Gastric and Large Colon Impactions Combined With Aggressive Enteral Fluid Therapy May Predispose to Large Colon Volvulus: 4 Cases

To resolve large colon impactions, frequent enteral administration of large volumes of water (8-10 liters in a 500 kg horse) has been suggested. Furthermore, in large colon volvulus, the simultaneous presence of gastric impaction has been described as a possible predisposing factor. To describe the clinical and surgical features of horses with large colon volvulus associated with aggressive enteral fluid therapy performed to resolve an initial large colon impaction. Records of horses that underwent exploratory laparotomy at the Veterinary Teaching Hospital of Turin between 2012-2019 were reviewed. Clinical and surgical features of cases initially diagnosed with large colon impaction that developed a large colon volvulus after enteral administration of large volumes of fluids were retrieved. Four horses met the criteria. In all horses an initial diagnosis of large colon impaction was made by the referring veterinarian. In all cases a sudden increase in pain was noticed shortly after enteral administration of large volumes (8-10 liters) of water. Administration of analgesic didn't resolve the pain in any of the horses that were then referred. A large colon volvulus was found during exploratory laparotomy in all cases. A moderate gastric impaction was also found intraoperatively, which was confirmed by gastroscopy postoperatively. Nasogastric administration of large quantity of fluids with a pre-existing gastric and colon impaction, may reduce the available space in the abdominal cavity and potentially predispose the colon volvulus. More frequent enteral administration of smaller volumes of fluids might be preferred when treating large colon impactions.