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Objective To evaluate the historical data, signalment, clinical signs, results of laboratory analyses, treatment, and outcome of horses with small intestinal (SI) volvulus. Study Design Retrospective study. Sample Population One hundred and fifteen client-owned horses, aged 1 month to 21 years. Methods Clinical signs, laboratory data, surgical or necropsy findings, and outcome for horses with SI volvulus were obtained from medical records, identified by computer search and manual review. Results There was no statistical difference in signalment between cases and the hospital population. Seventy-four percent of horses were ≥3 years. There were considerable variations in clinical signs on admission; high heart rate and signs of severe pain were not consistent features. Examination per rectum identified distended small intestine in only 69% of horses. One hundred horses had surgery, and small intestine resection was performed in 25. Eighty-four horses were recovered from surgery, and 67 horses survived to hospital discharge (80% of horses recovered from surgery, 58% of 115 horses). Forty-eight percent that were ultimately discharged had a post-operative complication and these horses had a longer average stay than horses with no complication (11 days versus 8.9 days). Conclusions We identified 115 horses with primary SI volvulus over a 12-year period. We found that the population of horses with this lesion was older than has previously been reported and that the prognosis for post-operative survival to hospital discharge is good (80%). Post-operative complications were common, and affected approximately half the horses that were ultimately discharged from the hospital. Clinical Relevance This information may aid diagnosis and prognosis and guide decision making for horses with this condition.