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Epidemiologic studies are essential for the generation of evidence-based, preventive health care strategies. This includes ways to minimize colic risk and assist informed decision making concerning diagnosis, treatment, and likely outcomes. It is important to consider that colic is not a simple "disease" but is a syndrome of abdominal pain that encompasses multiple different disease processes, and which is multifactorial in nature. This review focuses on prevention and diagnosis of colic, including specific forms of colic, communications with owners/carers concerning colic risk and management, and areas of future research., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Reasons for Performing Study: Colic is an important health problem in managed horse populations. Currently, there is limited information about colic prevalence and risk factors for colic in working horse populations., Objectives: To determine the prevalence of, and risk factors for, colic in a working horse population in Egypt and to describe management practices in this working horse population., Study Design: Cross-sectional survey., Methods: Owners of 350 working horses were interviewed. Data about their horses, management and colic episodes in the preceding 12 months were collected. Dental examination was conducted on 342 horses and blood samples (n = 100) were collected for immunodiagnosis of tapeworm (Anoplocephala perfoliata) infection. Multivariable logistic regression analysis was used to identify risk factors for a history of colic in the preceding 12 months., Results: The 12-month prevalence of colic was 54.6%. Severe and moderate tapeworm infection intensity was identified in 3% and 26% of horses tested, respectively. Horses that had severe dental disease (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.9-24.3, P<0.001), that displayed stereotypic behaviour (OR 2.0, 95% CI 1.15-3.5, P = 0.013), were fed ground corn during the 'dry season' (OR 1.65, 95% CI 1.03-2.6, P = 0.035) or that had received an anthelmintic in the previous 6 months (OR 2.1, 95% CI 1.3-3.3, P = 0.003) were more likely to have a history of colic in the preceding 12 months. Horses fed on rice bran during the 'green season' (OR 0.47, 95% CI 0.26-0.9, P = 0.015) and that displayed geophagia/coprophagia (OR 0.19, 95% CI 0.05-0.73, P = 0.001) were less likely to have a history of colic., Conclusions: Colic is common in this working horse population and this study has identified factors associated with altered likelihood of colic. The study provides important information that may be used to inform future prospective studies investigating colic in working horse populations and to assist development of preventive healthcare strategies. The Summary is available in Chinese - see Supporting information., (© 2016 EVJ Ltd.)

Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design., (© 2015 EVJ Ltd.)

Reasons for Performing Study: Recurrent colic occurs frequently in the general horse population but little evidence exists about what factors place horses at greater risk of recurrent colic., Objectives: To quantify time-varying and non time-varying risk factors for recurrent colic among horses attended by first-opinion veterinary surgeons in northwest England., Study Design: Nested case-control study., Methods: A nested case-control study was conducted on data from a prospective longitudinal cohort study of 127 horses recruited subsequent to an episode of medical colic. Data were collected on management and recurrent colic episodes at 4-monthly intervals by telephone questionnaires. All recurrent colic episodes were selected as cases; controls were unmatched and randomly selected from all horse-time at risk. Data relating to the 30 days prior to the date of colic or control selection were used to determine exposure status. Multivariable logistic regression analyses were used to determine risk factors for recurrent colic., Results: In total, 59 cases and 177 controls were included. The final model showed that horses that displayed crib-biting/windsucking (odds ratio [OR] 10.1, 95% confidence interval [CI] 2.5-41.0) or weaving behaviour (OR 3.9, 95% CI 1.5-10.1) had an increased risk of recurrence of colic. Increasing time at pasture reduced the risk of recurrence (OR 0.99, 95% CI 0.99-1.0). A significant interaction was found suggesting that the risk associated with crib-biting/windsucking may be modified by feeding fruit/vegetables; however, further research is required before recommendations for feeding practices can be made., Conclusions: This study suggests that sufficient access to pasture may be an important means of reducing recurrent colic risk. The behavioural risk factors highlight individuals who may be at increased risk of recurrent colic and whose colic prevention strategies should be carefully managed., (© 2014 EVJ Ltd.)

Reasons for Performing Study: Epiploic foramen entrapment (EFE) has been associated with reduced post operative survival compared to other types of colic but specific factors associated with reduced long-term survival of these cases have not been evaluated in a large number of horses using survival analysis., Objective: To describe post operative survival of EFE cases and to identify factors associated with long-term survival., Methods: A prospective, multicentre, international study was conducted using clinical data and long-term follow-up information for 126 horses diagnosed with EFE during exploratory laparotomy at 15 clinics in the UK, Ireland and USA. Descriptive data were generated and survival analysis performed to identify factors associated with reduced post operative survival., Results: For the EFE cohort that recovered following anaesthesia, survival to hospital discharge was 78.5%. Survival to 1 and 2 years post operatively was 50.6 and 34.3%, respectively. The median survival time of EFE cases undergoing surgery was 397 days. Increased packed cell volume (PCV) and increased length of small intestine (SI) resected were significantly associated with increased likelihood of mortality when multivariable analysis of pre- and intraoperative variables were analysed. When all pre-, intra- and post operative variables were analysed separately, only horses that developed post operative ileus (POI) were shown to be at increased likelihood of mortality., Conclusions: Increased PCV, increased length of SI resected and POI are all associated with increased likelihood of mortality of EFE cases. This emphasises the importance of early diagnosis and treatment and the need for improved strategies in the management of POI in order to reduce post operative mortality in these cases., Potential Relevance: The present study provides evidence-based information to clinicians and owners of horses undergoing surgery for EFE about long-term survival. These results are applicable to university and large private clinics over a wide geographical area., (© 2011 EVJ Ltd.)

Reasons for Performing Study: The frequency of recurrent colic in the UK equine general practice population is previously unreported. Elucidating risk factors for recurrent colic could provide a basis for clinical decision making and interventions., Objectives: To determine the incidence rate of and risk factors for recurrent colic., Hypotheses: Horse management, prophylactic health care and innate behaviour contribute to the risk of recurrent colic., Methods: A cohort of 127 horses was enrolled at the point of a veterinary-diagnosed medical colic episode. Participating owners completed a baseline and 3 follow-up telephone questionnaires over one year. Clinical details of each colic episode were collected with data on management, behaviour and preventive healthcare. Incidence was calculated using time at risk data; non-time varying covariates were assessed for association with recurrent colic using multivariable logistic regression., Results: The recurrence rate was 50 colic events/100 horse years at risk (HYAR). Including only veterinary attended recurrent colic episodes the incidence was 35 colic events per 100 HYAR. A multivariable logistic regression model was built to explore non-time varying risk factors for recurrence collected from baseline data. The model showed that horses that have a known dental problem (OR 5.5, 95% CI 1.3, 23.1) or crib-bite/windsuck (OR 12.1, 95% CI 1.4, 108.1) were at increased risk of recurrence during the year following a colic event., Conclusions and Potential Relevance: The incidence of recurrence in horses following a medical episode of colic is high in this population and represents a welfare concern. The incidence rate can be used to compare intervention efficacy in similar populations. Identified risk factors could provide the basis for management interventions or highlight at risk individuals., (© 2011 EVJ Ltd.)

Reasons for Performing Study: Epiploic foramen entrapment (EFE) is a common cause of small intestinal strangulation in the horse and its epidemiology requires further investigation., Objectives: To identify horse- and management-level risk factors for EFE and to explore reasons for the apparent seasonality of this condition., Hypothesis: Horses exhibiting certain behaviours and those exposed to particular management practices that vary seasonally are at increased risk of EFE., Methods: A prospective unmatched, multicentre case-control study was conducted over 24 months in the UK. Data on 77 cases and 216 control horses were obtained from 9 collaborating clinics and logistic regression was used to identify associations between horse and management variables and the likelihood of EFE., Results: In a final multivariable model crib-biting/windsucking behaviour was associated with the largest increase in likelihood of EFE. A history of colic in the previous 12 months, increased stabling in the previous 28 days and height of the horse also increased the likelihood of EFE. Horses with access to a mineral/salt lick, those easily frightened and horses not fed at the same time as others were at reduced risk of EFE., Conclusions: Horses exhibiting certain behaviours, those with a previous history of colic and horses of greater height appear to be at inherently greater risk of EFE. The increase in likelihood of EFE with increased duration of stabling may explain the apparent seasonality of this condition.

Reason for Performing Study: Epiploic foramen entrapment (EFE) is one of the most common causes of small intestinal strangulation in the horse. Identification of risk factors would generate hypotheses about causation and may suggest preventive strategies., Hypothesis: Horses exhibiting certain behavioural patterns and those exposed to particular management practices are at increased risk of EFE., Methods: A matched case-control study was conducted on EFE cases admitted to hospitals in the UK, Ireland and USA. Data on 109 cases and 310 control horses were obtained by telephone questionnaire and conditional logistic regression was used to identify associations between horse- and management-level variables and the risk of EFE., Results: Crib-biting/windsucking behaviour was strongly associated with increased risk of EFE (OR 67.3, 95%CI 15.3-296.5). A history of colic in the previous 12 months (OR 4.4, 95%CI 1.5-12.7) and horses of greater height (OR/cm 1.05, 95%CI 1.01-1.08) were also at increased risk. The person(s) responsible for horses' daily care (nonowner/relative/spouse OR 5.5, 95%CI 2.3-13.3) and a number of behavioural features, including response to a stimulus causing fright (easily frightened OR 0.4, 95%CI 0.1-1.0) or excitement (sweats up easily/occasionally OR 0.3, 95%CI 0.1-0.8), reaction to their surroundings (inquisitive OR 0.4, 95%CI 0.2-0.8) and feeding behaviour when stressed (goes off food in full/part OR 0.3, 95%CI 0.1-1.0) were also associated with altered risk of EFE., Conclusions: The association between horses of greater height and those with a previous history of colic and increased risk of EFE suggests that some horses may be inherently predisposed to EFE. Furthermore, a behavioural pattern has been characterised that is common to horses at increased risk of EFE. Further research is required to investigate the causal pathway linking behavioural traits with gastrointestinal dysfunction and to determine whether behavioural modification reduces the risk of EFE., Potential Relevance: The findings of the present study have relevance to horses in the UK, Ireland and USA.

Colic remains a significant problem in the horse in terms of welfare and economics; in some equine populations it is the single most common cause of death. Many causes of colic are cited in the equestrian and veterinary literature but little scientific evidence exists to substantiate these theories. Recent epidemiological investigations have confirmed that colic is complex and multi-factorial in nature. Studies have identified a number of factors that are associated with increased risk of colic including parasite burden, certain feed types, recent change in feeding practices, stabling, lack of access to pasture and water, increasing exercise and transport. These findings are reviewed together with examples of management practices that may be altered to reduce the incidence of specific types of colic. This is an opinionated, not a systematic, review focusing on those areas that are considered most relevant to the practitioner.

Summary: Background: There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy. Objectives: To investigate the bacterial species cultured from the ventral midline pre‐, intra‐ and post‐ laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates. Study design: Prospective cohort study. Methods: The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time‐points pre, intra and post‐operatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration. Results: Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra‐operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL‐producers were identified in the post‐operative period in one and four different horses respectively, but none of these developed a SSI. Main limitations: Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge. Conclusions: A variety of bacterial species may be isolated from equine laparotomy incisions peri‐operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri‐operatively and other mechanisms such as bacteraemia merit further investigation. [ABSTRACT FROM AUTHOR]

Summary: Five horses with a primary surgical lesion of the small (descending) colon were diagnosed with eosinophilic colitis based on visual and histopathological examination. These were evident as visibly striking, hyperaemic, focal lesions of the small colon, with serosal petechiation, oedema and marked thickening of the intestinal wall at the site. Areas of focal necrosis were also evident. The gross appearance of the lesions were considered to be sufficiently severe in all cases to merit resection, due to concerns about intestinal necrosis and septic peritonitis. An inability to fully exteriorise the affected portion of intestine to perform a resection and anastomosis necessitated intraoperative euthanasia of one horse. A total of three horses survived to hospital discharge. Eosinophilic colitis lesions are a rare cause of severe small colon disease, but should be considered in cases with similar visual characteristics. [ABSTRACT FROM AUTHOR]

It has been 21 years since the adoption of clinical audit by our profession was first suggested in the literature (Mosedale [17]) and 19 years since an editorial in this journal introduced two thought-provoking articles on the subject (Rossdale and Mair [25]). Colic surgery has been identified as a discipline well-suited to clinical audit (Mair and White [13]). Despite significant improvements in treatment and outcomes for horses undergoing colic surgery, mortality, and complication rates remain relatively high (Mair [12]; Salem I et al i . 14 Mair, T.S. and White, N.A. (2008) The creation of an international audit and database of equine colic surgery: Survey of attitudes of surgeons. [Extracted from the article]

Reasons for performing study Relaparotomy may be required to investigate and manage complications that occur following surgical management of colic. Objectives To report factors associated with survival following relaparotomy. Study design Retrospective cohort study. Methods Records of horses that had undergone exploratory laparotomy for treatment of colic over a 10-year period (2002-2012) and had undergone relaparotomy <8 weeks following the initial surgery were reviewed. Descriptive data were generated and association with survival time was modelled using Cox proportional hazards models. Results Relaparotomy was performed in 96 horses at <8 weeks following initial surgery at a median of 4 days. This represented 6.3% of horses that underwent laparotomy during the study period (n = 1531). Relaparotomy was most frequently undertaken based on signs of persistent post-operative colic (76%; n = 73). Short-term survival for horses undergoing relaparotomy due to persistent colic was 53%, incisional dehiscence 50%, post-operative reflux 37%, haemoperitoneum 17% and septic peritonitis 0%. Median survival was 6 days for all horses undergoing relaparotomy and 778 days for those that recovered following anaesthesia. Nonsurvival was associated with increased packed cell volume at 24 h following initial laparotomy (hazard ratio [ HR] 1.06, 95% confidence interval [ CI] 1.04-1.10, P = 0.009), peritonitis as a reason for undertaking relaparotomy ( HR 4.41, 95% CI 1.43-13.6, P = 0.01) and adhesions found at relaparotomy ( HR 1.77, 95% CI 1.03-3.04, P = 0.04). Increased likelihood of survival was associated with colic signs being the reason for performing relaparotomy ( HR 0.48, 95% CI 0.26-0.88, P = 0.02) and small intestinal distension found at relaparotomy ( HR 0.53, 95% CI 0.29-0.96, P = 0.04). Conclusions This study has provided information about survival rates and risk factors for survival in horses undergoing relaparotomy that can assist clinicians and owners when determining whether to perform relaparotomy and in predicting the likely surgical outcome. [ABSTRACT FROM AUTHOR]

Reasons for performing study Surgical site infection ( SSI) is an important cause of post operative morbidity following laparotomy. Objectives To investigate risk factors for SSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns. Study design Retrospective cohort study. Methods Data were obtained from horses that had undergone exploratory laparotomy over a 3-year period (2010-2013) in a UK hospital population. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre-, intra- and post operative variables and altered likelihood of SSI. Results Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [ OR] 1.002, 95% confidence interval [ CI] 1.0002-1.005, P = 0.03), increased packed cell volume (≥48%) on admission ( OR 3.03, 95% CI 1.32-6.94, P = 0.01), small intestinal resection ( OR 2.27, 95% CI 1.15-4.46, P = 0.02) and post operative colic ( OR 2.86, 95% CI 1.41-5.79, P = 0.003) were significantly associated with increased likelihood of SSI in a multivariable model. SSI was also significantly more likely to occur during winter ( OR 3.84, 95% CI 1.38-10.70, P = 0.01) and summer ( OR 5.63, 95% CI 2.07-15.3, P = 0.001) months in the model. Three-layer closure of the incision was protective ( OR 0.31, 95% CI 0.16-0.58, P<0.001) compared to 2-layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates were Escherichia coli (59.5%) , Enterococcus spp. (42.4%) and Staphylococcus spp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant. Conclusions Laparotomy during winter and summer months was associated with increased likelihood of SSI but there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk of SSI and informing development of preventive strategies. [ABSTRACT FROM AUTHOR]

This report describes the case management, histopathological and post mortem findings in a 23-year-old gelding with a peri-rectal mass. The mass was debulked surgically and submitted samples revealed it to be a poorly differentiated carcinoma. In the post operative period the horse developed signs of abdominal pain and dysuria and was subjected to euthanasia. Post mortem examination revealed a large infiltrative mass located between the rectum and urethra, consistent with a carcinoma of an accessory genital gland, most likely the seminal vesicle. [ABSTRACT FROM AUTHOR]

Reasons for performing study Risk factors for large colon volvulus ( LCV) in the horse have not been previously reported. Knowledge of these risk factors may allow the introduction of measures that could be taken to minimise the incidence of LCV. Objectives To investigate risk factors for LCV in the horse. Methods A prospective, multicentre, unmatched case-control study was conducted over a 24 month period in the UK. Data on 69 cases and 204 control horses, from 4 veterinary hospitals, were obtained via telephone questionnaires. Multivariable logistic regression was used to identify associations between horse and management-level variables and the likelihood of LCV. Results Increasing height, multiple colic episodes in the previous 12 months and mares, with a greater odds ratio in mares that had previously foaled, were associated with increased risk of LCV. Receiving medication (excluding anthelmintic treatment) in the previous 7 days and quidding behaviour were also associated with increased risk. Management-level variables associated with greater risk of LCV were an increase in the hours of stabling in the previous 14 days, an increasing number of horses on the premises, and 3 or more people involved in the horse's care. Variables related to nutrition associated with increased risk of LCV were being fed hay, being fed sugar-beet, a change in pasture in the previous 28 days, and an alteration in the amount of forage fed in the last 7 days. Conclusions This study has identified factors that may assist in the recognition of horses with increased risk of LCV and factors that might be altered to minimise the incidence of LCV. Potential relevance Clinicians can use this information to identify horses at risk of LCV and to provide evidence-based advice to owners of these horses. [ABSTRACT FROM AUTHOR]

Reasons for performing study There is limited information about risk factors and survival associated with disorders of the small colon requiring surgical management. Objectives 1) To document the types of surgical lesion in horses where pathology of the small (descending) colon was the primary cause of abdominal pain, 2) to describe the short- and long-term survival of these cases and identify factors associated with survival and 3) to identify preoperative variables associated with localisation of a lesion to the small colon. Methods Clinical data and long-term follow-up were obtained for horses that underwent exploratory laparotomy over a 10-year period. Descriptive data were generated for short- and long-term survival and survival analysis performed to identify factors associated with reduced survival. Univariable and multivariable relationships were explored using a Cox proportional hazards model. Preoperative factors associated with increased likelihood of a small colon lesion were explored, using controls randomly selected from horses undergoing exploratory laparotomy for treatment of colic unrelated to the small colon. Results The study population included 84 horses. Of horses with small colon lesions recovered from anaesthesia, the percentage that survived until discharge, one year and 2 years following surgery, was 91.0, 81.0 and 73.5%, respectively. Median survival time for horses in which a resection had been performed was 1029 vs. 3072 days in the nonresection group. Small colon cases were more likely to have shown a longer duration of colic signs prior to admission ( P<0.001) and to develop post operative diarrhoea ( P = 0.001) when compared with surgical controls. Conclusions Lesions of the small colon carry a good prognosis for survival following surgery. Resection and anastomosis was the only factor associated with reduced long-term survival. Potential relevance This study provides information about lesion types and post operative survival that may be used to assist informed decision-making when managing these cases. [ABSTRACT FROM AUTHOR]

Lipomatosis is an uncommon cause of colic. This case report details the pre- and intraoperative findings of a 9-year-old gelding, presented with acute abdominal pain. Exploratory laparotomy revealed a massive fatty infiltrate involving an extensive portion of the base and mid-body of the caecum. To the authors' knowledge, this is the first report of an infiltrative lipomatous lesion of the equine caecum. [ABSTRACT FROM AUTHOR]

Reasons for performing study: The pattern of long-term survival and specific factors associated with long-term survival have not previously been evaluated in horses with a strangulating large colon volvulus (LCV). Objectives: To provide data on the long-term survival of horses with LCV and to identify pre-, intra- and post operative variables associated with survival. Methods: Clinical data and long-term follow-up information were obtained from 116 horses with a strangulating LCV (≥360°) undergoing general anaesthesia. Two multivariable Cox proportional hazards models for post operative survival time were developed: Model 1 included all horses and evaluated preoperative variables and Model 2 included horses that survived anaesthesia and evaluated pre-, intra- and post operative variables. Results: The study population comprised 116 horses. Eighty-nine (76.7%) survived general anaesthesia. Of these, the percentage that survived until discharge, to one year and to 2 years was 70.7%, 48.3% and 33.7%, respectively. Median survival time for horses that survived general anaesthesia was 365 days. In Model 1 increased preoperative packed cell volume (PCV) was significantly associated with reduced post operative survival (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.05-1.11). However, this effect changed over time. In Model 2 abnormal serosal colour intraoperatively (HR 3.61, 95% CI 1.55-8.44), increased heart rate at 48 h post surgery (HR 1.04, 95% CI 1.02-1.06), and colic during post operative hospitalisation (HR 2.63, 95% CI 1.00-6.95), were all significantly associated with reduced post operative survival. Conclusions: Survival time in horses with a LCV was associated with preoperative PCV, serosal colour, heart rate at 48 h post operatively and colic during post operative hospitalisation. Potential relevance: This study provides evidence-based information on the long-term survival of horses with LCV and identifies parameters that may assist decision-making by clinicians and owners. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the clinical examination for chronic persistent colic. The author states that chronic intussusceptions should be considered as a differential diagnosis in the examination of chronic colic case. He says that serial evaluation of peritoneal samples can provide information to diagnose the said disease. He notes that chronic persistent colic was caused by colocolic intussusceptions which is difficult to diagnose without laparotomy recourse.