Small Intestine
Strangulating Lipoma
Basic Information 
Clinical Presentation
Physical Exam Findings
• Moderate to severe abdominal pain. Initially responsive to analgesics; response diminishes as disease progresses.
• Tachycardia (60–80 beats/min).
• Cardiovascular status diminishes with progression of disease. Signs of dehydration occur rapidly.
• As disease progresses, horses may become depressed and show progressive signs of endotoxemia.
Diagnosis 
Differential Diagnosis
• Other causes of strangulating obstruction of the small intestine
• Strangulating lipoma should always be the top rule-out disorder in horses older than 15 years with signs consistent with strangulating small intestinal lesion.
• Late in the disease as the abdominal discomfort lessens and depression and endotoxemia become more apparent, a strangulating lesion may be confused with inflammatory disease such as duodenitis–proximal jejunitis.
Initial Database
• Rectal examination reveals multiple loops of distended small intestine. As the disease progresses, the size and number of loops increase. Late in the disease, it may be possible to palpate thickened turgid small intestine consistent with mural congestion and devitalization. In rare cases, the lipoma may be palpated rectally.
• Nasogastric reflux (NGR) is seen as the disease progresses. NGR may be absent early in the disease. Pain relief may not be seen after decompression. Late in the disease when the horse appears less painful and depressed, NGR persists because of complete obstruction.
• Abdominocentesis is useful in distinguishing between a simple obstruction and strangulating obstruction. Peritoneal protein and nucleated cell count are often normal early in the disease process. As the colic progresses, the peritoneal protein elevates. Only in late disease with increased intestinal injury does the peritoneal nucleated cell count increase. Fluid is often serosanguineous. Results of abdominocentesis may underestimate the true severity of the disease.
• Complete blood count and chemistry profile are normal early in the disease process. As the colic progresses, changes consistent with dehydration and endotoxemia occur rapidly. A mild metabolic acidosis may also be present.
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