Meconium Impaction, Hernia, Colic

Case Overview

• Patient: 2-day-old colt

• Symptoms: Depressed, colicky, tail squishing, roach back posture

• Preliminary Diagnosis: Likely meconium impaction based on clinical signs and history

Diagnostics to Confirm Diagnosis

• Physical Exam: Critical for initial assessment

• Digital Rectal Examination: To identify the presence and location of meconium impaction

  • Expected Findings:

    • Temperature: Typically normal in cases of simple meconium impaction

    • Abdominal Distension: Potential for gas distension in the abdomen, not fluid bloat

• Other Diagnostic Tests:

  • CBC (Complete Blood Count): Likely normal, possible stress leukogram (mature neutrophilia, lymphopenia)

  • Abdominal Ultrasound: Expected to show gas distension but not much diagnostic value

  • Radiography: Gas distension primarily observed in the large colon, may also see in the small colon, additional findings to confirm diagnosis:

    • Use of fluoroscopy is limited

    • Barium Enema: Can help visualize meconium obstruction clearly and may provide therapeutic benefits

Treatment Options

• Initial Treatment: Soapy warm water enemas (e.g., dove soap) to stimulate defecation

• Alternative Treatments:

  • IV Fluids: For hydration if the colt shows signs of dehydration

  • Analgesics: Administer if the colt is in moderate pain

  • N Acetylcysteine Enemas:

    • Premixed solution used as retention enema, helps break down mucus over meconium

    • Administer using a Foley catheter for effective delivery

• Surgery: Rarely needed as most cases resolve with medical treatment

Inguinal Hernias in Neonates

• Presentation: Inguinal swelling, may not show colic unless strangulated

• Typical Course: Most cases are reducible and do not cause colic, but strangulation is a possibility

• Treatment:

  • Surgery: Recommended to reduce hernia and close inguinal ring; generally effective

  • Conservative Management: Temporary diapering methods can be used if surgery is delayed

Other Causes of Colic to Consider

• Clostridial Enterocolitis: Frequently observed in neonates, characterized by distended loops of intestine with fluid/gas

• Small Colon Impaction: More common in older foals

• Intussusception: Rarer, might occur in foals under one year of age

  • Appears as severely distended small intestine, indicative of strangulation

• Congenital Atresias: Rule out if a foal progressively enlarges without passing meconium, indicates lack of intestinal patency

Summary Points

• Most neonatal colic cases can be diagnosed and treated effectively without surgery

• Diagnosis relies heavily on physical examination and assessments of typical findings in suspected conditions

• Collaboration with diagnostic tools such as radiography and barium enema can aid in confirming the diagnosis if initial findings are inconclusive.