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Using feces characteristics as a criterion for the diagnosis of colic in the horse:
A clinical review of 207 cases

Article  in  Revue de Médecine Vétérinaire · January 2006

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Using fèces characteristics as a criterion for thé
diagnosis of colic in thé horse : a clinical review
of 207 cases
S. GONÇALVES12*, A. LEBLOND3, C. DROGOUL1 and V. JULLIAND1
1
Research Unit "Nutrition et Santé Digestive des Herbivores", ENESAD, Dijon, France.
2
Chambre d'Agriculture de Côte d'Or, Dijon, France,
3 Département Hippique et Unité Epidémiologie et Modélisation des Maladies Transmissibles, ENV Lyon, Marcy l'Etoile, France.
* Corresponding author : e-mail : s.goncalves@enesad.fr
The authors wish to thank those veterinarians who took part in thé study; their clinics are listed at thé end of thé article. Authors also acknowledge A. Roussel, N. Cohen and G.
Fosgate (Collège of Veterinary Medicine, Texas A&M Vniversity)for their scientific support and their help with thé manuscript.
SUMMARV
Objective - to assess thé characteristics of horse fèces as an ancillary dia-
gnostic procédure, for a better diagnosis of colic in thé horse .
Animais - 207 horses with digestive colic exarained in stables by practi-
cing veterinarians.
Procédure -from April 1999 to March 2001, 207 horses suffering from
digestive colic were thoroughly examined by veterinarians in Burgundy
(France). Thèse were asked to record thé différent symptoms, in order to
détermine thé type of colic and thé affected organs, and any information
relative to pain, to thé cardiovascular status, to thé palpation per rectum,
and to thé nasogastric intubation, as well as fécal characteristics as a new
criterion.
Résulte - thé usual clinical examination (pain, cardiovascular status, pal-
pation per rectum and nasogastric intubation) gave results in accordance
with observations in thé field and thé literature. Characteristics of fèces
significantly differed from obstructive colic to non obstructive, from fore-
gut-related colic. to ca;cum-related and colon-related, and from survivors to
non-survivors.
Conclusions and Clinical Relevance - Fécal characteristics appeared to
be one of thé most discriminating criteria during thé clinical examination of
a horse suffering from colic, by easily and quickly providing important
information on thé type and severity of thé colic and thé affected organ.
Keywords : horse - colic - fèces characteristics - clinical
examination - epidemiology.
Introduction
Due to thé horse's gastrointestinal tract anatomical and
physiologicalspecificities, colic, defined as abdominal pain
of digestive origin, is thé major digestive disease in equine
medicine [1, 2]. Différent parts of thé gastrointestinal tract
can be affected. The stomach, of small dimension and res-
tricted extension capacity, can be overloaded and dilated, as
thé cardiac orifice does not allow for food to reflux. The high
mobility of thé small intestine with ils high transit rate can
lead to torsion. The différent segments of thé intestinal tract
are loose, particularly thé voluminous colonie compart-
ments, and can easily be displaced[13]. Symptoms vary fol-
lowingthe affected organ, thé type and thé severity of thé
colic [22]. It is therefore essential for a veterinarian to dia-
Revue Méd. Vêt., 2006. 157, 1,3-10
î.
RÉSUMÉ
Les caractéristiques des fèces, critère de diagnostic des coliques
équines : une revue clinique de 207 cas. Par S. GONÇALVES, A.
LEBLOND, C. DROGOUL et V. JULLIAND.
Objectif - tester si les caractéristiques des fèces peuvent être un examen
complémentaire intéressant dans le diagnostic des coliques.
Animaux - 207 chevaux souffrant de coliques d'origine digestive, exa-
minés sur le terrain par des vétérinaires praticiens.
Matériel et méthodes - En Bourgogne, d'avril 1999 à mars 2001, des
vétérinaires praticiens ont réalisé un examen clinique complet sur 207 che-
vaux souffrant de coliques digestives. Ils ont dû décrire les différents symp-
tômes qu'ils observaient, afin de déterminer le type de coliques et l'organe
atteint. Ils ont également relevé des informations relatives à la douleur, au
statut cardio-vasculaire, aux résultats de la palpation per rectum et de l'in-
tubation nasogastrique, et aux caractéristiques des fèces.
Résultats - les résultats relatifs à l'examen clinique habituel (douleur,
statut cardio-vasculaire, résultats de la palpation transrectale et de l'intuba-
tion nasogastrique) ont confirmé ce qui était observé sur le terrain et dans la
littérature. Les caractéristiques des fèces ont été significativement diffé-
rentes entre les coliques obstructives et les coliques non obstructives, ainsi
qu'entre les coliques liées à l'Intestin Grêle, au caecum ou au colon ; les
caractéristiques des fèces ont également varié entre les chevaux qui ont sur-
vécu à leur colique, comparés à ceux qui sont morts.
Conclusions - Les caractéristiques des fèces apparaissent comme l'un
des principaux critères discriminants lors de l'examen clinique d'une
colique. Ce critère peut facilement et rapidement donner d'importantes indi-
cations sur les caractéristiques de la colique dont souffre un cheval (type,
sévérité, organe atteint).
Mots-clés : cheval - coliques - caractéristiques des fèces
- examen clinique - épidémiologie.
gnose accurately thé type of colic, in order to administer thé
appropriate treatment with minimum delay. This requires a
thorough clinical examination, which must be easily and
quickly performed in thé field.
Ancillary diagnostic techniques could help veterinarians in
their diagnosis. As part of an epidemiological study on colic
risk factors, we assessed thé clinical examination of horses in
colic and completed it with thé analysis of thé fèces. Fèces
characteristics hâve never been reported in thé literature. We
also decided to assess thé pertinence of such an analysis
during thé examination of a horse with colic, because fèces
are so easily observable.
This paper présents thé results of vêts' clinical examina-
tion of 207 horses suffering from colic. The aim was to test
fèces characteristics as a diagnostic aid.
 GONÇALVES (S.) AND COLLABORATORS

Material and Methods
Veterinarian and horse enrollment - The study was
conducted on thé equine population of Burgundy. Ail thé
equine and large animal practitioners in Burgundy were
contacted by mail ; 40 volunteered to take part and to sélect
and report equine colic cases.
The study was based on thé following définition of a colic
case : a horse suffering from abdominal pain of digestive ori-
gin [12, 15] and seen by a veterinarian involved in thé study.
Horses under 6 months, ponies less than 1.20 mètres in
height and donkeys were excluded from thé study. A similar
clinical form was provided to ail vêts involved to standardize
thé différent data collected on each colic case.
The clinical form - The form was designed:
- to describe quickly thé horse suffering from colic (main
intrinsic factors),
- to establish a putative diagnosis and predict thé outcome,
- to describe ail of thé symptoms observed by thé veterina-
rian during thé clinical examination (table I),
- and to describe precisely thé characteristics of thé fèces
(table I).
Intrinsic factors ofhorses - Sex (mâle, female, gelding),
âge (quantitative variable) and breed were recorded.
Putative diagnosis - Veterinarians were asked to establish,
a définitive diagnosis, when possible, by selecting thé type
of colic in thé clinical form :
- non obstructive colic : spasmodic colic or other,
- obstructive colic : non strangulated (stasis, enterolith,
simple displacement or other) or strangulated (torsion, vol-
vulus, intussusception, hernia ...).
When possible, veterinarians had to specify thé affected
organ(s) and digestive segment probably involved: stomach,
small intestine, caecum or colon.
Clinical examination criteria - A review of data in thé
literature highlighted différent criteria commonly used in a
thorough clinical examination to characterize thé type of
colic. Veterinarians had to record information relative to
physical criteria, classified into 4 catégories by SINGER and
SMITH [17] : pain, cardiovascular status, results of palpa-
tion per rectum and results of nasogastric intubation.

Bodily status : Q Normal a More Less

Récent loss of weight : G Yes aNO

Intensity ofpain : G Depressed
G Looking at ils flanks
G Abnormal positions
G Rolling on thé floor

Duration ofpain : Q<2h a 2 to 6 h 7 to 24h Q>24h

Mucous colour : Q Red Purple a Pale

Heart rate :

Rectal température :

Palpation per rectum : Q Yes aNO

Results :

Fèces characteristics :

Consistancy : G Normal G Cow-type G Diarrheic G Small and dried-up

Présence of foreign bodies : G Yes G No

\Vhich forcitzn bodies : G Sand Q Parasites G Mucus G Other •

Colour : G Normal G Black G Bloody G Discoloured & yellow

Présence of grains : G Yes G No

Présence of straw : G Yes G No

Quantity of fèces : G Normal G More than ordinarily Q Less than ordinarily

Moment of thé last fèces : G<2h G 2 to 6h G 7 to 24h G > 24h

Nasogastric sonde : G Yes G No

Quantity of reflux : GOL G<5L G>5L

TABLE I. — Clinical form designed to describe thé symptoms and thé characteristics of thé fèces.

Revue Méd. Vêt., 2006,157, 1, 3-10

A CRITERION FOR THE DIAGNOSIS OF COLIC IN THE HORSE
Pain is often due to an intestinal distension or mesenteric
tension [17]. Veterinarians were required to note its intensity,
using a scale based on thé posture and behavior of thé horse,
and its duration; thèse 2 criteria are known to give informa-
tion on thé severity of thé colic [17, 18].
Criteria indicative of shock and cardiovascular function
were recorded. Heart rate, rectal température and mucous
membrane colour hâve been shown to be correlated to thé
severity of colic [17, 18].
Palpation per rectum is a good forecaster for thé location
of thé colic : it can give useful indications on anatomical
abnormalities in thé caudal abdominal cavity (distensions,
displacements, torsion ...) [17,18]. Veterinarians were requi-
red to report whether or not they had performed a rectal pal-
pation and its resuit.
Nasogastric intubation gives information on thé status of
thé digestive tract, and especially thé foregut [17] ; thé pré-
sence of substantial nasogastric reflux (more than 2 Litres)
can suggest an obstruction of thé small intestine, a colonie
entrapment, a large colon displacement etc. [17]. In our
study, Veterinarians reported whether or not they had perfor-
med nasogastric intubation and thé amount of reflux, when
présent.
Characteristics of thé fèces - Characteristics of thé fèces
were recorded: Veterinarians had to note their consistence,
their color and thé quantity excreted. The présence of grain,
straw or foreign bodies in thé fèces and thé estimated time of
thé last défécation were also recorded. Ail thèse criteria are
indicators of digestive problems and can give useful infor-
mation on thé localization of thé colic [3].
Statistical analysis - Qualitative variables (sex, breed,
intensity of pain ...) were represented as percentages. Due to
a large number of breeds with few observations, breeds were
grouped into 4 classes, représentative of thé tempérament of
thé breed (sensitivity to stress) : warm blood horses
(Arabians, Thoroughbreds and French cross-bred horses),
cold blood horses (French Standardbred and non registered
cross-bred hack), ponies (between 1,20 and 1.45 mètres in
height ) and other breeds.
Quantitative variables (âge, heart rate and rectal tempéra-
ture) were transformed into qualitative variables; âge was
converted into 4 classes représentative of thé horse physiolo-
gie stage : <4 years old (growing horses), 4-8 years old
(young horses in activity), 9-15 years old (adult horses in
activity), >15 years old (old horses) ; heart rate was classi-
fied into 3 catégories : normal heart rate (28-40 beats per
minute), moderately elevated heart rate (41-60 beats per
minute) and greatly elevated heart rate (>60 beats per
minute) ; rectal température was divided into 2 classes : nor-
mal rectal température, called non fébrile (96.8 (35,5°C) to
100.4°F (37,8°C)) and elevated rectal température, called
fébrile >100.4°F (37°8°Q).
Each variable's distribution was analyzed for thé 207 cases
together, then colic cases were classified using thé following
criteria:
- thé type of colic : obstructive or non obstructive colic,
- thé affected organs : horses were grouped into 4 classes,
following thé affected organ : foregut (colic involving thé
Revue Méd. Vêt., 2006,157, 1, 3-10
stomach, thé small intestine or both), cœcum, colon and
other (colic related to cœcum + colon, small intestine +
colon, small intestine + caecum + colon or colic related to an
unknown organ),
- thé type of treatment : médical or surgical treatment,
- thé outcome of thé horse : dead or alive.
For each criterion, each variable's distribution was compa-
red between thé différent classes (obstructive vs. non obs-
tructive colic, médical vs. surgical treatment, etc). For com-
parisons between thé différent types of colic, thé différent
types of treatment and thé outcome of thé horse, and diffé-
rences between proportions, were ail examined by thé calcu-
lation of Odds Ratio (OR) and their 95% Confidence Interval
(CI) [4]. For comparisons between organs, thé first 3 classes
(foregut, cœcum and colon) were compared among them-
selves; différences between proportions were examined by
use of a %2 statistic. Ail thé analyses were made using thé
FREQ Procédure of thé SAS (SAS Inst. Inc., .Cary, NC).
Results
Data were collected from April 1999 till March 2001. In
this two year period, 13 of thé 40 veterinarians who volun-
teered to take part, collected 250 colic cases. Forty three
cases were excluded because thé horse had already been
recruited previously for thé study : sixteen horses had 2 épi-
sodes of colic, 6 had 3 épisodes and 1 had 4 épisodes; as spe-
cified in thé protocol, only thé first épisode of colic was
included. Twenty colic cases were ruled out either because
thé horse owner objected to being involved in our study (14
horses) or because thé diagnosis of colic appeared to be erro-
neous (6 horses). Consequently this paper présents thé study
of 207 colic cases.
Putative diagnosis of thé colic cases - Putative and organ-
related diagnoses of thé 207 cases are presented in table IL A
définitive diagnosis was established by veterinarians in
80.3% of cases. When this was not thé case, it was either
because thé type of colic (0.5%), thé organ (16.3%) or both
(2.9%) were unknown. The most frequently affected organ
was thé colon, alone or associated with other organs (31.4%
and 20.0% respectively), followed by thé small intestine
(19.3% alone and 13.7% associated), thé cœcum (5.3% alone
and 10.7% associated) and thé stomach (2.9% alone and
2.9% associated).
The most common cause of colic was obstruction (51.2%).
Most obstructions were due to a stasis (82.1%), mainly in thé
colon (34.9% of thé stasis colic), or in thé colon and in thé
cecum (15.1%) or in thé small intestine (11.3%).
Non obstructive colic made up for 47.6% of thé cases, of
which thé majority (82.6%) were spasmodic, and usually
affected thé small intestine (24.7% of thé spasmodic colic),
or thé colon (21.0%), or both (9.9%). The organ affected in
23.4% of thé spasmodic colic remained unknown. In 30.8%
of thé cases, a second visit by a veterinarian was necessary,
as thé épisode of colic did not résolve within 24 hours. Four
horses (1.9%) underwent surgery. 13 (6.3 %) died from
colic ; thé death rate was higher after a surgical treatment
(50.0%) than after a médical treatment (5.4%).
 GONÇALVES (S.) AND COLLABORATORS

Type of colic Affected organ(s) in %

total S+SI SI SI+C Sl+Ce+C Ce Ce+C
Non obstructive Spasmodic 39.2 1.4 2.9 9.7 3.9 0.5 2.4 1.0 8.2 9.2
47.6 Other 6.9 0.5 1.0 1.0 1.0 3.4
Unknown 1.5 0.5 1.0
Obstructive Non strangulated 47.4
51.2 Stasis 42.1 1.0 5.8 3.9 1.0 2.9 7.7 17.9 1.9
Enteroliths 0.0
Displacement 2.4 0.5 1.9
Other 1.5 0.5 1.0
Unknown 1.4 1.4
Strangulated 3.3 1.4 1.9
Unknown 0.5 0.5
Unknown 1 .2 1.2
Total: 2.9 2.9 19.3 9.3 1.5 5.3 9.2 31.4 19.2

Abbrevations : S : Stomach ; SI : Small Intestine ; C : Colon ; Ce : Cœcum ; X : unknown organ.

TABLE II. — Results : diagnostic hypothesis of thé 207 colic horses.

Intrinsic factors of thé 207 horses - table 3 présents thé
distribution of thé intrinsic factors of thé 207 cases, for those
horses with obstructive and non obstructive colic, for those
with foregut-related colic, caecum-related colic and colon-
related colic, and for those which survived or died from
colic. Significant différences between thé différent classes
were noticed; we chose not to perform a statistical analysis
and not to présent results for comparison between médical
and surgical treatment, due to thé small number of horses
that underwent surgery (4).
The distribution among thé 207 colic horses by sex was
50.7% females, 44.0% geldings and 5.3% mâles. Their
médian âge was 9.5±5.9 years ; thé prédominant breeds were
cold blood horses (62.3%, and mainly French Standardbred :
59.4%).
Clinical examination of thé 207 horses (table III) -
Characterization ofpain - Most of thé 207 horses (70.6%)
were seen by thé vêt less than 6 hours after thé outset of pain.
Pain appeared more rapidly in horses with non obstructive
colic than with obstructive colic (OR=2.14 (1.09-4.21) bet-
ween "< 2 h" and "2 to 6 h" and OR=4.33 (1.47-12.75) bet-
ween "< 2 h" and "25 to 48 h"). The behaviour of thé majo-
rity of horses included in our study was typical of mild pain :
75.7% looked their flanks or took abnormal positions ; 7.4%
were only depressed ; 16.8% developed sévère pain.
Comparée to horses that survived thé colic, horses that died
presented less often thé typical behaviour of colic ("looking
its flanks") (OR=0.16 (0.03-0.89)).
Cardiovascular status - Mucous membrane color was nor-
maà ipiak i in 87.6^c of horses. The médian heart rate was
I beats pcr mi™IIP and varied from 28 to 80 beats
had a heart rate significantly
iV86 w 42-8±9_5 beats per minute:
• =•" -I ut rnsaa» rctial température
99.9±1°F (37°2±0,5°C) and varied from 96.8°F (35,5°C) to
104°F(40°C).
Palpation per rectum - Palpation per rectum was perfor-
med in nearly every case (99.0%). In 63.0% of cases, it was
informative and indicated stasis (27.4%), displacement
(4.9%) or dilation (3.9%). Per rectum palpation usually
enbled to différend ate obstructive from non-obstructive
colic. Furthermore, results of thé palpation per rectum diffe-
red significantly depending on thé affected organ (%2 =37.49
and p<0.0001) : when thé colic involved thé foregut, thé
most commom resuit was "nothing to report," whereas,
when thé colic was related to thé colon, stasis was mostly
reported (43.8% of thé cases).
Nasogastric intubation - Nasogastric intubation was per-
formed in 59.4 % of horses, 1,8% of which had more than 5
L of gastric reflux, 5,3% less than 5 L, and 93,0% no relflux
at ail Horses that died from colic showed more gastric reflux
than those that survived (OR=19.1 (2.18-167.48)).
Characteristics of thé fèces in thé 207 horses (table IV)
- Most of thé time, fèces had a normal consistency (53.9%)
or were small and dried-up (29.1 %) ; their color was normal
(76.6%) or discolored and yellow (20.9%) ; fèces were
excreted in normal quantities in 40,2% of cases, and less
abundant in 55.8% of cases. With most horses (96.6%), no
foreign body was observed in thé fèces, except for straw,
which was found in 50.7% of cases. The last défécation was
less than 2 hours before (37.4% of thé 207 horses), 2 to 6
hours before (41.2%) or 7 to 24 hours before (20.9%).
Characteristics of fèces significantly differed from obs-
tructive colic to non-obstructive : small and dried-up fèces
(OR=6.84 (3.20-14.59)), discoloured and yellow (OR=2.58
(1.26-5.31)), less abundant than normal (OR=4.37 (2.39-
8.01)), with grains (OR=3.89 (1.06-14.29)), and dating back
2 to 6 h (OR=3.02 (1.59-5.74)), were observed more often in
obstructive than in non-obstructive colic .

Revue Méd. Vêt.. 2006, 157. 1. 3-10

 CRITERION FOR THE DIAGNOSIS OF COLIC IN THE HORSE

Global Type of colic (%) Affected organ (%) Outcome (%)

Catégories
Cnteria colic (%) Obst. Nonobst. For. Cec. Col. Non surv Surv.
Number of horses 207 106 99 p 52 11 65 p 13 194 p
Intrinsic factors
Sex Gelding 44.0 45.8 41.8 39.2 54.5 37.5 46.2 43.8
Female 50.7 51.4 50.0 49.0 45.5 60.9 38.5 51.5
Mâle 5.3 2.8 8.2 11.8 0.0 1.6 15.4 4.6
Age > 15 years 15.0 11.3 18.4 19.6 18.2 9.5 30.8 14.0
9 to 15 years 30.1 26.4 33.7 33.3 36.4 28.6 38.5 29.5
4 to 8 years 44.7 54.7 34.7 * 31.4 36.4 55.6 7.7 47.2 *
< 4 years 10.2 7.5 13.3 15.7 9.1 6.3 23.1 9.3
Breed Warmblood horse 14.0 14.0 14.2 9.8 36.4 12.5 7.7 14.5
Coldblood horse 62.3 60.7 63.3 56.8 54.6 57.9 38.5 63.9
Pony 13.0 15.0 11.2 15.7 9.1 18.8 7.7 13.4
Other breed 10.5 10.3 11.2 17.7 0.0 11.0 46.2 8.2
Characterization of pain
Intensity of pain Rolling on thé floor 16.8 17.1 16.7 17.6 27.3 6.3 41.7 15.3
Abnormal positions 39.6 39.0 40.6 43.1 36.4 39.7 41.7 39.5
Looking its flanks 36.1 37.1 34.4 33.3 36.4 42.9 16.7 37.4 *
Depressed 7.4 6.7 8.3 5.9 0.0 11.1 0.0 7.9
Duration of pain < 2 h 29.4 21.0 38.8 37.3 36.4 27.0 33.3 29.2
2to6h 41.2 43.8 37.8 * 29.4 36.4 39.7 33.3 41.7
7 to 24 h 16.7 18.1 15.3 19.6 18.2 19.0 16.7 16.7
>24h 12.8 17.2 8.1 * 13.8 9.1 14.3 16.7 12.5
Cardiovascular status
Mucous colour Pink 87.6 87.5 87.5 88.2 90.9 88.7 66.7 88.9
Red 6.5 7.7 5.2 5.9 9.1 6.5 16.7 5.8
Purple 2.0 2.9 1.0 0.0 0.0 1.6 8.3 1.6
Pale 4.0 1.9 6.3 5.9 0.0 3.2 8.3 3.7
Heart rate Normal 47.9 44.5 51.1 42.2 45.4 52.5 16.7 50.0
Moderately elevated 48.4 52.5 44.4 57.7 45.4 42.4 83.3 46.1 *
Abnormally elevated 3.6 3.0 4.4 0.0 9.1 5.1 0.0 3.9
Rectal température Not fébrile 86.2 88.9 83.1 77.1 90.0 86.2 66.7 87.6
Fébrile 13.8 11.1 16.8 22.9 10.0 13.8 33.3 12.4
Palpation per rectum
Results of palpation Nothing to report 33.3 10.5 70.0 52.1 10.0 12.3 *** 41.7 40.8
per rectum Stasis 27.4 72.6 6.7 *** 6.5 20.0 43.8 33.3 54.6
Displacement 4.9 10.5 6.7 *** 4.3 0.0 3.5 33.3 8.0
Dilation 3.9 4.2 16.7 4.3 10.0 3.5 0.0 8.0
Notrealized. 1.0 0.0 2.2 2.2 0.0 0.0 0.0 1.1
Nasogastric intubation
Nasogastric sonde Yes 59.4 82.7 33.3 54.9 54.5 62.3 58.3 59.5
No 40.6 17.3 66.7 *** 45.1 45.5 37.7 41.7 40.5
Quantityof reflux O L 93.0 91.4 96.8 80.8 100.0 94.6 71.4 94.4
<5L 5.3 7.4 0.0 11.5 0.0 5.4 14.3 4.7
>5L 1.8 1.2 3.2 7.7 0.0 0.0 14.3 0.9 *

Abbreviations: Obst.: obstructive colic ; Non obst.: non obstructive colic ; For.: foregut ; Cec.: cecum ; Col.: colon ;
Non surv.: non survivors ; Surv.: survivors
p: Pvalue ; * : Pvalue < 0,05 ; ** : Pvalue < 0,01 ; *** : Pvalue < 0,001

TABLE III. — Intrinsic factors and clinical variables of thé 207 cases ; distribution between thé différent types of colic, thé affected organs
and thé outcome of thé colic.

Other différences in fèces were observée following thé

affected digestive segment (table V) (/2 =26.00 and
P<0.001) : fèces were generally normal when colic involved
thé foregut (52.9% of thé cases) and thé caecum (66.7%);
when thé colon was suspected, fèces were normal (46.9%) or
small and dried-up (45.3%).
The colour of thé fèces varied significantly depending on
thé outcome : survival or death. Straw was more often obser-
ved in horses that eventually died (OR=6.23 (1.34-28.83)).
Discussion
Pertinence of thé clinical examination criteria -
Abdominal paracenthesis and blood testing are important in
thé assessment of a horse suffering from colic [7, 8] ; Some
other diagnostic techniques, such as ultrasound, are now
commonly used as precious diagnostic aids [7, 17]. Thèse
more sophisticated procédures were not included in our
study, as thé veterinarians examined thé horses in thé field
and not in referral hospitals, and did not ail hâve thé neces-
sary equipment.

Revue Méd. Vêt., 2006, 157, 1, 3-10

 GONÇALVES (S.) AND COLLABORATORS

. Global Type of colic (%) Outcome (%)

Criteria aegones co|jc(%) Obst ion obs P value OR 95% ci OR Non sur Surv. P value OR 95% ci OR
Number of horses 207 106 99 13 194
Consistency Normal 53.9 40.6 67.3 < 0,0001 1.00 53.8 53.9 0.223 1.00
Small and dried-up 29.1 46.2 11.2 6.84 3.20 - 14.59 15.4 30.1 0.52 0.10 - 2.57
Cow-type 13.6 11.3 16.3 1.15 0.50 - 2.66 30.8 12.4 2.50 0.68 - 9.23
Diarrheic 3.4 1.9 5.1 0.62 0.12 - 3.30 0.0 3.6 np
Color Normal 76.6 68.3 85.4 0.030 1.00 84.6 76.1 < 0.0001 1.00
Discoloured & yellow 20.9 27.9 13.5 2.58 1.26 - 5.31 0.0 22.3 np
Bloody 1.0 1.9 0.0 np 15.4 0.0 np
Black 1.5 1.9 1.0 2.38 0.21 - 27.00 0.0 1.6 np
Quanti ty Normal 40.2 25.5 55.8 < 0.0001 1.00 36.4 40.4 0.673 1.00
More 4.0 1.0 7.4 0.30 0.04 - 2.37 9.1 3.7 2.23 0.23 - 21.83
Less 55.8 73.5 36.8 4.37 2.39 - 8.01 54.5 55.9 1.01 0.31 - 3.30
'resence of grains Yes 6.9 2.9 10.4 0.031 1.00 0.0 7.4 0.309 1.00
No 93.1 97.1 89.6 3.89 1.06 - 14.29 100.0 92.6 np
Présence of straw Yes 50.7 57.1 43.6 0.057 1.00 15.4 53.2 0.008 1.00
No 49.3 42.9 56.4 0.58 0.33 - 1.01 84.6 46.8 6.23 1.34 - 28.83
•esence of foreign Yes 3.4 2.8 4.1 0.614 1.00 0.0 3.6 0.484 1.00
bodies No 96.6 97.2 95.9 1.48 0.32 - 6.80 100.0 96.4 np
Moment of thé <2h 37.4 26.3 48.9 0.009 1.00 37.5 37.4 0.640 1.00
last fèces 2to6h 41.2 50.5 31.1 3.02 1.59 -5.74 25.0 41.9 0.54 0.12 - 2.34
7 to 24 h 20.9 22.1 20.0 2.05 0.96 - 4.39 37.5 20.1 1.87 0.51 - 6.86
>24h 0.5 1.1 0.0 np 0.0 0.6 np

Abbreviations: Obst.: obstructive colic ; Non obst.: non obstructive colic ; Non surv.: non survivors ; Surv.: survivors ; OR: Odds Ratio ;
ci: 95% confidence interval ; np: non performed: OR incalculable because of a blank cell (0 observation in one cell)

TABLE IV. — Fèces characteristics of thé 207 horses ; distribution between thé différent types and outcome of thé colic.

Affected organ (%)

Catégories
Criteria For. Cec. Col. Khi2 P value
Number of horses 52 11 65
Consistance Normal 52.9 66.7 46.9 26.00 < 0.001
Small and dried 29.4 0.0 45.3
Cow-type 15.7 33.3 1.6
Liquid 2.0 0.0 6.3
Color Normal 80.4 81.8 71.9 3.44 0.752
Discolored yellow 15.7 18.2 25.0
Bloody 2.0 0.0 0.0
Black 2.0 0.0 3.1
Quantity Normal 45.1 36.4 32.3 4.60 0.331
More 5.9 0.0 1.6
Less 49.0 63.6 66.1
Présence of grains Yes 9.8 27.3 1.6 10.04 0.007
No 90.2 72.7 98.4
Présence of straw Yes 48.0 72.7 50.8 2.24 0.326
No 52.0 27.3 49.2
•esence of foreign Yes 3.9 0.0 4.7 0.54 0.764
bodies No 96.1 100.0 95.3
Moment of thé < 2 h 41.7 60.0 29.3 5.89 0.436
last fèces 2 t o 6 h 33.3 20.0 46.6
7 to 24 h 25.0 20.0 22.4
>24h 0.0 0.0 1.7

Abbreviations: For.: foregut ; Cec.: cecum ; Col.: colon

TABLE V. — Repartition of thé fèces characteristics between thé affected organs.

Furthermore, we did not compare précise types of colic to lity of thé diagnosis is a major problem encountered in thé
each other (for example, stasis colic of thé cœcum vs. spas-
modic colic of thé small intestine) because thé diagnosis field, when no surgery or necropsy enables confirmation [11,
could not always be definite ; as a matter of fact, thé reliabi- 20].

Revue Méd. Vêt., 2006,157, 1, 3-10

A CRITERION FOR THE DIAGNOSIS OF COLIC IN THE HORSE
Putative diagnosis of thé colic cases - The proportion of
définitive diagnosis (80.3%) was lower in our study than that
of 90.5% reported in another French study on 945 horses
[10] ; this was probably due to a différent recruitment :
unlike HENG [10], our horses were recruited also by mixed
veterinarians and not solely by equine specialists.
39.3% of our cases were spasmodic colic, which is similar
to thé 34.8% reported in a previous study [6]. Thèse percen-
tages are higher than thé 9% of spasmodic colic reported by
KANEENE et al [11] (7 cases / 77 colic horses). Thèse
authors explained their low resuit with thé fact that 64.0% of
their colic horses had no précise diagnosis, mainly because
many of them were directly reported by farmers without a
veterinary examination (43%). 51.2% of our cases were obs-
tructive colic, mainly as thé resuit of a stasis. KANEENE et
al. [11] reported only 17% of obstructive colic in their study;
but, as explained above, thé cause of many of their colic
cases was not diagnosed.
Clinical examination criteria - Our results relative to thé
usual clinical examination criteria are in accordance with
what is observed in thé field and in thé literature :
In 1986, a paper reviewed thé différent variables used
commonly for thé examination of equine colic cases to
assess thé prognosis [14] ; sévère pain appeared to be signi-
ficantly différent between survivors and non-survivors [14,
16, 19]. THOEFNER et al [19] found an OR of 38.4 for thé
criterion "sévère pain". Our results were in accordance with
their findings.
The mucous membrane colour is accurate in differentia-
ting groups of survivors and non-survivors : FURR et al [8]
observed a mucous membrane other than pink in 13.4% of
survivors and in 64.5% of non-survivors. THOEFNER et al
[19] measured an increase in thé probability of dying, when
thé mucous membrane was nof pink (red mucous mem-
brane : OR=5.42, pale mucous membrane : OR=11.30 and
cyanotic mucous membrane : OR=180.62). In our study,
even though différences appeared in thé distribution of thé
mucous membrane colours between survivors and non-sur-
vivors, thèse were not statistically significant, mainly due to
thé small number of dead horses. The relation between thé
rising heart rate and thé decrease in thé survival rate, confir-
med what was previously reported [14, 21]. Similarly, thé
higher rectal température in thé group of non-survivors was
also observed in a study by THOEFNER et al [19]. But
FURR et al [8] found no différence.
Palpation per rectum is an essential procédure in thé clini-
cal examination of a horse with colic. It enables to differen-
tiate from obstructive and non obstructive colic, by best pre-
dicting an obstruction [18].
The amount of reflux did not appear to be related to thé
affected organ, contrary to what is reported in thé bibliogra-
phy [9], where an important reflux was generally consistent
with a foregut problem or a displaced colon. The outcome of
thé colic differed foliowing thé importance of thé reflux.
According to CARTER [5], an abundant reflux (more than 3
L) indicates that thé colic is very serious and thé horse has to
be operated. In our study, thé amount of reflux was signifï-
cantly différent (OR= 19.1) between survivors and non-survi-
vors: 50% of non-survivors had more than 5 litres of reflux,
Revue Méd. Vêt., 2006,157, 1, 3-10
against only 1% of survivors.
The characteristics of fèces as a diagnostic aid - As
shown above, our first results are inaccordance with thé lite-
rature.
The characteristics of fèces were never reported as a crite-
rion in thé clinical examination of horse with colic, with thé
exception of one study [10]. Nevertheless, thé différent fèces
characteristics helped us to characterize thé colic, as shown
below.
The fèces characteristics appeared to be a relevant crite-
rion of differentiation between obstructive and non-obstruc-
tive colic : significant différences were observed for ail thé
criteria : consistence, colour, quantity of fèces, time of thé
last défécation and présence of particles in fèces (grains). In
fact, it is commonly known that an intestinal obstruction
modifies thé digestive transit by increasing thé rétention time
and thé water absorption in thé digestive tract. Thèse
changes logically aller thé fécal properties (colour, consis-
tency, quantity)). Grain was less frequently observed when
thé colic was obstructive, probably because thé increased
rétention time allowed for an enhanced food dégradation.
The consistency of fèces also varied significantly, follo-
wing thé affected organ (%2 =26.00 and P<0.001). No other
author has studied thé relation between fèces consistency
and affected organ, but, depending on ils cause, thé colic will
affect differently thé food digestion, and therefore thé cha-
racteristics of thé fèces.
Conclusion
Veterinarians take into account many criteria when exami-
ning a horse with colic, in order to establish thé best lesion-
related diagnosis possible. Pain, thé cardiovascular status,
results of palpation per rectum and nasogastric intubation are
commonly used to assess thé seriousness of thé colic and
predict its outcome. The examination of thé fèces characte-
ristics is an extra diagnostic aid, as it appears to be a most
discriminating criterion of thé type of colica horse is suffe-
ring from.
Acknowledgements
The following veterinarians provided data for this study : Jean-
Charles BLOCH, DMV, Clamecy (F) ; Stéfaan BUTSAEREN, DMV,
Decize (F) ; Dominique CHAMBON, Jean-Michel DAMIAN and François
ROULLEAU, DMV, Varennes-Saint-Sauveur (F) ; Philippe CHATELUS,
DMV, Charolles (F) ; Alain CHAUZY and Jean-Marc CHARVOLIN,
DMV, Semur-en-Auxois (F) ; Etienne CORDIER and Patrice BELLOCQ,
DMV, Saint-Jean-de-Losne (F) ; Jacques DELAGARDE, DMV, Toucy (F) ;
Eric DUDOUET and Brigitte PARENT, DMV, Aignay-le-Duc (F) ; Yves
GAY and Benjamin GONELLA, DMV, Dijon (F) ; Xavier GLUNTZ and
Gilles-André BATAILLE, DMV, Dammarie-les-Lys (F) ; Michel
MERESSE and Paul LUCAS, DMV, Neuvy-sur-Loire (F) ; Jean-Matthieu
RICARD, Michel SIMONET and François MAISONNEUVE, DMV, Nuits-
Saint-Georges (F) ; Yves SAGET, DMV, Lormes (F).
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