '''carboxymethylcellulose''' or '''dioctyl sodium sulfosuccinate (DSS)'''.  An '''enterotomy''' in the distal jejunum may be instigated to evacuate impacted contents and minimise intestinal manipulation.  Recurrent ileal impaction may demand a '''jejunocecostomy'''.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref>

 

Treatment consisted of intravenous administration of a balanced electrolyte solution, nasogastric intubation and siphonage, and administration of analgesics. Mineral oil was administered after gastric reflux had ceased. Mean time for resolution of ileal impaction was 11.7 hours.

Medical treatment may be a viable alternative for horses that cannot have surgery,provided persistent signs of severe pain or progressive gaseous distention ofthe small intestine are not features of the condition. Improvement ofcardiovascular status, reduction in signs of abdominal pain, decrease in distentionof loops of small intestine during repeated transrectal examination, softeningof the impaction, and decreases in amounts of gastric reflux were indicative ofa response to medical treatment.(Hanson Schumacher)

 

Reflux is found in 50% of horses requiring surgical conrrection for ileal impaction(35,41)

==Complications==

==Complications==

 

Small intestinal distension and manipulation of the ileum at surgery may lead to '''post-operative ileus'''<ref>Blikslager, A.T, Bowman, K.F, Levine, J.F, ''et al.'' (1994) Evaluation of factors associated with postoperative ileus in horses: 31 cases (1990-1992).  ''J Am Vet Med Assoc'', 205:1748-1752.</ref> but the risk is reduced if the duration between disease onset and surgical intervention is decreased.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref>  Depending on the degree of damage to the serosal surface of the small intestine at surgery, complications may develop several weeks after surgery due to intra-abdominal '''adhesions'''.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>  Most of the problems related to adhesions are thought to occur within 2 months.<ref name="Baxter">Baxter, G.M, Broome, T.E, Moore, J.N (1989) Abdominal adhesions after small intestinal surgery in the horse.  ''Vet Surg'', 18(6):409-14.</ref>

Small intestinal distension and manipulation of the ileum at surgery may lead to post-operative ileus<ref>Blikslager, A.T, Bowman, K.F, Levine, J.F, ''et al.'' (1994) Evaluation of factors associated with postoperative ileus in horses: 31 cases (1990-1992).  ''J Am Vet Med Assoc'', 205:1748-1752.</ref> but the risk is reduced if the duration between disease onset and surgical intervention is decreased.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref>  Depending on the degree of damage to the serosal surface of the small intestine at surgery, complications may develop several weeks after surgery due to intra-abdominal adhesions.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>  Most of the problems related to adhesions are thought to occur within 2 months.<ref>Baxter, G.M, Broome, T.E, Moore, J.N (1989) Abdominal adhesions after small intestinal surgery in the horse.  ''Vet Surg'', 18(6):409-14.</ref>

==Prognosis==

==Prognosis==

The prognosis for survival is generally good.<ref name="Hanson">Hanson, R.R, Wright, J.C, Schumacher, J, Baird, A.N, Humburg, J, Pugh, D.G (1998) Surgical reduction of ileal impactions in the horse: 28 cases. ''Vet Surg'', 27(6):555-60.</ref>Enterotomy,enterectomy, and/or jejunocecostomy performed during surgery had a deleteriouseffect on survival.(Parks)Itwas concluded that the shorter the duration of colic before surgicalintervention, the better the prognosis.(Embertson)Furthermore, the earlier development of postoperativeadhesions was associated with a poorer prognosis for survival.(Baxter)

*Adequate and appropriate feeding of good quality forage

*Avoidance of sudden dietary changes

*Avoid practices that encourage the development of [[Anthelmintic Resistance|anthelmintic resistance]]

==Prevention==

Feacal worm egg counts do not reliably detect horses infected with ''A.perfoliata''.  An '''ELISA''' to test for the host antibody response to tapeworms has been developed with a reported sensitivity of 70% and a specificity of 95%.<ref>Proudman, C.J, Trees, A.J (1996) Use of excretory/secretory antigens for the serodiagnosis of ''Anoplocephala perfoliata'' cestodosis.  ''Vet Parasitol'', 61:239-247.</ref>  Although this test is useful for detecting horses with a high intensity of infection, it measures past and current infection so must be interpreted in light of the anthelmintic history.  More recently, a '''coproantigen capture ELISA''' has demonstrated some promise in a small sample of horses.<ref name="Kania">Kania, S.A, Reinemeyer, C.R (2005) ''Anoplocephala perfoliata'' coproantigen detection: a preliminary study. ''Vet Parasitol'', 127(2):115-9.</ref>  Such tests may be used as part of a '''targeted strategic dosing''' programme for anthelmintic administration.

Faecal tapeworm ELISA test: senstivity 70%, specificity 95%(40).

Identification of infected animals based upon detection of eggs in feces is labor intensive and unreliable. This study involved the development of a test for A.perfoliata coproantigen using an antigen capture enzyme linked immunosorbent assay (ELISA) and correctly distinguished between infected and uninfected animals in a trial with a small sample size.(Kania)

|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28ileum%29+OR+title%3A%28ileal%29%29+AND+%28title%3A%28impaction%29+OR+title%3A%28obstruction%29%29+AND+od%3A%28horses%29 Ileal Impaction in horses publications]

==References==

==References==

<references/>

<references/>

[[Category:Intestine_-_Mechanical_Obstruction]]

[[Category:Intestine_-_Mechanical_Obstruction]]

[[Category:Surgical_Colic_in_the_Horse]]

[[Category:Surgical_Colic_in_the_Horse]]

[[Category:To_Do_-_Nina]]

[[Category:Expert_Review]]

[[Category:Impaction - Horse]]

[[Category:Small Intestinal Diseases - Horse]]