1. Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=tnzv20
Download by: [University of Liverpool] Date: 17 February 2016, At: 04:02
New Zealand Veterinary Journal
ISSN: 0048-0169 (Print) 1176-0710 (Online) Journal homepage: http://www.tandfonline.com/loi/tnzv20
Right dorsal displacement of the large colon as
a cause of surgical colic in three foals in New
Zealand
SE Hennessy & BSL Fraser
To cite this article: SE Hennessy & BSL Fraser (2012) Right dorsal displacement of the large
colon as a cause of surgical colic in three foals in New Zealand, New Zealand Veterinary
Journal, 60:6, 360-364, DOI: 10.1080/00480169.2012.694406
To link to this article: http://dx.doi.org/10.1080/00480169.2012.694406
Accepted author version posted online: 18
May 2012.
Published online: 21 Aug 2012.
Submit your article to this journal
Article views: 174
View related articles
Citing articles: 1 View citing articles

2. Clinical Communication
Right dorsal displacement of the large colon as a cause of surgical colic in
three foals in New Zealand
SE Hennessy*x
and BSL Fraser{
Abstract
CASE HISTORY: Over a 3-year period between July 2008 and
July 2011, 10 exploratory laparotomies were performed on foals
in a Waikato referral facility in New Zealand.
CLINICAL FINDINGS: Right dorsal displacement of the large
colon (RDDLC) was identified during four exploratory
laparotomies in three foals that presented for mild-to-moderate
colic that was non-responsive to medical management. One foal
required a repeat laparotomy 7 weeks post initial surgery, and
RDDLC was again diagnosed.
DIAGNOSIS: Right dorsal displacement of the large colon in
foals.
CLINICAL RELEVANCE: Further investigation may identify
risk factors or management practices contributing to this
condition. This is an important and uncommonly reported
cause of surgical colic in foals, that is also important to consider
in non-responsive medical colic cases that do not appear to be
associated with severe pain, but may still require prompt
surgical intervention to avoid a strangulating obstruction. The
incidence of the condition in one Waikato referral facility
appears higher than what could be expected based on the
current literature.
KEY WORDS: Colic, foal, gastrointestinal, abdominal, surgery,
neonatal, displacement
Introduction
The most common causes of surgical colic in foals less than 6
months include enteritis, intussusception, ascarid impactions,
small intestinal volvulus, ileus and strangulated hernias (Cable
et al. 1997; Barton 2006; Weese 2008). Small intestinal disease is
reported worldwide as the most common finding on exploratory
laparotomy with only a 14% (17/119) incidence of large
intestinal disease as a cause of surgical colic in neonatal and
suckling foals reported (Cable et al. 1997). Other studies classify
large intestinal displacements as a cause of colic in young foals as
less common (Bernard 2004) to rare (Barton 2006).
Right dorsal displacement of the large colon (RDDLC) occurs
when the pelvic flexure and left colon migrate into the right
abdominal quadrant, between the caecum and the right body wall
(Rakestraw and Hardy 2006). It has been suggested that foals do
not suffer from large intestinal displacements as commonly as
adults since fermentation in the large intestine has not reached its
mature capacity, while the foal continues to suckle the mare
(Bernard 2004). The degree of pain is not as severe as for
strangulating lesions, usually described as mild-to-moderate
(Bernard 2004) with a distended abdomen due to large intestinal
gas build up. Severity of pain and abdominal distension are
indicators of the need for surgery in foals (Bryant and Gaughan
2005), and as these foals do not improve significantly with pain
relief and sedation and continue to distend, surgery is advised
before a large intestinal volvulus develops.
The purpose of this paper is to highlight the occurrence of
RDDLC as a cause of colic in young foals in the Waikato region
and to describe its presentation as seen in four surgical cases in
three foals.
Case history
The records of all foals (56 months old) treated surgically for
colic over a 3-year period were obtained (July 2008 to July 2011)
from a single Waikato equine surgical referral facility. Ten
exploratory laparotomies were performed, in eight foals, with the
following findings: four surgeries diagnosed RDDLC, three
surgeries diagnosed jejunal intussusceptions (one case with
concurrent ascarid impaction), two surgeries diagnosed jejunal
volvulus, and one surgery diagnosed post-operative adhesions
leading to non-strangulating small intestinal obstruction.
Case 1
Case 1 with RDDLC was a 3-week-old 94 kg Thoroughbred filly
presentedforcolicofseveral hours’duration,witha heartrateof 116
bpm and displaying mild-to-moderate signs of colic. The foal had
reduced abdominal gut sounds, with no nasogastric reflux present.
Case 2
Case 1 re-presented 7 weeks post surgery, aged 10 weeks and
weighing 158 kg, with moderate signs of colic and abdominal
distension of 3-h duration. Heart rate was 104 bpm, with
petechial haemorrhages noted on the mucous membranes. The
colic episode had dramatically worsened in the hour before referral
with increasing heart rate and rolling noted, despite on-farm
administration of flunixin meglumine (Flunix Injection, Bomac* University of Melbourne, Equine Centre, 250 Princes Highway, Werribee,
Victoria 3030, Australia.
{
Cambridge Equine Hospital, PO Box 488, 71 Racecourse Road, Cambridge
3450, New Zealand.
x Author for correspondence. Email: simonhennessy@hotmail.com RDDLC Right dorsal displacement of the large colon
New Zealand Veterinary Journal 60(6), 360–364, 2012360
Downloadedby[UniversityofLiverpool]at04:0217February2016

3. Laboratories Limited, Manukau City, NZ). There had been no
history of colic since previous surgery.
Case 3
Case 3 with RDDLC was a 4-week-old 107 kg Thoroughbred
filly presented with mild-to-moderate colic, with flank kicking
and occasional rolling. The foal’s heart rate was 124 bpm, with a
rectal temperature of 38.88C. The filly was described as showing
signs of abdominal discomfort over the previous 3 days. A
thickened umbilicus was believed to be the cause of the problem
and had been treated for 2 days with oral trimethoprim
sulphonamide paste (Sulpha T, Caledonian Holdings New
Zealand, Takanini, Auckland, NZ) (30 mg/kg BW twice daily).
Case 4
Case 4 with RDDLC was a 6-week-old Thoroughbred colt
presented for persistent abdominal pain and moderate abdominal
distension. The foal had been seen by the referring veterinarian
6 h earlier and despite intravenous flunixin meglumine (Flunix
Injection, Bomac Laboratories Limited, Manukau City, NZ)
(1.1 mg/kg BW) had not improved. Heart rate at presentation
was 112 bpm, but within 2 h had deteriorated to 136 bpm, with
more obvious signs of colic such as rolling and increased
abdominal distension.
Clinical findings
Case 1
Abdominal ultrasound of Case 1 revealed moderately distended
small intestine, and gas distended large colon. Due to increasing
severity of colic and abdominal distension, despite treatment with
ketoprofen (Key Injection, Parnell Technologies New Zealand
Limited, Auckland, NZ) (1.1 mg/kg BW) prior to referral, in
addition to xylazine hydrochloride (Xylase 100, Bomac Labora-
tories Limited, Manukau City, NZ) (0.6 mg/kg BW) and
butorphanol tartrate (Torbugesic, Fort Dodge Australia, Baulk-
ham Hills, NSW 2153, Australia) (0.01 mg/kg) during clinical
examination, exploratory laparotomy was advised.
Case 2
Abdominal ultrasound of Case 2 during the repeat colic episode, also
revealed distended small intestine and obvious colonic wall oedema.
The filly had not been seen to nurse in 6–8 h and appeared mildly
dehydrated (3–5%), with decreased abdominal gut sounds. Xylazine
(Xylase 100, Bomac Laboratories Limited, Manukau City, NZ)
(0.6 mL/kg BW) and butorphanol (Torbugesic, Fort Dodge
Australia, Baulkham Hills, NSW 2153, Australia) (0.01 mg/kg
BW) sedation managed to reduce signs of discomfort only briefly.
Surgery was again recommended due to deteriorating colic signs.
Case 3
Abdominal ultrasound of Case 3 revealed mildly distended small
intestine, with mild colonic wall oedema. Umbilical artery and
vein diameters were both greater than 1 cm with an enlarged
urachus, indicative of infection. Flunixin meglumine (Flunix
Injection, Bomac Laboratories Limited, Manukau City, NZ)
(1.1 mg/kg BW I/V) failed to improve the acute colic and
abdominal distension continued. Clinical signs of moderate
abdominal pain continued despite xylazine (Xylase 100, Bomac
Laboratories Limited, Manukau City, NZ) (0.6 mL/kg BW) and
butorphanol (Torbugesic, Fort Dodge Australia, Baulkham Hills,
NSW 2153, Australia) (0.01 mg/kg BW) sedation, prompting
surgical intervention.
Case 4
Abdominal ultrasound of Case 4 was performed initially and
revealed mildly distended small intestine. The owners opted for
medical treatment with intravenous sterile polyionic fluids
(Compound Sodium Lactate Intravenous Infusion, Baxter
Healthcare Pty.Ltd., Old Toongabbie NSW 2146, Australia)
(8 mL/kg/h), sedation with xylazine (Xylase 100, Bomac
Laboratories Limited, Manukau City, NZ) (0.6 mL/kg BW)
and butorphanol (Torbugesic, Fort Dodge Australia, Baulkham
Hills, NSW 2153, Australia) (0.01 mg/kg BW) and analgesics
(ketoprofen (Key Injection, Parnell Technologies New Zealand
Limited, Auckland, NZ) (1.1 mg/kg BW)whilst preventing
suckling and monitoring for deterioration. Within 2 h both
abdominal distension and signs of colic had worsened, with an
increased heart rate and rolling. Surgical intervention was then
requested.
Surgical approach
All foals diagnosed with RDDLC were aged between 3 and 10
weeks. Routine haemogram and biochemistry bloods were
taken on presentation. Intravenous catheters were placed in an
aseptic fashion and sterile polyionic fluids (Compound Sodium
Lactate Intravenous Infusion, Baxter Healthcare Pty.Ltd., Old
Toongabbie NSW 2146, Australia) were given pre and intra-
operatively (8 mL/kg/h). All foals were pre-medicated with
xylazine (Xylase 100, Bomac Laboratories Limited, Manukau
City, NZ) (0.8 mg/kg BW), procaine penicillin (Depocillin,
Schering-Plough Animal Health Limited, Upper Hutt, NZ)
(22 mg/kg BW twice daily IM) and gentamicin (Gentavet
100, Bomac Laboratories Limited, Manukau City, NZ)
(6.6 mg/kg BW once daily I/V) and general anaesthesia was
induced using ketamine (Ketaset, Parnell Technologies New
Zealand Limited, Auckland, NZ) (2.2 mg/kg BW) and
diazepam (Pamlin Injection, Parnell Technologies New
Zealand Limited, Auckland, NZ) (0.1 mg/kg BW) I/V.
Anaesthesia was maintained with halothane (Halothane Vet,
Piramal Healthcare Limited, Mumbai 400 013, India) in
oxygen on a semi-closed circle system. The ventral abdomen
was clipped and aseptically prepared using 4% chlorhexidine
solution (Hibitane, Schering-Plough Animal Health Limited,
Upper Hutt, NZ), followed by isopropyl alcohol. Sterile
disposable human abdominal incise drapes were applied. A
ventral midline incision was created through the linea alba
starting at the umbilicus and extending as required craniad.
Following surgery the linea alba was closed with a simple
continuous suture of 0 polyglactin 910 (Vicryl1, Ethicon
Inc., Somerville NJ 08876, USA). The subcutaneous tissue
was closed using 2-0 poliglecaprone 25 (Monocryl1, Ethicon
Inc.), and the skin was closed in a simple continuous pattern
with nylon (Ethilon, Ethicon Inc., Somerville NJ 08876, USA)
suture. A stent bandage was sutured, using nylon (Ethilon,
Somerville) suture over the incision, and left in place for up to
48 h depending on contamination. Unless otherwise stated
procaine penicillin (Depocillin, Schering-Plough Animal Health
Limited, Upper Hutt, NZ) (22 mg/kg BW twice daily I/M)
and gentamicin (Gentavet 100, Bomac Laboratories Limited,
Manukau City, NZ) (6.6 mg/kg BW once daily I/V) and
ketoprofen (Key Injection, Parnell Technologies New Zealand
Limited, Auckland, NZ) (1.1 mg/kg BW once daily I/V) were
continued post-operatively for 3 days.
Hennessy and Fraser New Zealand Veterinary Journal, 2012 361
Downloadedby[UniversityofLiverpool]at04:0217February2016

4. Case 1
In Case 1 abdominal exploration revealed marked distension of
the large colon caused by RDDLC. The colon was needle
decompressed of gas using an 18-gauge needle tunnelled in the
submucosa attached to a suction unit, and the pelvic flexure was
replaced in the correct orientation. The small intestine was
decompressed to the caecum with no further abnormalities
detected. The caecum was then needle decompressed using the
previously described technique.
Case 2
On repeat exploratory laparotomy in Case 1, the abdomen was
entered via the previous midline incision, and the peritoneum pre-
treated with 500 mL of 1% solution of sodium carboxy-methyl
cellulose. Marked distension of the large colon was evident with
marked petechial haemorrhage of the serosa and moderate mural
oedema. Exploration confirmed that the colon was displaced again to
the right side and it had begun to twist on itself through 1808 at the
sternal and diaphragmatic flexures. Mild non-specific small intestinal
distension was present presumably resulting from a secondary ileus.
The pelvic flexure was replaced in correct orientation and the small
intestinal contents were decompressed into the caecum, followed by
needle decompression of both colon and caecum of free gas, as
describedpreviously.Theabdominalcontents were copiouslylavaged
and replaced, followed by peritoneal lavage and routine closure of the
abdomen. The foal recovered without incident and showed no signs
of colic post surgery. Intravenous fluids (Compound Sodium Lactate
Intravenous Infusion, Baxter Healthcare Pty. Ltd., Old Toongabbie
NSW 2146, Australia) were continued at 4 mL/kg/h until the foal
began nursing.
Case 3
In order to maintain an aseptic technique in Case 3, the infected
umbilicus was removed initially. An elliptical incision was made
around the umbilicus and continued into the abdomen. The
umbilical vein was ligated and transected allowing visibility of a
severely haemorrhagic and oedematous urachus and cranial
bladder. The two umbilical arteries were ligated, using 2-0
poliglecaprone 25 (Monocryl1, Ethicon Inc.) and resected before
placing stay sutures in the normal bladder tissue. The urachus and
affected bladder tissue were resected and the bladder closed in two
layers of inverting sutures, using 2-0 poliglecaprone 25 (Mono-
cryl1, Ethicon Inc.). The abdomen was lavaged and explored
revealing a RDDLC. The large colon was severely distended, and
was decompressed using an 18-gauge needle tunnelled in the
submucosa as described previously. The displacement was
corrected and replaced in normal orientation. The abdomen was
investigated and closed routinely.
Case 4
Upon entering the abdomen in Case 4, the large colon was markedly
distended due to a right dorsal displacement of the large colon. The
colon was needle decompressed, using an 18-gauge needle tunnelled
through the submucosa, and replaced in the correct orientation. The
smallintestinewasexaminedanddecompressedtothecaecumandno
other abnormalities were detected. Abdominal closure was routine,
and the foal recovered without any complications.
Post-operative management
Case 1
The foal in Case 1 was allowed to nurse as soon as it showed
interest in the mare and did not colic again during this period.
Due to the presence of on-farm veterinary nurses, the foal was
discharged within 2 days of surgery.
Case 2
Post repeat laparotomy the foal was allowed to nurse from 8 h
post surgery. Ceftiofur sodium (Calefur, Caledonian Holdings
New Zealand, Takanini, Auckland, NZ) (5 mg/kg BW IM twice
daily) was given pre-operatively and continued for 3 days post-
operatively. Ketoprofen (Key Injection, Parnell Technologies
New Zealand Limited, Auckland, NZ) was also given at 1.1 mg/
kg BW twice daily for 3 days, reducing to 1.1 mg/kg BW once
daily for another 3 days. The foal was again discharged within 2
days of surgery. The owners were warned of potential recurrence
of displacement and adhesion development.
Cases 3 and 4
Cases 3 and 4 were allowed to nurse at 8 h post surgery and were
discharged 3 days post surgery.
Results
Cases 1 and 2
After 18 months post second surgery, signs of colic recurred,
with abdominal distension and rolling, and the horse was
euthanised. Post-mortem examination showed RDDLC and
substantial generalised adhesion formation of the small intestine,
with occasional adhesions also noted to the caecum and
body wall, resulting in non-strangulating small intestinal
obstruction.
Case 3
The owners were contacted via telephone 18 months post-
operatively, and the foal was described as being a normal rising 2-
year-old entering into training, with no more incidences of colic
being reported.
Case 4
The foal was released out to pasture 2 weeks post surgery and
developed mild diarrhoea, which was treated by the owners. The
owners were contacted via telephone 2 years post surgery and the
colt was described as a normal 2-year-old, preparing for future
training, with no other episodes of colic seen.
Discussion
In this study, RDDLC accounted for 40% (4/10) of all
exploratory laparotomies performed in foals less than 6 months
of age, in one Waikato referral facility over a 3-year period. In the
cases described in this series, three foals presented on four
occasions for mild-to-moderate colic of varying duration. In all
cases foals were described as flank watching, lying down and
occasionally rolling. Surgery was elected due to the duration of
clinical signs, failure to improve with sedation and analgesia, and
deteriorating abdominal distension. Prompt surgical treatment
resulted in 100% (4/4) of cases surviving to discharge and two of
the three (67%) foals survived long term (418 months.)
Foals with colic present quite a diagnostic challenge as clinical
signs can be more difficult to interpret, although colonic oedema
and changes in the topographical anatomy on ultrasound aid
diagnosis (Neal 2003). The literature describing colic in foals is
quite limited, with much emphasis being put on medical colic
362 New Zealand Veterinary Journal, 2012 Hennessy and Fraser
Downloadedby[UniversityofLiverpool]at04:0217February2016

5. (Wilkins 2004). Cable et al. (1997) reported only 14% (17/119)
of surgical cases of colic in foals were due to large intestinal
disease, including caeco-colic intussusceptions, pelvic flexure and
caecal impaction, colon volvulus and colon displacement.
RDDLC is a less common condition of the foal (Bernard
2004; Barton 2006). Vatistas et al. (1996) described three cases of
right dorsal displacement, in a study of 67 foals, with only one
case surviving long term. Adams et al. (1988) (20 cases) and
Cable et al. (1997) (119 cases) also described three cases each of
large colon displacement, where more drastic surgical interven-
tion, including resection and anastomosis of the large colon was
performed. None of the cases seen in the current study required
such severe intervention due to early surgical management of the
displacement, prior to volvulus development. In our population,
RDDLC in foals appears higher than what would be expected
based on the current literature, though no discussion with other
surrounding referral facilities as to the prevalence of RDDLC in
their practices has been carried out.
Several studies have examined surgical treatment of colic in foals
and published survival rates to discharge of 59% (49/83 cases;
Bartmann et al. 2002), 61% (73/119 cases; Cable et al. 1997)
and 63% (42/67 cases; Vatistas et al. 1996), and a long-term
survival rate of 57% (29/51 cases; Vatistas et al. 1996).
Strangulating lesions were associated with a much poorer long-
term prognosis (19%; 3/16 cases) than non-strangulating lesions
(69%; 25/36 cases; Vatistas et al. 1996.) Foals that undergo colic
surgery are less likely to race than their siblings, with only 63%
(111/175) of colic surgery survivors ever making it to the track, of
the 85% (175/206) of foals that survived in the short term
(Santschi et al. 2000). However, foals with non-strangulating
obstructions (96% short-term survival; 111/116) develop less
adhesions and race more frequently (70%; 78/111) versus those
with strangulating lesions (63% short-term survival; 26/41) who
raced less frequently in the long term (54%; 14/26) (Santschi
et al. 2000). In another study, 79% (27/34) of foals receiving
only intestinal manipulations during colic surgery survived,
whereas cases requiring intestinal resection had a poorer long-
term survival (Cable et al. 1997). Therefore our study suggests
that, early surgical intervention, prior to large intestinal volvulus
or severe tissue compromise is likely to result in a better
prognosis. All foals in this study had early surgical intervention
before the development of strangulating lesions which resulted in
a good long-term prognosis for two of the three foals.
The cause of right dorsal displacement in adult horses is
unknown (Hacket 2002), though the condition has been linked
with high-concentrate diets and parasitic migration (Wilkins
2004). Intestinal dysmotility due to a transient intestinal
inflammation or ileus is a possible cause of displacement in foals
(Wilkins, 2004). Cases seen in our study showed no consistent
history. Only in Case 3 was a painful and traumatised urachus
present which may have caused a localised ileus allowing the
pelvic flexure to fill with gas and displace. Further investigation
into the cause of this condition in foals as well as adults is
necessary in the future as a means of prevention. Areas to
consider include worm load of affected patients, the diet and
roughage of their feed, and any association of climate conditions.
In adult horses it is now widely recognised that treatment of right
dorsal displacement is possible medically, provided only mild
abdominal pain and minimal to moderate abdominal distension
exists (Rakestraw and Hardy 2006.) Medical treatment involves
I/V fluids, analgesia, exercise and withholding feed. In one study,
only 8 of 64 cases of suspected right dorsal displacement, in adult
horses, required surgical intervention when conservative therapy
was utilised (McGovern et al. 2008). I/V fluids and analgesia
were utilised, unsuccessfully, in one case in this study (Case 3).
In adult horses, repeat laparotomy for colics is required in
approximately 10% of cases; 27/254 cases were reported by Mair
and Smith (2005b) and 113/1,014 cases were reported by Gorvy
et al. (2008), with pathological adhesions, post-operative ileus
and anastomosis complications being the most common cited
diagnoses at re-laparotomy (Gorvy et al. 2008). Recurrence of
surgical colic post exploratory laparotomy for RDDLC in adults
is a noted complication with an incidence of 10.5–15%, with 3/
20 cases reported by Hance and Embertson (1992) and 9/86
cases reported by Smith and Mair (2010), while 42% (36/86) of
horses developed episodes of colic requiring veterinary assistance,
but not re-laparotomy, in one study (Smith and Mair 2010). No
information regarding recurrence of the condition in foals is
documented. In our study, only Case 1 had recurrent colic
requiring re-laparotomy, which was due to re-displacement.
Eighteen months later at necropsy the horse was again seen to
have developed a right dorsal displacement, as well as extensive
adhesions within the abdomen. Prevention of repeat displace-
ment can be achieved by colopexy or large colon resection. Large
colon resection is associated with an increased risk of post-
operative peritonitis, weight loss and poor water absorption, and
so should be reserved for severe cases (Hughes et al. 1997) and in
our opinion avoided in foals. Colopexy was considered in Case 2
as right dorsal displacement had recurred, but was decided against
as colopexy has not been described in foals. As foals have an
increased tendency to develop intestinal adhesions it was
surmised that a colopexy may lead to excessive adhesion
formation and create strangulating problems as the abdominal
viscera enlarge within the developing abdomen.
Following first laparotomy in foals, adhesions have been reported
to occur in 8% of cases (14/179) by Santschi et al. (2000), 10%
of cases (7/69) by Singer and Livesey (1997) and 16% of cases (8/
51) by Vatistas et al. (1996), with only 3.7% (4/109) of cases
with non-strangulating lesions developing adhesions (Santschi
et al. 2000). No information regarding repeat laparotomy in foals
is available, however, Mair and Smith (2005a) reported that 50%
(7/14) of adult horses which underwent re-laparotomy developed
adhesions. The efficacy of intra-peritoneal 1% sodium carbox-
ymethycellulose to act as a lubricant and a mechanical barrier
between intestinal serosal surfaces (Hay et al. 2001) is debatable.
One percent sodium carboxymethycellulose has been shown to
reduce the incidence of adhesion formation after abdominal
surgery in susceptible horses (Hay et al. 2001), however, the use
of 3% sodium carboxymethycellulose in foals with ischaemic
reperfusion injuries of the small intestine failed to prevent
adhesions (Sullins et al. 2004.) In our report, only Case 1
underwent repeat laparotomy, and no adhesions were present
from the previous surgery. Despite intraperitoneal pre-treatment
with 1% sodium carboxymethycellulose at second laparotomy,
adhesions occurred. As this foal had a non-strangulating, non-
ischaemic injury, intestinal manipulation or surgical trauma
appears to be the likely cause (Gorvy et al. 2008). The foal was
also treated with antibiotics and anti-inflammatories post surgery,
which, together with intravenous dimethylsulphoxide, Sullins
et al. (2004) found to be the most effective treatment to prevent
adhesions. Higher concentrations of sodium carboxymethycellu-
lose may have been more effective in preventing adhesion
Hennessy and Fraser New Zealand Veterinary Journal, 2012 363
Downloadedby[UniversityofLiverpool]at04:0217February2016

6. formation, however, such high concentrations (43%) are
associated with adverse effects (Fredericks et al. 1986; Peck and
Goldberg 2000). Minimal intestinal manipulation during surgery
may have contributed in preventing adhesion formation in Cases
3 and 4.
Results of our study showed that early and aggressive surgical
intervention in cases of RDDLC in foals seen at a single Waikato
referral facility was associated with a good short-term prognosis as
intestinal manipulation, strangulation and ischaemia were
minimised. The obvious limitation of this study is the low case
numbers, with only 10 exploratory laparotomies performed on
foals less than 6 months of age over a 3-year period. Co-operation
with other equine surgical referral facilities in the Waikato region
may increase the numbers of foals with RDDLC reported and
determine if RDDLC is a significant cause of colic in foals in this
area. However, surgical colic in foals is less common than in
adults (Cable et al. 1997) and RDDLC is also a less common
cause of colic in foals (Bernard 2004). Other studies that have
documented colon displacements in foals have had similarly low
numbers over longer time periods and in studies with much larger
surgery numbers (Adams et al. 1988; Vatistas et al. 1996; Cable
et al. 1997). The results from our referral facility in the Waikato
region suggest that RDDLC could be an important differential to
consider in any foal colic workup and merits further epidemio-
logical examination in this area in the future.
In conclusion, our experiences describe RDDLC as an important
differential cause of colic in foals with mild-to-moderate signs of
pain, and worsening abdominal distension. The poor documen-
tation of the condition in the literature, and the mild-to-
moderate clinical signs associated with RDDLC is in our opinion
likely to result in delayed surgical treatment of these foals. Our
experience at a single Waikato referral facility has been that
prompt surgical correction of the condition in these cases, before
deterioration to a more severe strangulating surgical lesion, such
as a large intestinal volvulus, has given good clinical results due to
the uncomplicated nature of the condition and the less surgical
manipulation required, though no comparison with conservative
therapy has been performed. Further work is necessary to identify
risk factors, especially within the Waikato region, associated with
RDDLC in foals, and to establish if colopexy is a safe preventive
measure against recurrence of the condition.
References
Adams R, Koterba AM, Brown MP. Exploratory celiotomy for gastrointestinal
disease in neonatal foals: a review of 20 cases. Equine Veterinary Journal 20, 9–
12, 1988
Bartmann CP, Freeman DE, Glitz F, von Oppen T, Lorber KJ, Bubeck K,
Klug E, Deegan E. Diagnosis and surgical management of colic in the foal:
literature review and a retrospective study. Clinical Techniques in Equine
Practice 1, 125–42, 2002
*Barton MH. Colic in the newborn foal. In: Paradis MR (ed). Equine Neonatal
Medicine. Pp 191–207, Elsevier, Philadelphia, USA, 2006
Bernard W. Colic in the foal. Equine Veterinary Education 16, 319–23, 2004
Bryant JE, Gaughan EM. Abdominal surgery in neonatal foals. Veterinary Clinics
of North America Equine Practice 21, 511–35, 2005
Cable CS, Fubini SL, Erb HE, Hawkes JE. Abdominal surgery in foals: a review
of 119 cases (1977–1994). Equine Veterinary Journal 29, 257–61, 1997
Fredericks CM, Kotry I, Holtz G, Askalani AH, Serour GI. Adhesion
prevention in the rabbit with sodium carboxymethylcellulose solutions.
American Journal of Obstetrics and Gynecology 155, 667–70, 1986
Gorvy DA, Edwards GB, Proudman CJ. Intra-abdominal adhesions in horses: a
retrospective evaluation of repeat laparotomy in 99 horses with acute
gastrointestinal disease. The Veterinary Journal 175, 194–201, 2008
*Hacket RP. Displacement of the large colon. In: Mair T, Divers T, Ducharme,
N (eds). Manual of Equine Gastroenterology. Pp 284–8. WB Saunders,
Edinburgh, Scotland, 2002
Hance SR, Embertson RM. Colopexy in broodmares: 44 cases (1986–1990).
Journal of the American Veterinary Medical Association 201, 782–7, 1992
Hay WP, Mueller POE, Harman B, Amoroso L. One percent sodium
carboxymethylcellulose prevents experimentally induced abdominal adhesions
in horses. Veterinary Surgery 30, 223–7, 2001
Hughes FE, Slone DE. Large colon resection. Veterinary Clinics of North America
Equine Practice 13, 341–9, 1997
Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing
surgical treatment of colic. Part 3: Long term complications and survival.
Equine Veterinary Journal 37, 310–4, 2005a
Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing
surgical treatment of colic. Part 4: Early (acute) relaparotomy. Equine
Veterinary Journal 37, 315–8, 2005b
*McGovern K, Fraser B, Bladon B. Conservative management of large colon
displacements in the horse. Proceedings of the 47th British Equine Veterinary
Association Congress. Liverpool, pp 254, 2008
Neal HN. Foal colic: practical imaging of the abdomen. Equine Veterinary
Education 15, 263–70, 2003
*Peck LS, Goldberg EP. ‘Adjunctive’ surgical trauma. In: diZerega G (ed).
Peritoneal Surgery. Pp 501–2. Springer-Verlag, New York, USA, 2000
*Rakestraw PC, Hardy J. Large intestine. In: Auer JA, Stick JA (eds). Equine
Surgery. 3rd Edtn. Pp 436–78, WB Saunders, St. Louis, USA, 2006
Santschi EM, Slone DE, Embertson RM, Clayton M, Markel MD. Racing
performance of Thoroughbred horses after colic surgery as juveniles: 206 cases.
Equine Veterinary Journal 32, 32–6, 2000
Singer ER, Livesey MA. Evaluation of exploratory laparotomy in young horses:
102 cases (1987–1992). Journal of the American Veterinary Medical Association
211, 1158–62, 1997
Smith LJ, Mair TS. Are horses that undergo an exploratory laparotomy for
correction of a right dorsal displacement of the large colon predisposed to post
operative colic, compared to other forms of large colon displacement? Equine
Veterinary Journal 42, 44–6, 2010
Sullins KE, White NA, Lundin CS, Dabareiner R, Gaulin G. Prevention of
ischaemia induced small intestinal adhesions in foals. Equine Veterinary Journal
36, 370–5, 2004
Vatistas NJ, Snyder JR, Wilson WD, Drake C, Hildebrand S. Surgical
treatment for colic in the foal (67 cases): 1980–1992. Equine Veterinary
Journal 28, 139–45, 1996
*Weese JS. The gastrointestinal system. In: McAuliffe SB, Slovis NM (eds). Color
Atlas of Diseases and Disorders of the Foal. Pp 79–131, WB Saunders,
Philadelphia, USA, 2008
*Wilkins PA. Disorders of foals. In: Reed SM, Bayly WM, Sellon DC (eds).
Equine Internal Medicine, 2nd Edtn. Pp 1381–431, WB Saunders, St. Louis,
USA, 2004
Submitted 30 August 2011
Accepted for publication 10 May 2012
First published online 18 May 2012
*Non-peer-reviewed
364 New Zealand Veterinary Journal, 2012 Hennessy and Fraser
Downloadedby[UniversityofLiverpool]at04:0217February2016