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might be difficult to differentiate from severe typhlitis and a diagnosis based on ultrasonographic findings alone can be difficult. History, clinical signs and rectal findings are important information in these cases. Differentiation between caecocaecal intussusception and typhlitis can sometimes be


made by localising the intraluminal fluid line. In typhlitis, the fluid is present on the inside of the oedematous bowel wall and usually the oedematous wall and intestinal fluid can also be visualised towards the more cranioventrally located caecal apex. In the case of a caecocaecal intussusception, intestinal fluid is more difficult to visualise in the intussuscepted area but the fluid is predominantly found towards the caecal base. On rare occasions, caecocaecal intussusception may present as a concentric ring structure, as was the case in one horse in our study. In this case, the ring structure was found more cranioventrally, making the differentiation with caecocolic intussusception difficult. Despite colocolic intussusceptions being described in the equine literature, no horses with this lesion were presented to the hospital during this time period. This diagnosis can be missed since colocolic intussusceptions might not be visible on ultrasonography (Albanese et al. 2011; le Jeune and Whitcomb 2014). All colic horses included in this study underwent a full


abdominal ultrasound examination. This seems of major importance in order to be able to visualise caecal intussusceptions ultrasonographically, since they are often found in regions that tend to be less frequently evaluated in colic patients if a limited ultrasound examination or the FLASH (focused localised abdominal sonography in horses) technique is used (Busoni et al. 2011; le Jeune and Whitcomb 2014).


Short-term survival for horses subjected to surgery with


caecocaecal intussusception was better (80%) than for caecocolic (61%) intussusception. However, survival data for caecocaecal intussusception were only available from 10 horses. Overall short-term survival after successful surgery was good (83%). Survival is slightly better if only reduction (92%) was needed compared to partial typhlectomy (84%) and markedly better than after colostomy with partial typhlectomy (50%). Colostomy was however performed in only 4 out of 38 surgical cases (11%) and two of them died during anaesthetic recovery. In the literature, the survival for horses with caecal intussusception is reported to be good to fair with caecocaecal intussusception often leading to slightly better outcome compared to caecocolic intussusception (Edwards 1986; Martin et al. 1999; Bell and Textor 2010). This is in accordance with the results of our study and can possibly be attributed to the fact that, in caecocolic intussusception, a larger piece of bowel is affected, making surgery more difficult. Furthermore, a caecal intussusception commences with the caecal apex invaginating into the caecal body and may progress into a caecocolic intussusception over time, suggesting that caecocolic intussusceptions may have been present longer than caecocaecal intussusceptions. Certain described surgical techniques (ileocolostomy, partial intraluminal typhlectomy etc.) were not performed and may have influenced the short-term survival in our cases. In light of the different surgical techniques described, a correct differentiation between caecal intussusceptions based on ultrasound might be helpful in the decision process before surgery. This study has several limitations. Due to the retrospective nature, interpretation of the ultrasonographic images was


performed while the observer was not blinded to the clinical status of the horse. A fully blinded, prospective study would provide more information regarding ultrasonographic findings on its own, but the current approach more closely resembles the clinical situation. Another limitation is that survival after surgery can be biased by case selection prior to surgery. However, decisions for euthanasia or conservative treatment were largely based on financial restraints rather than on prognosis.


Conclusion


Caecal intussusception is a rare but important cause of colic in the horse, especially in young horses. Transabdominal ultrasound is a powerful aid for the diagnosis of caecal intussusception and to differentiate between caecocaecal and caecocolic intussusception. Caecal intussusception has a good short-term survival after surgical correction.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research


All horses were client owned horses. No ethical approval was necessary.


Source of funding None.


Acknowledgements Preliminary results of this study were presented as an abstract at the 11th Equine Colic Research Symposium in Dublin, Ireland.


Authorship


E. Paulussen, B. Broux and T. van Bergen contributed to this article by study design, study execution, data analysis and interpretation, and preparation of the manuscript. L. Lefere and D. De Clercq contributed by study execution. G. van Loon contributed to the manuscript by study design, data analysis and interpretation, and preparation of the manuscript. All authors gave their final approval of the manuscript.


Manufacturers' addresses


1Esaote Benelux, Maastricht, The Netherlands. 2GE Healthcare, Horten, Norway.


References


Albanese, V., Credille, B., Ellis, A., Baldwin, L., Mueller, P.O.E. and Woolums, A. (2011) A case of a colocolic intussusception in a horse. Equine Vet. Educ. 23, 281-285.


Bell, R.J. and Textor, J.A. (2010) Caecal intussusceptions in horses: a New Zealand perspective. Aust. Vet. J. 88, 272-276.


Boussauw, B.H.S., Domingo, R., Wilderjans, H. and Picavet, T. (2001) Treatment of irreducible caecocolic intussusception in horses by jejuno(ileo)colostomy. Vet. Rec. 149, 16-18.


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