Gastric Impaction in a QuarterHorse Gelding

History

Matthew was a 10 year old QuarterHorse gelding that presented to SWEH for evaluation of his poor appetite and reduced manure production.  He had been increasingly uninterested in food for three days prior to his arrival.  He had been treated in the field 2 days prior by the referring veterinarian for suspected gastric ulcers or mild colic, but there was no improvement in his appetite despite Banamine, nasogastric intubation with mineral oil and water, and anti-ulcer medication.  Additionally, he had not passed manure for 24 hours. He never acted overtly colicky or uncomfortable. Matthew had no history of exposure to toxic plants or substances, and was up-to-date on vaccinations.  He had no history of any illness.

Upon presentation, Matthew was quiet alert and responsive. He had normal vital signs, but his intestinal sounds were quiet in all quadrants. No sand was ausculted.  Bloodwork was within normal limits (no signs of anemia or infection) except for a mildly elevated total bilirubin – most likely associated with anorexia (not eating).

Matthew was sedated to allow for a thorough oral examination and other necessary diagnostics.

• Oral Examination:  A speculum was used to perform a thorough oral exam.  No foreign bodies, ulcerations, abscesses, or masses were seen in the oral cavity.  There were no dental abnormalities noted that may be causing his inappetence.
• Rectal Examination:  A small amount of pasty, mineral oil covered feces was present in the rectum.  The GI tract was empty on palpation, and no other abnormalities were palpable.
• Abdominal Ultrasound:  There was small intestine visible in the inguinal region that was contracting normally and the stomach was enlarged and full of ingesta. No masses or internal abscesses were seen. The diaphragm was intact (no evidence of a hernia).  No abnormalities were present in the liver, spleen or kidneys.
• Gastric Endoscopy:  The upper airway was evaluated and found to be within normal limits (no swelling or inflammation in the throat).  The upper esophagus was normal; however there was feed material in the lower esophagus obscuring the entrance into the stomach, so the stomach could not be evaluated (so his stomach was full despite the fact that he had not been eating for several days).
• Nasogastric Intubation:  A tube was passed into the lower esophagus and stomach. A large amount of non-rancid, thick feed material was lavaged out with 100L (25gal) of water in small volume increments (4-6L at a time).
• Repeat Gastric Endoscopy:  Matthew was placed in a stall with a muzzle for 3 hours, and repeat endoscopy performed. Feed material was still lodged at the lower esophagus and his stomach was still full of feed. The gastric lavage was repeated and more thick feed material that was rancid-smelling was removed from the stomach until the water ran clear (an additional 100 L lavage).

Based upon the history and endoscopy, Matthew was diagnosed with a Gastric Impaction  

TREATMENT:  Coca-Cola, Lavage, and Scope!

Water and antacid were left in the stomach overnight to attempt to soften any feed in the stomach.  Endoscopy was repeated the next morning, but the camera still could not be passed into the stomach.  Therefore, gastric lavages were repeated to remove any loose feed material, and water and 3 cans of Coco-cola were left in the stomach to break up the impaction.  Lavages continued every 3 hours that day and overnight, although they were minimally productive.  The next evening, the scope could be passed into the stomach revealing a large ball of hardened feed material (called a phytobezoar).

Matthew was started on the anti-ulcer medications. He was started back on feed, only allowed to eat well-soaked pellet mashes.  Once we removed all the old rancid feed from his stomach and started treatment for his ulcers, he had a fantastic appetite. He was discharged from the hospital with instructions to feed soaked pellet mashes for 4 weeks then gradually transitioned back to hay. He did well and did not have recurrence of the impaction.

EDUCATION:

Inappetence in the horse is always abnormal and should be promptly evaluated.  Not all horses with intestinal problems will show classic colic signs of pawing, laying, down or rolling.  Horses with gastric impactions tend to feel chronically “full” and disinterested in feed and rarely show typical colic signs.

Gastric impactions (impactions of the stomach) are a relatively common cause of inappetence in horses (we see gastric impactions every month at Southwest Equine). They occur less frequently than impactions in the large or small intestine, but they are often more difficult to treat because they tend to have been going on for several days before anyone notices there is a problem (vs a painful colic that is usually found within hours).

Anything that delays gastric emptying can result in gastric impactions, this includes ulceration or inflammation of the stomach, gastrointestinal infections, poorly digestible forage, dehydration, etc.  Affected horses most commonly present with reduced or no appetite or interest in feed.  They can also present with chronic, recurrent mild colic, or acute and painful colic depending on the degree of impaction and the primary cause.  Left untreated, the stomach may spontaneously rupture.  In the past, most gastric impactions were diagnosed at the time of surgery, but with more endoscopy and ultrasound being performed, we can now often diagnose this issue before it becomes too severe or before surgery is performed unnecessarily.

Caught early, these can be successfully treated medically with frequent (every 3hr), aggressive (70-100L) gastric lavages.  The acidity and carbonation in coca-cola has been shown to help break up these hard balls of feed, therefore coke, water, and surfactant is left in the stomach in between lavages to soften the ball.  Once the impaction has been eliminated, it is important to fully evaluate the stomach for any underlying issues affecting motility (masses, strictures, ulcers).  Horses with gastric impactions should be fed frequent small meals of soaked, small fiber size pellets for 4-6 weeks (until the stomach has time to heal and regain normal motility).  Encouraging excellent hydration and treating any known underlying causes are important in preventing recurrence.

Take away note: please call your veterinarian immediately if your horse doesn’t finish a meal!  If he/she has not eaten in over 24hrs it is recommended to have an ultrasound of the abdomen to check the size of the stomach as stomach tubing alone is not usually sufficient to determine if your horse has an impaction in the stomach.