Sand Enteropathy
Basic Information 
Clinical Presentation
History, Chief Complaint
• Horses with sand enteropathy most often present with mild recurrent colic, inappetence, and chronic or intermittent diarrhea (see “Diarrhea, Chronic” in this section).
• Acute inappetence, colic, fever, and diarrhea may also occur, as for other causes of colitis (see “Colitis/Diarrhea, Acute, in Adult Horses” in this section).
Physical Exam Findings
• As for other causes of colitis (see “Colitis/Diarrhea, Acute, in Adult Horses” in this section), although the diarrhea and clinical signs of endotoxemia and hypovolemia are usually less severe.
• Occasionally, it is possible to auscultate sand moving in the ventral colon along the ventrum, which has been described as sounding like ocean waves crashing on a beach, although this is by no means a consistent finding.
• If concurrent large colonic obstruction with sand is present, gross abdominal distension and moderate to severe signs of colic are often present, and large colonic gas distension may be noted on rectal examination (see “Sand Impaction” in this section).
Etiology and Pathophysiology
• Small amounts of sand or soil are ingested during grazing or feeding of hay or grain in sandy environments. Alternatively, some (often young or bored) horses actively ingest sand or dirt when turned out.
• However, why sand accumulation only occurs in some horses in sandy regions is not understood. Individual dietary, anatomic, and colonic motility factors likely play roles.
• Because of its increased density, large amounts of sand settle in the ventral colon. The presence of a large amount of sand, when coupled with normal colonic peristalsis, can irritate the colonic mucosa and damage the colonic mucosal barrier.
• This results in systemic exposure to bacterial toxins and diarrhea as for other causes of colitis (see “Colitis/Diarrhea, Acute, in Adult Horses” and “Diarrhea, Chronic” in this section).
• Colonic obstruction, particularly at the transverse colon, may also occur with sand ingestion and accumulation (See “Sand Impaction” in this section).
Diagnosis 
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