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Records of 75 horses with ileal impactions were examined retrospectively. There was a sex predilection towards mares. Arabians were over-represented compared to the hospital population. The average age was 8.3 years. Abdominal pain was observed in 96% of horses. Nasogastric reflux was present in 56% of horses, small intestinal distention was found on rectal palpation in 96% and an ileal impaction in 25%. Exploratory celiotomy was performed in 69 horses, the mass was reduced by extramural massage in 67 horses, and ingesta was removed via enterotomy in 2. Jejunocecostomies were performed in 47 horses. Twenty-five horses developed postoperative ileus, and 11 developed laminitis. Twenty-seven horses survived. Significant differences (p less than 0.05) between survivors and non-survivors were found for rectal temperature (37.7 and 38.2 degrees C, respectively), plasma protein concentration (7.8 and 8.9 g/dl, respectively) and anion gap (15 and 21.3 mEq/l, respectively). Survival decreased with increasing duration of clinical signs. Enterotomy, enterectomy, and/or jejunocecostomy performed during surgery had a deleterious effect on survival.