In human medicine, doctors must follow specific guidelines before recommending a procedure or treatment. Though not without controversy, this at least provides clear-cut standards for proceeding.

“In veterinary medicine, veterinarians can basically do whatever they deem necessary to increase the chances of survival and/or recovery,” said Anthony Blikslager, DVM, PhD, Dipl. ACVS, a professor of equine surgery and gastroenterology at North Carolina State University, in Raleigh.

This can be problematic in treating syndromes such as equine postoperative ileus (POI); Blicklslager recently researched clinical features and management techniques for this ailment. Horses coming out of abdominal surgery are at risk of reduced gastrointestinal tract motility. This is most challenging in the small intestine. When the small intestine doesn’t work properly, fluid backs up into the horse’s stomach. Because horses can’t vomit, they can experience a painful, distended stomach.

The challenge is defining POI. Most commonly, a veterinarian will pass a nasal tube when a horse shows signs of pain or an increased heart rate after surgery. The volume of fluid present determines whether a horse has POI. However, veterinarians don’t always agree on the amount of fluid that correlates with a POI diagnosis.

“Some veterinarians begin treatment if any fluid or a small volume (about 2 liters) is present,” Blikslager explained. “Others monitor the horse until the fluid reaches a specific volume, such as 8 liters, before beginning treatment.”

Once diagnosed, horses are most often treated with lidocaine (a