Cecal Impaction
Basic Information 
Definition
Distension of the cecum with feed material or fluid (or both) associated with mechanical or functional obstruction to flow of ingesta
Epidemiology
Species, Age, Sex
It appears that older horses (>15 years in one study) are predisposed to cecal impaction. Cecal impaction in hospitalized patients may not have the same age predisposition.
Genetics and Breed Predisposition
One report indicated predisposition in Arabians, Appaloosas, and Morgans. Other studies have not reported any breed predisposition.
Risk Factors
Proposed risk factors have included:
• Dietary factors: Poor-quality or coarse roughage, Bermuda grass hay
• Parasitism: Parasite-induced thromboembolism, tapeworm (Anoplocephala perfoliata) infestation
• Change in exercise: Lack of exercise with use of nonsteroidal antiinflammatory drugs (NSAIDs)
• Hospitalization with or without surgery and anesthesia, frequently for nongastrointestinal (GI) disease (especially musculoskeletal problems)
Clinical Presentation
Disease Forms/Subtypes
Cecal impactions are frequently divided into two types: impaction with firm ingesta causing a mechanical obstruction and distension with fluid ingesta without any apparent mechanical obstruction. Motility dysfunction has been proposed in horses with distension with fluid ingesta.
History, Chief Complaint
• Horses with cecal impactions often show signs of mild colic (lying down, flank watching) for several days to weeks. Horses with fluid cecal impaction or dysfunction may have acute and increased signs of pain.
• Decreased appetite is one of the first clinical signs in many horses with cecal impactions. Horses frequently have decreased fecal output or changes in fecal consistency (soft or firm small fecal balls). Historical findings may indicate any of the risk factors identified in the epidemiology section.
• It is important to note that cecal perforation may occur in horses with cecal impaction with little to no signs of colic (see “Cecal Perforation” in this section).
Physical Exam Findings
• Physical examination in horses with cecal impaction often reveals vital signs within normal limits with the exception of tachycardia during episodes of colic. Horses with fluid cecal impaction or dysfunction may have more pronounced tachycardia.
• Affected horses frequently have decreased borborygmi. Horses with fluid cecal impaction or dysfunction may show signs of endotoxemia.
• If perforation occurs, clinical signs will worsen rapidly (see “Cecal Perforation” in this section).
Etiology and Pathophysiology
• Impaction with dry, firm feed material may have a similar pathogenesis to large colon impactions (see “Large Colon Impaction” in this section). Risk factors described above may affect motility, particle size of feed material, and water content of ingesta, resulting in accumulation of dry, firm feed material in the cecum.
• Motility dysfunction has been proposed in horses with distension with fluid ingesta. Anesthesia, NSAID administration, diet changes, and parasites (especially tapeworms) have been proposed to alter GI motility. Administration of NSAIDs may mask the mild clinical signs associated with cecal impactions and contribute to ulceration and predispose to cecal perforation.
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