May 8, 2026
Equine Strangulating Lipoma
Acute severe colic in an older horse — pedunculated lipoma wrapping the small intestine.
The older horse with unrelenting colic — lipoma until proven otherwise.
18yo QH gelding ~500kg. Acute colic, violent rolling, HR 64, no gut sounds, nasogastric reflux 8L, PCV 52 TP 8.2. Rectal: distended SI loops. Banamine and buscopan not touching it. Strangulating lipoma? How fast do I need to refer for surgery?
🚨STRANGULATING LESION — SURGERY NOW — Violent pain + nasogastric reflux + distended SI + elevated PCV/TP in an 18yo = pedunculated lipoma strangulation until proven otherwise. This is a surgical emergency.
⚠️ Why This Is Surgical
- Unrelenting pain despite analgesia + 8L reflux (SI obstruction) + PCV 52/TP 8.2 (hemoconcentration) + distended SI on rectal
- Pedunculated lipoma = #1 cause of strangulating SI obstruction in horses >15 years
Pre-Referral Stabilization
- Keep NGT in place — decompress q1h, prevent gastric rupture
- IV fluids: LRS 10–20 mL/kg/hr bolus → 2–4 mL/kg/hr maintenance — target PCV <45
- Analgesia: Flunixin already given (do NOT repeat within 8 hrs) ± xylazine 0.3–0.5 mg/kg IV or detomidine 0.01 mg/kg IV for transport
- Transport ASAP — strangulating lesions have a 4–6 hour window for viable bowel
Surgical Expectations + Prognosis
- Exploratory celiotomy — find lipoma stalk; typically 6–12 ft SI involved
- Viable bowel: Transect pedicle → ~75% discharge | Non-viable: Resect + anastomose → ~50–65% | Without surgery: Fatal
- Post-op: Ileus, adhesions, incisional infection, laminitis | Long-term ~70% 1-year survival | Cost $7,000–$15,000+
A fatty tumor on a stalk has wrapped around the intestine, cutting off blood supply. This will not resolve without surgery — if we operate quickly and the bowel is healthy, survival is about 75%. Time is the most important factor.
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