ALL’S WELL THAT ENDS WELL Surgical and Medical Treatment for Sand Accumulations Likely to End Well
A general rule states that the more of a bad thing you eat, the worse the outcome becomes. While that may hold true for pizza and cake in humans, it does not necessarily hold true for sand in horses. In regions that have naturally sandy soils, such as California, Texas and Florida, sand is inadvertently ingested while grazing, or intentionally ingested in horses with conditions such as pica. “The accumulation of sand may result in luminal obstruction, causing colic,” said Isabelle Kilcoyne, MVB, DACVS, of the William R. Pritchard Veterinary Medical Teaching Hospital at the University of California, Davis. “If they become completely obstructed you may see mucosal irritation or motility dysfunction.” Clinical signs vary. Some horses will have weight loss, while others will present with diarrhea or chronic or acute colic. Diagnosis
Issue 8/2018 | ModernEquineVet.com
Radiography is one of the only ways to objectively measure sand accumulation. involves auscultation of the ventral abdomen, typically behind the xiphoid process. In some cases, sand can be palpated on rectal examination or found on fecal sedimentation testing. Some reports have shown that ultrasonography is useful for diagnosis, but radiography is one of the only ways to objectively measure the accumulation of sand inside the horse. Medical treatment involves rehydrating the colon with IV fluids or enteral fluids mixed with laxa-
tives such as magnesium sulfate or psyllium. “Psyllium is somewhat controversial,” Dr. Kilcoyne said. “Some studies have shown that it fails to hasten the evacuation of sand in experimental models, but a study in 2014 showed that a combination of psyllium and magnesium sulfate was an effective treatment to eliminate sand from the GI tract.” Surgery is indicated in the presence of concurrent pathology, but the literature varies on the prognosis of these cases versus medical management. Some studies show a fair-to-good prognosis for surgical cases, while other reports show that the likelihood of survival of surgical patients is decreased when compared with those who receive medical management. Dr. Kilcoyne and her colleagues
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