When to Refer a Colic Case
If your horse colicked today, what would you do? In many colic scenarios, the time spent deciding whether to transport the horse to an equine hospital for specialized care can mean the difference between life and death. For this reason, it’s important for veterinarians and owners to be able to make a quick decision about when to refer a colicking horse.

At the American Association of Equine Practitioners’ Focus on Colic, held July 16-18, 2017, in Lexington, Kentucky, Jarred Williams, MS, DVM, PhD, Dipl. ACVS-LA, ACVECC, clinical assistant professor of Large Animal Emergency Medicine at the University of Georgia’s College of Veterinary Medicine, shared protocol for referring colic cases.

The two decision-makers for referral, he said, are the type of abdominal lesion and the owner’s opinion.

“The vet’s job is to identify the lesion as quickly as we can and educate the owner,” he said.

Situations in which referral is simply not an option include a lack of finances, no trailer access or a horse that refuses to load, and personal opinion about surgery or referral off the farm.

Otherwise, Williams said, the veterinarian should proceed immediately with a colic workup to determine what section of the gastrointestinal tract is involved—the small intestine, large intestine, or other—and the type of disease—strangulating obstruction (SO), nonstrangulating obstruction (NSO), or inflammatory.

He reviewed with attendees the different types of lesions they might find and whether they typically warrant referral.

Small Intestinal Disease

  • Strangulating obstruction of the small intestine These are always surgical cases. “It’s not going to fix itself medically on the farm,” Williams said. “The lesion has dictated what the horse needs.”
  • Inflammatory disease (e.g., enteritis) While these aren’t usually surgical, they do require a lot of time and effort spent refluxing (emptying stomach contents via stomach tube) and getting fluids into the horse. Thus, Williams recommends referral, if practical.
  • Nonstrangulating obstruction of the small intestine Veterinarians can manage horses with NSOs on the farm with sedation, gastric decompression, and intravenous (IV) fluids. Less commonly do these cases require surgery. Williams said veterinarians might still elect to refer, however, if it looks like there will be frequent farm visits.

Large Intestinal Disease

  • Strangulating obstruction of the large intestine Again, SOs such as volvulus aren’t going to fix themselves. Refer, said Williams.
  • Inflammatory disease (e.g., hypovolemic shock) These cases almost always require referral due to the need for isolation of the horse to prevent spread of pathogens such as Salmonella. These horses also require continuous support including IV fluids and cryotherapy or icing to prevent secondary laminitis.
  • Nonstrangulating obstruction of the large intestine “These are the vast majority of colics we see,” said Williams, and they include impactions, left and right dorsal displacement, and gas/spasmodic colic. He said veterinarians can manage them in the field with sedation, supportive fluids, and hand-walking. If horses don’t respond to treatment, however, they might still be referred to a tertiary facility.

Special Considerations

Generally, horses with mild to moderate pain and that are medically manageable can be treated in the field, said Williams. There are, however, some scenarios in which the veterinarian should refer the horse immediately. These include:

  • Distended loops of small intestine, evident via rectal or ultrasonographic examination;
  • Postpartum broodmares;
  • Diarrhea, for biosecurity reasons;
  • Cardiovascular instability;
  • A very, very painful horse; and
  • Uncertainty about the lesion site or type. “It’s never wrong to get the horse some place where surgery can be done,” said Williams.

Once the horse arrives at the hospital, the referral vet will repeat the colic workup, possibly take bloodwork, analyze abdominal fluids, and make a recommendation about whether to go to surgery.

Take-Home Message

Williams wrapped up his presentation with practical tips for making that all-important decision about how to manage a colicking horse:

  • Be sure of the lesion site and type.
  • Make sure the owner knows the costs involved.
  • Estimate how much multiple farm visits or treatment at the primary clinic will cost. Sometimes it’s more cost-effective and efficient to refer.
  • Make sure the owner knows that delaying surgery after it’s been recommended might increase the risk of postoperative complications.

“Eighty to 90 percent of presenting colics (at the University of Georgia’s Veterinary Medical Center) don’t go to surgery,” said Williams. “For many cases, referral is more about the ability to manage efficiently.

“If you’re not sure what’s going on,” he concluded, “don’t sit on it.”