Gastric impaction and secondary oesophageal obstruction in a pony – the additional value of total body CT in cases of chronic colic

Abstract

A 21-month old Miniature-Appaloosa stallion was presented to the University Equine Clinic with severe colic, unsuccessful nasogastric intubation and compulsive walking behaviour. A total body computed tomography and a magnetic resonance examination of the head was performed as the horse was too small and in such an agitated status that another diagnostic approach was impossible without general anaesthesia. A large amount of coarse granular mixed soft tissue attenuation material was present in the stomach and caudal part of the oesophagus, with the rest of the abdomen and dental structures found to be within normal limits. Based on the computed tomographic findings the imaging diagnosis was gastric overload and secondary incomplete oesophageal emptying. A primary gastric impaction was suspected and confirmed with gross pathology. The MRI showed no abnormalities; hence no explanation for the agitated behaviour was found other than severe abdominal discomfort caused by the gastric impaction. Inconclusive basic diagnostic work-up of abdominal pathology, including clinical examination and ultrasound, prompts further evaluation. Computed tomographic imaging should be considered a non-invasive and reliable diagnostic modality in the advanced diagnostic work-up in miniature breeds or foals with severe and undefined colic and, such as seen with gastric impaction.