Small intestinal obstruction due to epiploic foramen entrapment in a miniature horse with concurrent enterolithiasis

Abstract

A 14-year-old female miniature horse presented with mild colic signs. The owner reported a history of colic attributed to presumed gastric ulceration, treated with flunixin meglumine and omeprazole. On admission, physical examination demonstrated a normal temperature, pulse and respiration (TPR), with reduced intestinal motility. Abdominal ultrasonography revealed distended small intestinal loops with a wall thickness of 14 mm, particularly in the right abdomen. Radiographs confirmed multiple enteroliths and the presence of sand. Routine bloodwork indicated dehydration, with a packed cell volume (PCV) of 54%, and mild hyperlactataemia (3.79 mmol/L). Based on the combined imaging findings, an exploratory celiotomy was performed, revealing a strangulating obstruction of the distal jejunum and ileum due to epiploic foramen entrapment (EFE), along with multiple large colon enteroliths. Approximately 2 feet of nonviable distal jejunum and ileum were resected, and a jejunocecostomy was created. Two large colon enterotomies were performed to remove enteroliths and sand. Postoperatively, the miniature horse received intravenous (IV) fluids with lidocaine and dextrose, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics and omeprazole. By day 7, the miniature horse resumed a normal diet and was discharged on day 10. At an 18-month follow-up, the miniature horse remained healthy and fully active. This case represents the first reported instance of EFE in a miniature horse.