Horse Colic: Violent Rolling, Pawing, Looking at Flank, Absence of Gut Sounds, and Why Walking a Twisting Volvulus Cannot Replace Surgery¶

Across every discipline, breed, and management style in the equine world, Acute Abdominal Pain ("Colic") is the number-one medical killer of domestic horses (Equus caballus) after old age. Unlike cattle or dogs, the horse possesses a uniquely fragile gastrointestinal anatomy engineered for continuous slow grazing that turns any gas buildup, dry feed impaction, or intestinal displacement into a life-threatening crisis: (1) a one-way muscular cardiac sphincter (lower esophageal sphincter) at the entrance to a relatively small 8-to-15-Liter stomach that physically prevents a horse from vomiting or burping, meaning that if fluid and gas back up from the small intestine (enterogastric reflux), the horse's stomach will literally rupture (100% fatal within hours) unless a veterinarian passes a nasogastric (NG) tube to siphon the pressure off; and (2) a massive, 3.5-meter-long (11.5-foot), 80-to-100-Liter Ascending Large Colon that floats freely inside the abdomen anchored ONLY at its base (the right dorsal colon and cecocolic fold), allowing the entire colon to flip over the nephrosplenic ligament or twist 180 to 720 degrees on its own mesenteric blood supply (Large Colon Volvulus).

What separates horses that survive acute colic from horses that die or require euthanasia is early recognition of a strangulating surgical lesion during the "Golden 2-to-4-Hour Window" and avoiding three deeply entrenched barn myths: (1) the myth that walking a horse continuously for hours "walks out" a twisted gut (walking only distracts a horse from rolling and injuring itself while you wait for the vet; walking a horse with a 360-degree volvulus to exhaustion accelerates endotoxic shock and never untwists a strangulated colon); (2) the myth that injecting Flunixin Meglumine (Banamine) into the horse's neck muscle (IM) is a safe quick fix (intramuscular Banamine causes fatal Clostridium gas gangrene / myonecrosis (30%+ mortality) and masks the rising heart rate and pain of a surgical twist until the bowel turns black and necrotic); and (3) waiting 8 to 12 hours at the barn "to see if a second dose of Banamine works" before hooking up the horse trailer. When a horse has a strangulating Large Colon Volvulus or small intestinal Epiploic Foramen Entrapment, the twisted bowel loses its venous and arterial blood flow immediately: hauled to an equine surgical hospital within 2 to 4 hours, survival exceeds 80% to 90%, whereas waiting 8 to 12 hours drops survival below 20% to 30%. If your horse is colicking right now, call your equine veterinarian immediately, consult your local numera fa'afuase'i if a human handler is kicked or crushed by a rolling horse, and review our sibling guides on livestock bloat, rumen tympany, and stomach tubing, hay barn spontaneous combustion and wet alfalfa, ma poison hemlock, giant hogweed, and toxic pasture weeds.

Fai nei loa¶

1. Call your equine veterinarian IMMEDIATELY at the very first sign of colic, DO NOT "wait an hour to see if it passes" and DO NOT give any pain medication (Banamine, Bute, pe Dipyrone) before speaking to the vet. Tell the vet the horse's exact behavior and the 5 Barn Vitals (Heart Rate, Gum Color / Capillary Refill Time, 4-Quadrant Gut Sounds, Rectal Temperature, and Digital Pulses).
2. Remove ALL hay, grain, mash, and edible bedding (straw/shavings) from the stall or paddock immediately, while leaving clean water available unless the horse is violently thrashing. Putting a grazing muzzle on a horse bedded on straw prevents them from eating bedding on top of an impaction.
3. NEVER step into a small 3.6 x 3.6 meter (12 x 12 foot) box stall with a horse that is throwing itself down and rolling violently. A 500-kg (1,100-lb) horse in severe strangulating colic is blind to human presence and can crush you against the stall wall (causing fatal human pelvic/chest trauma). Move the horse into a small, soft-footed, enclosed arena, round pen, or grass paddock if safe to lead, and stay at the horse's shoulder in an open space.
4. Walk the horse slowly for 15 to 20 minutes ONLY if the horse is trying to roll violently, NEVER walk a tired, quiet horse to exhaustion. If the horse wants to lie quietly on its sternum (sternal recumbency) without thrashing or casting itself against a wall, let the horse rest quietly. Contrary to old barn folklore, a horse rolling on the ground does not cause the gut to twist; rather, the gut has already twisted (or distended with gas), and the resulting excruciating pain makes the horse roll.
5. NEVER inject Flunixin Meglumine (Banamine) into the horse's muscle (IM), and NEVER squirt injectable Banamine i mata o le solofanua (only give IV into the jugular vein or orally into the mouth if explicitly instructed by your vet). Intramuscular Banamine suia maso pH ma mafua ai le faaleagaina o aano o le necrotic lea e faagaioi ai le moe *** Clostridium septicum / Clostridium perfringens* spores**, e mafua ai le Clostridial Myonecrosis ("Malignant Edema / Gas Gangrene"), o se fula tele, ma'i, fula oona e oti ai pe tusa ma le 1 i le 3 solofanua.
6. Faamau i luga lau taavale toso solofanua (pe valaau se equine la'u fa'alavelave fa'afuase'i) I LE NEI loa a'o fa'atali mo le taunu'u mai o le foma'i manu. Afai o lau solofanua o lo'o maualuga le fatu fatu. 60 beats per minute (bpm), aulaula e mumu-mumu pe lanu viole, e leo leo o le gutu i vaega uma e 4, pe toe foi mai le tiga matuia i totonu 1 i le 2 itula pe a uma le fa'a'a'a'a/analgesia a foma'i manu, e mautinoa lava ua i ai se ta'otoga titina (Volvulus pe Small Intestinal Entrapment) ma e tatau ona i luga o le auala i se falema'i tipitipi equine vave.

Laau fa'ai'uga: Barn Triage of Equine Colic: Foma'i A'afiaga/Gas vs. Fa'ata'otoga Fa'ama'i (Volvulus) vs. Colitis¶

Fa'aoga lenei siata fa'ata'ita'iga fa'ata'ita'i manu e su'esu'e ai fa'ailoga autu e 5 a lau solofanua ma fa'amautinoa pe o e feagai ma se ma'i ma'i, se ta'otoga mimilo gut, po'o se fiva fever colitis.

flowchart TD
    A["Solofanua o lo'o Fa'aalia Fa'ailoga o le Colic: Pa'u, Va'ai i le Ivi, Fa'a'u'u Laugutu I luga (Flehmen), Ta'oto i lalo, po'o le Ta'avale Saua."] --> B{"Aveese Fafaga Fa'ato'a uma ma Si'i Saogalemū le 5 Fale Fa'ato'aga (Tata o le Fa'ato'aga, Gums/CRT, Su'esu'e, 4-Quadrant Gut Sounds, Digital Pulses)"}
    B -->|"MAUA FA'ATA'U > 38.6 C (101.5 F): Fa'anoanoa, leai se mea'ai, fa'ailoga vaivai, pulu piliki-mumu, soso'o ai le pai povi po'o le manava manava."| C["COLITIS FA'AI'I/TOXIC ACUTE (Fiva Solofanua Potomac, Salmonella, Coronavirus, Clostridia, poo NSAID Right Dorsal Colitis)"]
    B -->|"VIOLENT, UNRELENTING PAIN: Throwing body to ground, bloated abdomen, sweating, Heart Rate > 60-80+ bpm, CRT > 2.5-3 sec, red/purple gums, SILENT gut"| D["SURGICAL STRANGULATING OBSTRUCTION (Large Colon Volvulus, Small Intestinal Epiploic/Inguinal Entrapment, or Intussusception)"]
    B -->|"TIGA FA'ATA'I MAMA'I I'A'E LEAGA: Ta'u, fa'aloloa, taoto lemu, Ta'alili o le fatu 36-52 bpm, La'au Susū piniki (CRT <2s), Temp Normal (<38.3 C)"| E["SIMPLE MEDICAL COLIC TRIAGE (Spasmodic/Gas Colic, Pelvic Flexure Impaction, or Sand/Enterolith Obstruction)"]
    C --> F["BIOSECURITY & FLUID EMERGENCY: 1. Isolate Horse Immediately (Footbath + Gloves) 2. DO NOT Give NSAIDs Before Vet Checks Hydration 3. Aggressive IV Fluids + Polymyxin B / Plasma + Ice Boots on All 4 Hooves (Prevent Laminitis)"]
    D --> G["IMMEDIATE SURGICAL REFERRAL (Every 30 Minutes Counts): 1. Keep Handler Safe in Open Area 2. Load Trailer Immediately 3. Vet Passes NG Tube right away to Decompress Stomach (Prevent Fatal Gastric Rupture) + IV Fluids -> Surgery"]
    E --> H["Veterinarian On-Farm Exam: 1. Nasogastric (NG) Tube (Check for > 2 L Reflux & Administer Water + Electrolytes + Laxative) 2. Rectal Palpation / Portable Ultrasound 3. Single Vet-Directed IV Analgesic/Antispasmodic (Buscopan / Xylazine / Banamine IV)"]
    H --> I{"Does pain return within 1 to 2 hours of vet treatment, OR does Heart Rate climb > 60 bpm, OR is there > 4 Liters of NG Reflux?"}
    I -->|"IOE: Fa'alavelave tiga, fa'atupula'ia le HR, po'o le fa'afofoga lelei o le NG"| G
    I -->|"LEAI: E nofo lelei le solofanua, pasi otaota, toe fo'i mai le gutu"| J["Fa'aauau le Anapogi Fa'ata'ita'i Vet -> Toe Fa'asusu Fa'asolo (Mash Susū -> Lu'u Laiti ole vaomago) I luga ole 48-72 Itula"]

Vaega 1: Fa'atusatusaga Fa'afoma'i ole 5 Ituaiga Tele ole Colic Solofanua¶

Pe tusa o le 80% i le 85% o mataupu equine colic e foia i togafitiga faafoma'i i totonu o faatoaga, ae 15% i le 20% o suiga faainisinia, aafiaga, po o le mimilo titina (volvulus) e mana'omia ai togafitiga malosi ole vai ile falema'i po'o le fa'alavelave fa'afuase'i su'esu'e celiotomy (ta'otoga colic).

Vaega 2: Maulu loloto: Fa'afefea ona siaki le 5 Fa'ato'aga Fa'ato'aga A'o le'i Valaau lau Foma'i¶

A e vala'au lau foma'i manu i le 2:00 i le taeao mo se solofanua, tu'u atu ia i latou nei numera fa'amoemoe e lima i luga o le telefoni e ta'u vave atu ia i latou pe tatau ona latou feiloa'i ia te oe i luga o le alatele e aga'i atu i le falema'i tipitipi po'o le sau i lou fale pa mo se su'esu'ega o aafiaga. (Ia faamuamua i taimi uma lou saogalemu patino: afai e oso malosi le solofanua i le eleele, aua neʻi taumafai e ave se vevela o le saʻo pe faʻalogo i le itu.)

+-----------------------------------------------------------------------------+
|       THE 5 EQUINE COLIC BARN VITALS & SURGICAL RED-FLAG THRESHOLDS         |
+-----------------------------------------------------------------------------+
|  1. HEART RATE (Stethoscope Behind Left Elbow OR Facial Artery Under Jaw):  |
|     - Normal Adult Resting HR:     28 to 40 beats per minute (bpm)          |
|     - Mild / Medical Colic:        40 to 52 bpm                             |
|     - Moderate / Borderline:       52 to 60 bpm                             |
|     - SURGICAL RED FLAG:           > 60 bpm (and > 80 bpm = Severe Shock)   |
|                                                                             |
|  2. GUM COLOR (Mucous Membranes) & CAPILLARY REFILL TIME (CRT):             |
|     - Lift upper lip gently; press thumb against gum above upper corner     |
|       incisor for 2 seconds, release, and count seconds for pink to return. |
|     - Normal:   Moist, pale bubble-gum pink; CRT = 1 to 2 seconds.          |
|     - RED FLAG: Dry/tacky (dehydration), Pale/White (internal bleed/shock), |
|                 Brick-Red, Muddy, or Purple/Blue line around teeth          |
|                 ("Endotoxic Halo"); CRT > 2.5 to 4.0+ seconds.              |
|                                                                             |
|  3. FOUR-QUADRANT GUT SOUNDS (Auscultate Both Flanks, Upper & Lower):      |
|     - Listen for 30-60 seconds at: (1) Upper Left, (2) Lower Left,          |
|       (3) Upper Right (Cecum, should have a loud 'toilet-flush' sound      |
|       every 30-60 sec), and (4) Lower Right.                                |
|     - RED FLAG: Complete silence in all 4 quadrants ("Silent Abdomen" =     |
|                 ileus/strangulation) OR high-pitched metallic 'pings'.      |
|                                                                             |
|  4. RECTAL TEMPERATURE (Stand Safely Against Left Hip, Tail Held Aside):    |
|     - Normal Adult Temp:  37.2 C to 38.3 C (99.0 F to 101.0 F)              |
|     - RED FLAG HIGH:      > 38.6 C (101.5 F) -> Suspect Infectious Colitis  |
|                           (Salmonella/PHF), Peritonitis, or Pleuropneumonia |
|     - RED FLAG LOW:       < 36.6 C (98.0 F) with high HR -> Endotoxic Shock |
|                                                                             |
|  5. HOOF TEMPERATURE & DIGITAL PULSES (Back of Fetlock / Pastern):          |
|     - Palpate medial & lateral digital arteries over the sesamoid bones.    |
|     - RED FLAG: Bounding, throbbing digital pulses + hot hooves -> Acute    |
|                 Endotoxic Laminitis ("Founder") triggered by gut toxins.    |
+-----------------------------------------------------------------------------+

Fa'afefea ona Su'e le Pa'u o le Solofanua e aunoa ma se Stethoscope¶

Afai e leai sau stethoscope i totonu o lau pusa fesoasoani muamua, tu'u mau tamatamailima e lua i le Facial Artery lea e ta'avale ai le pito i lalo o le ponaivi auvae pito i lalo (mandible), i luma tonu o le musele lapo'a lapotopoto alafau (masseter). Faitau le pa'u mo 15 sekone ma faatele i le 4 e maua ai beats per minute (bpm).

Vaega 3: O le Upu Moni e uiga i le Savaliga o le Solofanua, Taavale, ma le mafuaaga o le Intramuscular Banamine E Fa'asa¶

1. Pe o le Taavale e Mafua ai le Pisoina o le U'u, ma O le a le Tele e Tatau Ona E Savali ai i le Solofanua?¶

O se tasi o tulafono tuai ma sili ona le malamalama i le tietie solofanua o le "Aua neʻi taoto i lalo pe taʻavale se solofanua, neʻi mimilo lona gutu, savali pea i ai e tusa lava po o le a." - Veterinary Surgical Reality: O fomai tipitipi equine i falema'i a'oa'oina i iunivesite ua faamaonia e faapea taavale e LĒ mimilo se kolone masani; ae, o le ma'i o le kasa po'o le suiga o le gaioioiga e mimilo muamua ai le koluma, ma o le tiga matuia o le mesenteric e mafua ai ona togi le solofanua i lalo ma ta'avale. - Pe a Fesoasoani Savali (ma Pe a Tiga): - GAE savali lemu (15 to 20 minutes at a calm walk) pe afai: (a) o le solofanua e vaivai le kasa/a'afiaga o le colic, lea e fa'agasolo malie ai le gaioi o le gutu (peristalsis) ma fesoasoani e pasi le kesi; POO (b) o lo'o taumafai malosi le solofanua e togi i lalo ma sasa i totonu o se pa pe fa'asaga i pa, lea o le savali e fa'alavelave ai le solofanua ma puipuia ai fa'aleaga na o ia lava (skull/orbital fractures, ruptured spleen, or casting itself upside-down against a wall). - AUA LE savali se solofanua i le vaivai: Afai na savali se solofanua mo le 20 i le 30 minute, ua vaivai, ma na o le manao e ** taoto filemu i luga o lona fatafata (sternal recumbency) po'o le fa'apalapala i lona itu e aunoa ma le sasa**, TUMA LE SAVALI ma tu'u le solofanua e taoto i lalo i se malae saogalemu, loloto le moega po'o se malae mutia. O le savali fa'amalosi o se solofanua vaivai ma fa'a'o'o mo le tele o itula e fa'auma ai le glycogen, fa'ateteleina le fa'amama ma le lactic acidosis, ma fa'atelevave ai le te'i endotoxic.

2. Aisea Flunixin Meglumine (Banamine) E le tatau ona tui i totonu o musele (IM)¶

O le tele o tagata e ana solofanua e teu se fagu tui ** Flunixin Meglumine (Banamine, 50 mg/mL)** i le potu tack ma faaosoosoina e avatu a 10 mL fana i le ua po'o le pito i tua maso (IM) pe a o'o se solofanua. Aua le faia lenei mea, mo mafuaaga e lua o le ola po o le oti: 1. Fatal Clostridial Myonecrosis ("Gas Gangrene" / Malina Edema): - O solofanua soifua maloloina e masani lava ona fa'aputuina ni pomu o le anaerobic Clostridium septicum, Clostridium perfringens, ma le Clostridium chauvoei i totonu o latou musele skeletal (lea e sao mai le gutu po'o pores o le pa'u ma taoto e aunoa ma se afaina pe afai e lelei le okesene a maso). - tui Banamine (pH about 8.2 to 8.5 fa'atasi ai ma propylene glycol ma phenol preservatives) e matua fa'aitaina ai alava maso. Pe a tui i totonu o le ua poʻo le maso gluteal, e mafua ai le focal ischemic muscle necrosis ma paʻu ai le okesene o le tino i le zero. - I totonu o le 12 i le 48 itula, e tupu a'e spores moe * Clostridium* i totonu o lena musele mate ma faamatuu mai ai le alpha- ma beta-exotoxins e faamamā ai maso o le ua o le solofanua, ma faatumulia ai le subcutis i pulu kasa manogi leaga (crepitus), fa'atupu ai le toxemia, ma fasiotia ai le 25% i le 35%+ o solofanua na a'afia e o'o lava i le fa'amama fa'ama'i fa'apitoa o le itu atoa o le ua. - Tulafono a le Auala Saogalemu: Afai e faatonuina manino oe e lau foma'i manu i luga o le telefoni e fa'atonuina oe. Banamine (pe a uma ona e lipotia le 5 mea taua), pe faʻatau le FDA-faʻamaonia Banamine Paste, pe aumai i luga le vai e tui Banamine i totonu o se tui LEAI se nila ma sasau tuu i le tulimanu o le gutu o le solofanua (absorbs into the bloodstream in 30 to 45 minutes, almost as fast as an IM shot, with ZERO risk of Clostridial gas gangrene or carotid artery injection). E na'o se foma'i manu po'o se tekinisia fa'aa'oa'oina e agava'a ile aseptic jugular venipuncture e tatau ona fa'atonuina. IV Banamine (o le misia o le vein jugular ma tui i totonu o le carotid artery e mafua ai le vave faoa faamalosi ma le oti). 2. Ufiufiina o se Ta'otoga Volvulus: - Banamine ose cyclooxygenase malosi (COX) iniseti e poloka ai le tiga o le visceral e ala i le prostaglandin ma faʻafefe ai le vave fiva / tachycardia o le endotoxemia. - Afai ei ai se manu'a vave strangulate le intestinal po'o le colon volvulus, tu'u Banamine a'o le'i taunu'u mai le foma'i manu e mafai ona tu filemu le solofanua ma 'ai mo 2 i le 4 itula a'o le matasele o le manava ua maua i le ischemic necrosis le mafai ona suia i tua o vaaiga.

Vaega 4: O le a le mea o le a faia e le foma'i manu i luga o le saite & fa'afefea ona va'ai sese "Vavevega Toe Fa'aleleia" (Gastric Rupture)¶

1. Le Fa'ato'aga Fa'ato'aga Colic Workup¶

A o'o mai lau foma'i manu, ia saunia se pakete vai mafanafana, se mea fa'amau ma moli lelei: 1. Nasogastric (NG) Intubation (Passing the Stomach Tube): O se su'ega su'esu'e ma se togafiti lavea'i le ola. E pasi e le fomai manu se paipa i luga o le isu i totonu o le manava ma faia ai se siphon. - E masani lava, o le manava equine e fua mai < 1 to 2 Liters o vai. - Afai 4 to 15+ Liters o le manogi leaga, moli-enaena, alkaline (pH > 6) e puna mai i fafo le sua o le inumaga laiti (Positive Nasogastric Reflux), ua poloka fa'ainisinia le tootoo la'ititi (strangulation pe anterior enteritis), ma ua fa'atoa lavea'i e le foma'i manu le manava mai le ta. - Afai e iai le zero reflux, e pamu e le fomai manu 4 to 8 Liters o vai mafanafana, paleni eletise, ma Magnesium Sulfate (Epsom masima, 0.5 to 1 g/kg) po o Mineral Oil (2 to 4 Liters) i totonu o le manava e fa'asusu ai se a'afiaga tele o le koluma. 2. ** Fa'ata'i Tu'u'ese'esega & Fa'ata'ita'i Fa'ata'i Fa'ata'oto (FLASH Su'ega):** Fa'ailoa ai se a'afiaga o le pelvic, fa'a'a'a'a le kesi, fusi fa'amau, po'o fa'aalaala laiti o le manava > 5 cm (2 inches) ma puipui mafiafia edematous (> 4 mm). 3. Abdominocentesis ("Ta'o le manava"): O le sua masani o le peritoneal e mama vao-samasama (lactate < 2 mmol/L). Serosanguinous (toto-toto po'o le enaena enaena) vai peritoneal ma le lactate maualuga (> 4 mmol/L) ua fa'amaonia ai se vaega o le manava ua titina, e mana'omia ai se taotoga vave.

2. O le Mailei sili ona mata'utia i Fa'afoma'i Equine: Fa'afuase'i le "Fa'atiga o le Ma'i" Mai le Gastric po'o le Cecal Rupture.¶

Afai ua i ai se solofanua i tiga tele o le colic mo ni itula ma le tata o le fatu 80 to 100 bpm ma faafuaseʻi, i totonu o le 5 minute, taofi le taʻavale, tu ma lona ulu e tautau maualalo, ma foliga "filemu": - AUA LE manatu ua malolo le colic lava ia. Siaki loa le fatu, fatu, ma le pa'u. - Afai ua tu le solofanua e le gaioi, gatete, susu i le afu malulu, ma le tata o le fatu 100 to 120+ bpm, lanu viole/palapala aula, ma le pa'u ifo o le vevela (< 36.5 C / 97.7 F)**, ua ta le manava po'o le cecum (perforated) i totonu o le manava. - O le taimi lava e matala ai le puipui o le manava, ona taofi loa lea o le fanaina o mea faʻaloloa (o lea e teʻa ai le tiga taʻavale), ae 15 Liters o le manava o le manava ma siama e lolovaia ai le manava o le peritoneal, ma mafua ai le te'i septic i totonu 1 i le 3 itula.

(Mo faʻalavelave faʻafuaseʻi o lafumanu ma faʻatoʻaga, tagaʻi Fugalaau lafumanu: vao efuefu legume, rumen tympany, manava manava, ma trocar faalavelave faafuasei., O le vao mago fa'afuase'i ona mu ma susu susū alfalfa, ma Oona oona, hogweed tele, ma vao oona.)

Numera fa'aitulagi o fa'alavelave fa'afuase'i ma fa'atonuga a le lala sooupu¶

Fesili e fai soo¶

Taiala fa'atatau¶

• Fugalaau lafumanu: vao efuefu legume, rumen tympany, manava manava, ma trocar faalavelave faafuasei.
• Fa'asao vao mago fa'afuase'i mu, alfalfa susu susu, ma le fua o le su'esu'ega
• Oona oona, puaa tele, ma vao vao oona vao
• Manuia i tuafale o le fulu manu, soli fale manu fe'ai, ma le vevela o lafumanu
• Numera fa'alavelave

Punavai ma ta'iala aloa'ia¶

• American Association of Equine Practitioners (AAEP): Equine Colic: Clinical Triage of Medical vs. Surgical Abdominal Pain, Nasogastric Decompression, and Early Referral.
• ** British Equine Veterinary Association (BEVA), British Horse Society (BHS), & Iunivesite o Nottingham:** O le REACT Nei e Taia Colic Evidence-Based Triage Campaign.
• American College of Veterinary Internal Medicine (ACVIM) & ACVS: Fa'amatalaga Autasi i le Large Colon Volvulus, Ititestinal Strangulation, ma Clostridial Myonecrosis mai IM Flunixin Meglumine.
• Merck Veterinary Manual: Aotelega o Colic i Solofanua: Gastric Rupture, Pelvic Flexure Impaction, ma Endotoxic Laminitis.