How to Surgically Reduce Ileal Impactions Using Intraluminal Injection of Commercially Available Carboxymethylcellulose

Ileal impactions have previously been described as a common cause of colic, seen most notably in the southeastern United States. The impaction occurs within the ileum at the level of the ileocecal orifice and may extend up to 90 cm in an oral direction. Ileal impactions have been reported as the most frequent cause of non-strangulating small intestinal obstructions and account for 6.5–7.4% of all colic cases and 2.2–23% of small intestinal colic cases. A strong association has been made between the development of ileal impactions and the feeding of Coastal Bermudagrass hay, accounting for the regional distribution of the disease. Ileal impactions have varying degrees of pain as manifested by typical signs of colic in a horse. The disease process is unique in that the pain cycle is biphasic. The first phase of pain is actually caused by intense muscle spasms that occur within the ileum in response to the formation of the developing impaction. In cases where the spasm is ineffective in moving the impaction through the ileocecal orifice, the impaction is compressed and becomes more firm and dry. As the impaction remains unresolved, fluid begins to accumulate oral to the impaction, resulting in subsequent small intestinal and gastric distension, giving rise to the second phase of the pain cycle. Depending on the progression of the impaction and individual variation, these horses present with widely varying levels of pain. Medical treatment of ileal impactions has been previously described and is considered preferable to surgical treatment in most cases. For this reason, it is imperative to differentiate ileal impactions from strangulating diseases of the small intestine as quickly as possible. If caught early, a diagnosis by transrectal palpation of the impaction is possible, assuming that significant small intestinal distension has not occurred yet. In the presence of small intestinal distension confirmed by rectal palpation or abdominal ultrasonography, a presumptive diagnosis is possible by attaining a normal peritoneal fluid sample in conjunction with a history of ingestion of Coastal Bermudagrass. In many cases, however, when medical management fails or when a diagnosis cannot be made by examination and history alone, a definitive diagnosis is made during an exploratory celiotomy. Sur-