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Peritonitis - Potentially Deadly
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Peritonitis - Potentially Deadly

All horse owners should be very familiar with the signs and symptoms of colic – anyone in doubt should check out PonyGirl's extremely detailed and informative blog post on the subject. But how many of us would even think of peritonitis as the cause of our horse's distress?

Peritonitis can be very easily confused with colic. Signs indicative of peritonitis include rolling, watching the flanks and pawing at the ground. The horse may hold himself in a hunched, tucked up position; he may be breathing unusually heavily and his temperature could be elevated. Examination of his nostrils will show bright red mucous membranes rather than a healthy salmon pink. This could indicate toxic shock which his potentially fatal.

What is peritonitis?

The peritoneum is a thin protective membrane that covers the intestines. The peritoneum also lines the insides of the walls of the horse's abdominal cavity and provides a smooth surface along which the various pieces of bowel can slide without sticking together or becoming entangled. It also produces fluid to help lubricate the contents of the abdomen. Inflammation or irritation of the peritoneum is called peritonitis.

Peritonitis is not common but it is very serious and requires immediate veterinary intervention. Provided treatment is commenced early enough the prognosis for a full recovery is good. In cases of sudden, acute onset where the stomach has ruptured, the horse will usually be found dead or in an extremely poor state when euthanasia is the only option.

Case history

Bingo was a 12 year old thoroughbred gelding owned by a friend of mine.

He began showing classic colic signs one evening after a normal day out in the field and the vet was called. The vet referred Bingo as an emergency to the Equine Unit and on admission he was placed in intensive care.

Bingo stood quietly while he was examined; his tummy was tucked up and his demeanour was dull and depressed. He was clearly in considerable discomfort. The vet checked his heart and respiratory rates and listened to his gut sounds. He then carried out an abdominal ultrasound which showed an abnormally high amount of fluid around his intestines; a sign of infection. Bingo then underwent a rectal examination and a nasogastric intubation. During this procedure a tube is fed down the horse's throat and into its stomach to check for signs of reflux which could indicate a problem with the small intestine. Finally, a sample of the peritoneal fluid was taken.

Peritoneal fluid should be amber in colour. In cases of colic you would expect to see blood in the fluid. Bingo's sample was opaque and murky in colour. Tests revealed a high level of white blood cells in the fluid. Elevated levels of white corpuscles are indicative of bacterial or viral infection. These cells migrate from the blood to the area of the body which is under attack; in Bingo's case this was his abdomen. With the exception of the abnormal peritoneal fluid, all the other tests and examinations were normal. The vet therefore diagnosed not colic, but septic peritonitis.

Peritonitis sometimes has an obvious cause such as a penetrating injury to the abdomen, damage to the intestines caused by ulcers, abscess or a compromised immune system. Complications during foaling, damage caused by worms or a tumour are also possible causes. Most cases have no discernible cause however. Immediate treatment of the symptoms begins with a course of broad-spectrum antibiotics administered intravenously, orally and into the muscles to cover all bases.

Bingo remained on the cocktail of three antibiotics for a week until he showed signs of improvement. This was then reduced to just oral antibiotics and he was able to be turned out for short periods each day. After ten days he was finally able to come home and resumed his usual routine of being turned out during the day and stabled at night. The medication was continued for a further week and bute (phenylbutazone) was also given to combat any residual inflammation, fever or pain.

Happily, thanks to the prompt action of his owner's vet and the staff at the Equine Hospital, Bingo made a full recovery although the cause of his frightening illness remains a mystery.

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  1. PonyGirl
    Another good article. One of my ponies had to be put down because I could not afford the surgery. The vets necropsied him and found he had a benign tumor which had finally grown large enough to interfere with his intestines resulting in peritonitis. He had always had a tendency to colic mildly on occasion, but at the time I didn't know this could be caused by a serious, underlying problem. The tumor was probably slightly restricting the intestine for years before it got big enough to cause him real problems. Vets are able to diagnose problems much more easily now than they were then (over 20 years ago), plus (unfortunately) I know a great deal more first hand about serious causes of colic symptoms. Had I had some idea of what might have been causing him to colic in the tumor's early stages, I might have been able to save him. P.S. I did remember to actually vote this time, and thanks for the kind mention. :D
    1. autumnap
      Lol! Many thanks. Yes, I think back to what happened to my little horse two years ago when he got Grass sickness. To all intents and purposes he just presented with symptoms of mild colic which could easily have been left to resolve overnight with the usual colic meds. Somehow we just knew there was more to it than that and even though we lost him in the end I'm just so glad we took the action we did. Had he been left, he'd have died alone and in terrible pain and we'd have found his body in the morning. The total bill was a few quid (dollars!) short of eight grand! Thank heavens for insurance - I'll never grumble about premiums again! x
  2. Teshaw R
    1. autumnap
      Thank you! I'm off to read your posts now! x
  3. Rene Wright
    Rene Wright
    Voted. Such an array of issues in the equine world.. and so thankful for the variety of posts on here to learn about them. Thanks for sharing! :)
  4. Emma2012
    I realize this is an old post, but we have been battling peritonitis for 9 weeks now. We caught is very soon, and hit it hard with gram negativeantibiotics, IV fluids. He had secondary complications that we are now treating. We finished the 7.5 weeks of antibiotics and are hopeful that he will have a full recovery. We do not know why he developed peritonitis, we sent in slides with abdominal fluid, no clear answer, we just did tithers, not clear answer. We are scared to be hopeful.
    1. autumnap
      Hi Emma, so sorry to hear about your poor horse. I really hope he pulls through and makes a full recovery - sending positive vibes over the web! xx
  5. HorsePower123
    Thank you for this article! I found it because I was searching for more information about peritonitis in horses. My horse got peritonitis at the end of summer this year and after examination in university`s vet clinic she had grave prognosis. As I am a small animal veterinarian I didn`t give up and started to treat her. I gave her the course of antibiotics for one more week (at total 2 weeks - Gentamicin IV and PenStrep IM), Flunixin when she had a fever and added a homeopathy (Heel). Luckily she got through this deadly disease! But I wanted to find the cause. So I had a consultation with a colleague who works with horses and she advised to check for Equine Rhinopneumonitis. And there it was! Positive for EHV4! I still not sure if it was a source of peritonitis but it might be. After 2 months of recovery I vaccinated her.

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